Personal Responsibility Agreement

This Agreement is made and entered into on this [Date], by and between:

[Name of Individual]
(Hereinafter referred to as "Individual")
Address: [Address]

and

[Name of Caregiver/Agency/Organization, if applicable]
(Hereinafter referred to as "Caregiver/Agency")
Address: [Address]

1. Purpose

The purpose of this Agreement is to formalize the Individual’s sole responsibility for their own care and well-being, including but not limited to health, daily activities, and personal management.

2. Responsibilities of the Individual

The Individual agrees to:

a. Assume full and complete responsibility for their own health and well-being, including making all decisions related to medical care, medication management, and overall health practices.

b. Manage all aspects of their daily activities and personal needs, including but not limited to personal hygiene, nutrition, and any required medical treatments.

c. Seek professional medical or psychological advice and assistance as needed, and adhere to prescribed treatment plans or recommendations.

d. Notify the Caregiver/Agency of any significant changes in their health or circumstances that may impact their ability to manage their own care effectively.

e. Follow any guidelines or recommendations provided by healthcare professionals to the best of their ability.

3. Acknowledgment

The Individual acknowledges that:

a. They understand that they are solely responsible for their own care and well-being as outlined in this Agreement.

b. They have had the opportunity to ask questions and seek clarification regarding their responsibilities.

c. They are voluntarily assuming full responsibility for their own care and well-being, and the Caregiver/Agency has no responsibility or liability for their care.

4. Termination

This Agreement may be terminated by the Individual at any time with written notice to the Caregiver/Agency.

5. Governing Law

This Agreement shall be governed by and construed in accordance with the laws of New South Wales, Australia.

6. Dispute Resolution

Any disputes arising out of or in connection with this Agreement shall be resolved through mediation in New South Wales before resorting to any other form of dispute resolution or litigation.

7. Signatures

By signing below, the Individual acknowledges and agrees to the terms and conditions outlined in this Agreement.

[Individual's Name]
Signature: ________________________
Date: ___________________________