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Sign a contract

Download a printable form here of this sample contract you might use, or change to meet your needs.  Please note that it is not legally binding.    

Name of person to receive respite care:____________________________________________

Describe the care and activities required

In the home

Out of the home

Additional comments










Medication requirements (if required to give medication):













Rate and frequency of pay





Overnight rate 


Flat 24 hour rate 


When and how often the Respite contractor will be paid? 



Respite Contractor

 Contacting Me

Best way to contact  



Times to contact 



Hours notice to be given  to cancel 



Hours notice to be given to book





Expenses  (activity fees; for example, cost of transportation, admission to the movies, meals while out, etc)

Covered by us

Not covered by us

(to be paid by Respite contractor)








In our home

In the Respite contractor’s home

In the community

In the vehicle:( smoking is against provincial law when transporting those under the age of  16)

Yes or no






As a self-employed independent Respite contractor,

  • I am responsible for reporting my own income and to make appropriate Canada Pension Plan, Employment Insurance premiums, Income tax and GST/HST remittances if needed. 
  • I will carry vehicle liability insurance if I am providing transportation.
  • I will carry my own liability insurance if I consider it to be needed.
The family has no responsibility for remitting all necessary statutory payment and remittances.  For example: a T4 slip, vacation pay, provincial medical plan,  Workplace Safety and Insurance coverage, Employment Insurance premiums, higher rate of pay for overtime hours, severance pay etc.
When providing the above care in this capacity, the self-employed independent Respite contractor  is not an employee of:  Access Better Living Inc., Cochrane Temiskaming Extend-a-Family, Cochrane Temiskaming Resource Centre, Cochrane Temiskaming Children’s Treatment Centre, Community Living Iroquois Falls, Community Living Kirkland Lake, Community Living Temiskaming South, Community Living Timmins, North East Association for Community Living, Hearst Community Living, North Eastern Ontario Family and Children's Services/autism


Ending the contract

Days notice will be given

If the Respite contractor wishes to end the contract 


Should Parent/guardian wish to end the contract 


However; Abuse (verbal, physical, emotional, financial) or suspicion of abuse will result in an immediate end to this contract. 


Agreement:  This agreement is signed in respect of each person’s confidentiality

I agree with all of the above



*Contract is agreed to from


To date:

Respite contractor signature




Parent/guardian/caregiver’s signature




Signature of person receiving care




*It is suggested that the contract is reviewed and re-signed yearly.



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