Admission agreement for assisted living facility covering care services, fees, resident rights, and discharge procedures. Two signers (facility and resident).
The Assisted Living Facility Admission Agreement is a ready-to-use senior & elder care template you can send for signature in minutes. It is written for 2 signers (facility and resident) and, by default, expires 30 days after it is sent if left unsigned. It covers two signers, agreement. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.
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# Assisted Living Facility Admission Agreement **Effective Date:** ___________ This Assisted Living Facility Admission Agreement ("Agreement") is entered into by and between: **Facility:** ___________ ("Facility") **Resident:** ___________ ("Resident") **Responsible Party (if applicable):** ___________ ## 1. Facility Information **Facility Address:** ___________ **License Number:** ___________ **Facility Administrator:** ___________ **Facility Phone:** ___________ ## 2. Resident Information **Date of Birth:** ___________ **Preferred Room Type:** ___________ **Assigned Room/Unit:** ___________ **Primary Physician:** ___________ **Known Medical Conditions:** ___________ **Allergies:** ___________ **Current Medications:** ___________ **Dietary Requirements:** ___________