SHARED LIVING AGREEMENT TEMPLATE Social worker or probation officer may provide guidance to assist caregiver and young adult with completing SLA, or young adult and caregiver may choose to complete SLA on their own. Section 1: Mentoring/Skills/Interests in which young adult wants to gain Caregiver plan to provide assistance (may include skills/resources: referrals to other resources): Section 2: Health and Safety Concerns Is there anything regarding medication or health that the caregiver needs to know about the young adult in case of an emergency (including allergies to foods or medications)? Is there anything regarding medication or health that the young adult needs to know about caregiver in case of an emergency (including allergies to foods and medications)? Section 3: Household Agreements and Customs Each category below should be discussed if applicable. The questions in each box are designed as a guide for each conversation. The empty box below each section can be used to record what is decided upon. There are blank sections at the bottom to add additional topics of discussion. How often do young Does adult have a How will communication take place Check-in / curfew / adult & caregiver need curfew? If yes, what is it and about schedules, including when the schedules: to check in with one does it vary on the young adult or caregiver will be away another? weekends? overnight? Agreement: What volume is appropriate for Noise: Is there a noise curfew? Other discussion? music or television? Agreement: Are certain forms of language Language: Is swearing allowed? Other discussion? (e.g. name calling) Agreement: Cigarette smoking: Is smoking allowed inside? Is smoking allowed near or around house? Other discussion? Agreement: Is young adult allowed to Is young adult allowed to Is young adult allowed to have small Guests: have daytime guests? Of have overnight guests? Of gatherings of a group of guests? How
SHARED LIVING AGREEMENT TEMPLATE Social worker or probation officer may provide guidance to assist caregiver and young adult with completing SLA, or young adult and caregiver may choose to complete SLA on their own. Section 1: Mentoring/Skills/Interests in which young adult wants to gain skills/resources: Caregiver plan to provide assistance (may include referrals to other resources): Section 2: Health and Safety Concerns Is there anything regarding medication or health that the caregiver needs to know about the young adult in case of an emergency (including allergies to foods or medications)? Is there anything regarding medication or health that the young adult needs to know about caregiver in case of an emergency (including allergies to foods and medications)? Section 3: Household Agreements and Customs Each category below should be discussed if applicable. The questions in each box are designed as a guide for each conversation. The empty box below each section can be used to record what is decided upon. There are blank sections at the bottom to add additional topics of discussion. Check-in / curfew / schedules: How often do young adult & caregiver need to check in with one another? Does adult have a curfew? If yes, what is it and does it vary on the weekends? How will communication take place about schedules, including when the young adult or caregiver will be away overnight? Agreement: Noise: Is there a noise curfew? What volume is appropriate for music or television? Other discussion? Agreement: Language: Is swearing allowed? Are certain forms of language (e.g. name calling) Other discussion? Agreement: Cigarette smoking: Is smoking allowed inside? Is smoking allowed near or around house? Other discussion? Agreement: Guests: Is young adult allowed to have daytime guests? Of Is young adult allowed to have overnight guests? Of Is young adult allowed to have small gatherings of a group of guests? How