Client Acknowledgement Form

Please Review the Client Manual:

Client Manual

Client Manual Acknowledgement Form

I have received and reviewed the Client Manual, and agree to follow the practices listed in the manual.

I agree to inform Eastside Senior Services (ESS) of any concerns prior to or following a service. I understand ESS cannot guarantee safety against any risk, and I understand there are inherent risks involved with participating and accepting transportation services and other activities provided by ESS. I agree to hold Eastside Senior Services harmless against any claims as a result of my acceptance and participation in those services, even if due to the negligence of ESS or its volunteers.