Senior Assisted Living Unit Lease Form
Resident Information
Resident Name
Date of Birth
Current Address
Phone Number
Email
Emergency Contact
Name
Relationship
Phone Number
Email
Lease Details
Unit Number
Move-in Date
Lease Start Date
Lease End Date
Monthly Rent ($)
Security Deposit ($)
Care Level & Services
Level of Care
Services Included
Additional Notes
Resident Signature
Date
Facility Representative Signature
Date