Caregiver Agreement Template
A free caregiver agreement template for families and care agencies. Caregivers add their details, duties and schedule, read the terms, and sign online.
Customize the pages and design to fit your needs.
About this template
A caregiver agreement with ready terms for duties, hours, pay, time records, privacy and notice. The caregiver adds who they care for, the schedule and duties, uploads any certifications, then signs, and you keep a signed PDF.
Common uses
- Families hiring a private caregiver
- Home care agencies placing caregivers
- Live in and overnight care
Key features
- Duties and schedule
- Pay, notice and privacy terms
- Signed PDF for every caregiver
What this template asks
What's your full name?
Short Text
What's your email address?
Email
What's your phone number?
Phone
What's your home address?
Short Text
Who will you care for?
Short Text
When do you start?
Date
What's your regular schedule?
Short Text
Which duties are included?
Multiple Choice · Companionship, Bathing, dressing and grooming, Meals, Medication reminders, Light housekeeping and laundry, Transportation and errands, Overnight care
Upload any caregiving certifications
File · Optional
Caregiver agreement
Agreement text, accepted with “I agree”
Sign the caregiver agreement
Signature
How to use this template
Copy it
Select Use template and a copy opens in your workspace as an unpublished draft.
Make it yours
Edit any question or answer, choose a theme, and add your logo.
Share it
Publish, then send the link, show a QR code, or embed the form on your site. Responses arrive in Submissions.
Caregiver agreement
Signers read this text in the form before they accept it. Edit the bracketed details to match your business, and have the wording reviewed for your situation.
Please read this before you sign.
This agreement is between [Family or agency name] (the "Client") and the caregiver named in this form.
- Duties. The caregiver provides the care chosen above. Medical tasks such as giving injections are not included unless the caregiver is licensed and the Client agrees in writing.
- Schedule. The caregiver works the schedule above. Changes need [number] days notice from either side, except in an emergency.
- Pay. The Client pays [hourly rate] per hour, paid [weekly or every 2 weeks]. Overtime and holidays are paid as [state] law requires.
- Time records. The caregiver keeps a record of hours worked and care given, shared with the Client each [week].
- Privacy. The caregiver keeps the care recipient's health, finances and home private, during and after this agreement.
- Emergencies. In an emergency the caregiver calls 911 first, then the Client.
- Ending. Either side may end this agreement with [number] days written notice, or right away for serious misconduct.
By signing below, I confirm that I have read this agreement and agree to it.
Frequently asked questions
What should a caregiver agreement include?
Duties, schedule, pay rate, overtime, time records, privacy, emergencies and how to end it. This template includes each of them.
Can families use it for a relative who gives care?
Yes. Families often use a caregiver agreement when paying a relative. Check tax and benefit rules in your state before you rely on it.
Is the caregiver an employee or a contractor?
That depends on your state and how the work is set up. The template is a sample to start from, not legal advice.