Liability Release Form printable pdf download

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LIABILITY RELEASE FORM

____________________________________

(Date)

As the parent/legal guardian of ________________________________________,

(Client name)

I am requesting that BRC hire

1. __________________________________________

(Prospective worker name)

2. __________________________________________

(Prospective worker name)

3. __________________________________________

(Prospective worker name)

as a Respite Care Provider under the Self-Service Respite program (Employer of Record) to

serve my family. I understand that I am serving as a reference for this Respite Care Provider

and that I am responsible for his/her training in the care/needs of my family member(s). I am

releasing Bay Respite Care from the responsibility of completing any further reference check or

training of this individual.

I understand that the Respite Care Provider must submit all required forms and documents,

pass a criminal background check/DOJ clearance, and sign the Bay Respite Care Self-Service

Program hiring agreement BEFORE s/he can provide service to my family. I also understand

that my Respite Worker must provide proof of current CPR & FA certification to BRC within

90 days of hire and maintain that certification or face termination.

I understand that, once hired, the Respite Care Provider, as an agency employee, must abide

by all BRCs policies, procedures, and requirements. I understand that Bay Respite Care is not

responsible for any injury or accident resulting from the Respite Care Provider driving the

client in an automobile.

Parent/Legal Guardian Signature

Program Manager/Assistant for Self-Service Respite Signature

Liability Release Form