Fill and Sign the 1 Instructions for Completion of Pennsylvania Form

Agreement with Activities Director and Companion for Seniors Agreement made on the __________________ (date) , between _________________________ (Name of Owner) , d/b/a ________________________ (Name of Business) of __________________________________________________ ______________________ (street address, city, state, zip code) , referred to herein as Director , and __________________ (Name of Client) , of _____________________ ____________________________________________________ (street address, city, state, zip code) , referred to herein as Client . Whereas, Director owns and operates an organization which acts as an activity planner and companion to seniors at the address set forth above, and Client desires to participate in such services; Now, therefore, for and in consideration of the mutual covenants contained in this Agreement, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the parties agree as follows: 1. Description of Services The services to be performed by Director will include the following: A. Plan activities and act as a companion to seniors; B. Accompany and provide transportation to various locations in the community for activities, appointments, and other outings that may interest a senior citizen. C. Provide meaningful activities that meet the individual needs and interests of the Client ; D. Encourage the enjoyment of the Client of daily living; E. Create a plan for the Client which will reflect the Client’s interests and capabilities, taking into consideration the cultural, religious, gender, and age- related preferences of Client; and F. Tailor the plan based on the strengths, capabilities, preferences, lifestyle and cultural background of the Client and his or her needs, being sensitive to the lifestyle and cultural background of the Client. 2. Payment Client will pay Director $____________ for the services to be performed under this Agreement, according to the schedule set forth in Exhibit A attached hereto and made a part hereof. 3. Relationship of the Parties Director is an independent contractor and is not an employee, servant, partner or joint venturer of Client. Client shall determine the services to be provided by Director , but Director shall determine the legal means by which she accomplishes the services in accordance with this Agreement. Client is not responsible for withholding, and shall not withhold or deduct from the commissions FICA or taxes of any kind, unless such withholding becomes legally required. Director is not entitled to receive workers compensation, unemployment compensation, medical insurance, life insurance, paid vacations, paid holidays, pension, profit sharing, or Social Security on account of her services to Client. 4. Liability The services to be performed under this Agreement will be performed entirely at Client’s risk. Director will carry, for the duration of this Agreement, public liability insurance in an amount acceptable to Client. Client agrees to indemnify Director for any and all liability or loss arising in any way out of the performance of this Agreement. 5. Duration of Agreement Either party may cancel this Agreement on _____days' written notice; otherwise, the Agreement shall remain in force for a term of (specify period time) ____________ _____________________ from the date of this Agreement. 6. Severability The invalidity of any portion of this Agreement will not and shall not be deemed to affect the validity of any other provision. If any provision of this Agreement is held to be invalid, the parties agree that the remaining provisions shall be deemed to be in full force and effect as if they had been executed by both parties subsequent to the expungement of the invalid provision. 7. No Waiver The failure of either party to this Agreement to insist upon the performance of any of the terms and conditions of this Agreement, or the waiver of any breach of any of the terms and conditions of this Agreement, shall not be construed as subsequently waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. 8. Governing Law This Agreement shall be governed by, construed, and enforced in accordance with the laws of the State of ______________. 9. Notices Any notice provided for or concerning this Agreement shall be in writing and shall be deemed sufficiently given when sent by certified or registered mail if sent to the respective address of each party as set forth at the beginning of this Agreement. 10. Mandatory Arbitration Any dispute under this Agreement shall be required to be resolved by binding arbitration of the parties hereto. If the parties cannot agree on an arbitrator, each party shall select one arbitrator and both arbitrators shall then select a third. The third arbitrator so selected shall arbitrate said dispute. The arbitration shall be governed by the rules of the American Arbitration Association then in force and effect. 11. Entire Agreement This Agreement shall constitute the entire Agreement between the parties and any prior understanding or representation of any kind preceding the date of this Agreement shall not be binding upon either party except to the extent incorporated in this Agreement. 12. Modification of Agreement Any modification of this Agreement or additional obligation assumed by either party in connection with this Agreement shall be binding only if placed in writing and signed by each party or an authorized representative of each party. 13. Assignment of Rights The rights of each party under this Agreement are personal to that party and may not be assigned or transferred to any other person, firm, corporation, or other entity without the prior, express, and written consent of the other party. 14. In this Agreement, any reference to a party includes that party's heirs, executors, administrators, successors and assigns, singular includes plural and masculine includes feminine. WITNESS our signatures as of the day and date first above stated. ______________________________ (Name of Owner), d/b/a _____________________________ (Name of Organization) ________________________ By: ___________________________ (Printed Name of Client) (Printed Name of Owner) ________________________ ___________________________ (Signature of Client or Client’s (Signature of Owner) Legal Guardian or Conservator)