The following consists of an agreement made between [_____________] as a registered care provider and [_________________] as an individual who has applied to live in the home.

[The details will need to be adapted to individual circumstances and to the purpose of the period of residence, ie permanent or semi-permanent care, respite or phased care, rehabilitation, intermediate care, etc as applicable but noting that for Wales it should be actively offered in the Welsh language. See also model policy for suggestions on possible contents.]

Care home name:

_____________________________

Service user name:

_____________________________

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