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Caregiver Agreement Template

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  1. Templates
  2. Agreements
  3. Caregiver Agreement Template


Caregiver Agreement Template

Image 1

Prepared by:


Prepared for:



This Caregiver Agreement ("Agreement") is effective as of [Document.CreatedDate] between:

[Client.FirstName][Client.LastName], who resides at [Client.StreetAddress], [Client.City], [Client.State][Client.PostalCode] ("Client"), and

[Caregiver.FirstName][Caregiver.LastName] who resides at [Caregiver.StreetAddress], [Caregiver.City], [Caregiver.State][Caregiver.PostalCode] ("Caregiver").

Purpose of the Agreement

The purpose of this Agreement is to outline the role and responsibilities of the Caregiver in assisting the Client with the tasks of daily living. It also contains information about the compensation terms for the Caregiver.


The Caregiver agrees to perform their responsibilities on the following schedule:

Start Time

End Time








The schedule is subject to change based on the needs of the Client. If the Caregiver cannot attend work due to illness or injury, they must contact the Client as soon as possible via phone.

Employment Type

(Choose One)

W-9 Employee: The Caregiver will be recognized as a W-9 employee by the Client. The Client will withhold taxes from the Caregiver's pay and provide the Caregiver with the proper tax forms. Additionally, the Caregiver is entitled to employment rights.

1099 Independent Contractor: The Caregiver is working individually for the Client and agrees to pay any taxes and report their earnings to the government.

Caregiver Compensation

(Check all that apply)


The Client agrees to pay the Caregiver $(amount) per (insert time, e.g., hourly, daily, monthly). The Caregiver will receive a direct deposit of the amount owed on the (insert date) and (insert date) of every month. If these dates fall on the weekend or are a holiday, the payment will be processed the following business day.

Room and Board

Full Room and Board: The Client agrees to provide the Caregiver with room and board, including a personal room, and will pay for all expenses, including (insert utilities covered, e.g., electric, water, internet, cable).

Room and Board Reimbursement: The Client agrees to reimburse the Caregiver for all costs associated with room and board, including (insert utilities and amenities covered, e.g., groceries, rent, electric, water, internet, cable) up to $(amount) per month.


The Caregiver will be reimbursed for any costs associated with caregiving. Additionally, the Caregiver will have access to a reliable vehicle and be reimbursed for any mileage costs at current rates. The Caregiver will submit expense reports at the end of each month.


The Client will provide the Caregiver with the following benefits in addition to the compensation listed above:

Health insurance reimbursement for up to $(amount) per month.

Continuing education reimbursement for up to $(amount) per year

Transportation reimbursement for up to $(amount) per month

Paid Time Off

Sick Leave:

The Caregiver is entitled to (insert number of hours or days) of paid sick leave per year.


The Caregiver is entitled to (insert number) of paid vacation days per year. The Caregiver must give the Client a minimum of (insert number) days' notice prior to taking vacation days.

Caregiver Responsibilities

(Check all that apply)

The Caregiver is responsible for performing the following caretaking tasks for the Client:


Transporting the Client to any healthcare appointments

Taking notes about the information discussed during healthcare appointments

Scheduling any follow-up healthcare tests or appointments

Picking up prescriptions and other medical supplies

Administering and monitoring medication


Planning and preparing (insert number) of snacks and (insert number) of meals per day

Grocery shopping for planned meals and other items requested by the Client

Serving prepared snacks and meals

Washing and putting away dishes

Preparing drinks, such as coffee and tea


Laundering and changing bed linens

Cleaning counters and appliances

Vacuuming carpets and rugs

Washing hardwood floors

Washing, drying, folding, and putting away laundry items, including towels and clothing

Watering houseplants

Caring for lawns and gardens, including watering, weeding, raking leaves, and mowing lawns

Shoveling snow and applying de-icer as needed

Caring for pets

Sorting recycling and taking out garbage and recycling

Cleaning sinks and bathrooms

Personal care & companionship

Assist with dressing

Assist with self-administration of medication

Assist with personal grooming

Assist with bathing and/or toiletries

Assist with walking

Assist with exercises

Playing cards or board games

Reading out loud

Going on walks or sitting outside

General companionship and conversation


This contract can be terminated at any time with (insert time, e.g., days, weeks) notice from either party. Additionally, illegal conduct committed by the caregiver will result in immediate termination of the contract.







THE STATE OF [Notary.State]

COUNTY OF (Insert)


This instrument was acknowledged before me on (date) by [Notary.FirstName][Notary.LastName].

Notary Public


(Notary Stamp)

Caregiver Agreement Template

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