Nursing Home Disclaimer Form

This form serves to acknowledge the understanding and acceptance of the conditions under which care is provided by [Your Company Name]. It is imperative that family members or legal guardians read and comprehend the entirety of this document to ensure a mutual understanding of the responsibilities and limitations of [Your Company Name].

Resident Information	Full Name
	Date of Birth	[MM-DD-YYYY]
Family Member/Legal Guardian	Full Name
	Relationship to Resident
	Contact Number
Acknowledgment of Risks	Initials to Acknowledge Understanding
Assumption of Responsibility	Initials to Acknowledge Assumption of Responsibility
Liability Release	Initials to Release [Your Company Name] from Liability

Signature

Signature of Family Member/Legal Guardian

Date: [MM-DD-YYYY]

Please read the following Nursing Home Disclaimer:

I, [Your Name], understand the risks and consequences involved in letting my loved one reside in a nursing home. I assume full responsibility for my decision and hold [Your Company Name] free of any liability.

I, [Your Name], have read and understood the Nursing Home Disclaimer.

This Nursing Home Disclaimer Form is a crucial document that clarifies the scope of care and responsibilities of [Your Nursing Home Name] and the resident's family members or legal guardians. Signing this form indicates a comprehensive understanding and agreement to the terms laid out, ensuring a transparent and cooperative relationship between all parties involved.