, __________________________________ wish to have _______________________, (hereafter referred to as the client) enter the program offered by the Life Center for a New Tomorrow, LLC, located in Woodbury TN.
I will be either responsible for the payment for the program or I will be acting on behalf of the client to ensure the payment is taken care of.
As I act on behalf of the client, I hereby gree to the following terms.
1- I understand that the Life Center is neither a medical nor a psychiatric facility. The Life Center does not offer medical treatment of any kind and does not use psychiatric or psychology treatments.
2- I understand that the Life Center's purpose is to provide a safe and peaceful environment to their clients so that the clients can be in a stress free environment.
3- I understand that clients are sometimes very difficult, having either psychotic tendencies or because of having taken too many drugs are generally in a less than optimum condition, mentally or physically. I understand that the Life Center does not guarantee or promise in any way that the client will feel better and will improve. Drugs may sometimes damage the brain and physical structure of the body to a point where no recovery is possible. The Life Center will do everything possible to help the client have a better life, feel better and by doing so, it is possible that his condition will improve.
4- I understand that there is no set amount of time in which an improvement of a condition might be noticeable. I understand that the condition might improve but that the client might still not be able to function normally in life once he leaves the Life Center.
5- I understand that the cost for the service offered by the Life Center is $2000 per week. This include lodging, preparing and delivering three meals a day, supervising the client is a way that he/she will feel at ease, will feel that this is a peaceful environment. The staff at the Life Center will listen and be interested in what the client has to say, they will do what is required to make the client feels he can communicate anything and may be then get a grip on some of the troubling issues.
6- I understand that there is no refund for the service. As stated above, clients might or might not improve depending on the severity of the condition. I understand that working with some clients is often very difficult. That is the reason for the cost of the service. However the Life Center will only charge for the time the client has stayed at the facility. If some weeks were paid in advance but unused, they will be refunded.
7- I understand that very often clients might have an underlying physical condition that could be the cause of his problems. The Life Center suggests strongly that the client receive a thorough physical check by a competent medical doctor, preferably before arriving at the Life Center. I understand that I will ensure to see to it that whatever treatment, supplements, or physical programs are recommended by the doctor, are administered. The staff at the Life Center can help in administrating what the doctor recommends but I will remain responsible for it.
8- I understand that the Life Center will provide standard vitamins but if the client requires extra supplements or extra vitamins, treatments, etc. I will be paying for such in addition to the cost of the service.
9- I understand that the meals provided by the Life Center consist of food bought at a regular grocery store. The Life Center will do its best to provide nutritious food and complete meals. If the client requires special food or all organic food which cost extra then the Life Center and I will discuss a proper financial arrangement.
10- Client should have spending money to buy cigarettes, clothes, soap, shampoo, etc. Usually $50 per week should suffice if the client smokes. Less if he doesn't. A separate check from the regular service cost should be written for spending money. The supervisor will keep track of the expenses.
11- I understand that if client destroys the property, furniture, etc at the facility, I will be responsible for payment of the damages.
I agree with all of the above.
________________________________________________ Date: ____________________
(Name of the person responsible for the client)
_________________________________________________ Date: ____________________