At Homecare Services – Homecare Resources
Live In YesNo
Social Security Number
This agreement is to inform you of At Homecare Resources Inc. policies and the type of service you will
be receiving. Please read the following items carefully.
I, , hereby guarantee, that in the event , defaults in paying the amount under tehse circumstances, I will be personally liable for any monetary obligations that may be due under this agreement.
I acknowledge that I have read and understand the above terms and conditions and give my consent to At Homecare Resources Inc. to provide their services under those conditions.
Name of Client/Representative
Signature of Client/Representative