Admission Agreement
Professional Admission Agreement template for Adult Family Homes. Includes editable Word (.docx) and printable PDF formats.
[YOUR ADULT FAMILY HOME NAME HERE]
Admission Agreement
TEMPLATE • Inspection-Ready AFH Standard
1. Parties to Agreement & Resident Identification
This agreement is entered into on this _____ day of ____________, 20___, between [ADULT FAMILY HOME NAME] (Provider) and [RESIDENT / POA NAME].
2. Services Provided & Room Rate Structure
FINANCIAL TERMSBase Rate & Payment Schedule: Resident agrees to pay Provider a monthly base fee of $______ payable in advance on the first (1st) day of each calendar month.
3. Additional Service Fees & Payment Schedule
Provider Signature / Date
Resident / POA Signature / Date
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Document Section Breakdown (6 Sections)
Parties to Agreement & Resident Identification
Names, legal representatives, and home identification details.
Services Provided & Room Rate Structure
Detailed breakdown of room, board, and personal care services included in base rate.
Additional Service Fees & Payment Schedule
Payment due dates, late payment terms, security deposits, and specialized care charges.
House Rules & Resident Rights
Daily schedules, visitor policies, smoking, personal items, and resident rights guarantees.
Discharge, Transfer & Termination Policies
30-day notice provisions, emergency discharge criteria, and refund terms.
Signatures & Acknowledgments
Legal binding signature block for resident, power of attorney, and AFH provider.
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