Liability Waiver

RESPITE CARE WORKER
LIABILITY WAIVER




I, ­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­_______________________________ am not a licensed respite worker or care provider. I am a volunteer with a heart for service and am working to give a Family Caregiver some relief. While I will do everything in my power to provide the best of care in the absence of this Loved One’s usual caregiver, I am in no way infallible. I will follow the directions of the usual caregiver to the best of my ability and will carry out my duties with tenderness and compassion.

I am, am not (circle one) certified in CPR. I will call the necessary emergency personnel if there is a problem beyond my control. I will not be held responsible for any situation that might arise to cause harm or injury to this Loved One, barring negligence or abuse on my part.

The Family Caregiver relieves me of all liability in the event of injury, harm, or death, to this Loved One in my charge for the date or dates listed below.

Date(s): _________________________________________



____________________________________  ____________________
Respite Worker Volunteer                                      Date

____________________________________  ____________________

Family Care Provider                                              Date

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