Respite Care - Provider Timesheet
The Family & Children's Center Respite Care Program contracts with person named below, known as the Respite Care Provider, to provide respite for the individual identified as the Client/Child. This contract is effective for the date named and the rate previously specified. Respite providers are used only for respite services. Additional private payment to respite providers, for clients within the respite program is not acceptable. The Family & Children's Center accepts no responsibility for damages that occur during the respite period to persons or property. The Respite Care Provider agrees to follow the guidelines for behavior management and for medical emergencies that have been set forth.
Respite Care Provider (RCP)
RCP First Name *
Your answer
RCP Last Name *
Your answer
RCP Phone # *
Please use 123-456-7890 format.
Your answer
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