Contract for In-Home Care Services

I agree to retain Professional Sitters Home Health, Inc, a Kansas corporation (the "Agency") to refer individuals to me, to provide services on the following terms and conditions:

1. SCREENING. I have received a copy of the Agency's current requirements for individuals providing the services I have requested, and I understand that the Agency's referral of an individual to me simply means that he or she has met such requirements and not that the Agency has conducted an exhaustive investigation of such individual. I realize that the individual referred to me is an employee. The decision whether to contract with any individual referred to me will be made solely by me.

2. FEES. I agree to pay for the services rendered in accordance with the Agency's fee schedule in effect when the services are provided, as the same may be changed from time to time, when such services are provided. I further agree that, if I request the Agency to provide me with an individual for any of the Agency's temporary, part-time services and later cancel such request within six (6) hours of the time such services are to be provided, I will pay the Agency one-half (1/2) of the hourly rates which would have been charged for such services or the sum of Ten Dollars ($10.00), whichever is greater, (If you call the Agency and can explain in full why you need to cancel such services the Agency will review cancellation request and make a response to the request within 24 hours). All payments shall be made by check or money order payable jointly to the Agency and the individual providing such services. If any amount is not paid within three (3) business days of the date such amount becomes due, I will not have the right to request any further services or referrals from the Agency until all amounts have been paid in full.

3. NON-CIRCUMVENTION. I agree to not have any individual referred to me by the Agency other than under the terms of this Agreement, and expressly agree not to refer any such individual to any other person or to pay such individual other than in the manner described above or to take any other action, which would have the effect of depriving the Agency of business or fees, or both.

4. TAX WITHHOLDING. I understand that the individuals referred to me will work as an employee of the Agency (Professional Sitters Home Health, Unlimited, Inc.).

5. TERMINATION. I understand that I may terminate this Agreement at any time by written notice to the Agency, but that the termination of this Agreement will not relieve me of my obligation to pay the Agency a referral fee if I later employ any individual(s) referred to me by the Agency while this Agreement was in effect. I further understand and agree that such termination will not relive me of my obligations under Paragraph 3 of this Agreement.

6. COOPERATION. I agree to cooperate with the Agency in its efforts to continually evaluate the performance and qualification of the individuals sit refers and to immediately notify the Agency of any information concerning the honest, integrity, and character of any individual referred to me by the Agency.

7. CONTRACT. I understand that this is a contract between myself and the Agency, enforceable in accordance with its terms.

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Professional Sitters Home Health, Inc.
PO Box 3581
Lawrence, KS 66046
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Phone: (785) 842-3301
Fax: (785) 842-3340