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Month-to-Month Residential Occupancy Agreement

Please complete this agreement to confirm the resident’s monthly occupancy details, payment responsibilities, and required acknowledgements for Healthy Hearts Home Living. This form helps us keep accurate records and make sure each resident understands the terms of their home living arrangement before or during residency. After submitting the form, Healthy Hearts Home Living will review the information and follow up if anything else is needed.

Agreement Details
Assigned Rent Due Date
Rent and Fees
Room Type
Responsible Party / Guarantor
Agreement Acknowledgements

Month-to-Month Renewal Acknowledgement

30-Day Written Notice Acknowledgement

Failure to Give Notice Acknowledgement

Immediate Termination Acknowledgement

No Grace Period Acknowledgement

Late Fee Acknowledgement

AutoPay Requirement Acknowledgement

AutoPay Cancellation Acknowledgement

Community Fee Acknowledgement

Risk Fee Acknowledgement

Utility Overage Acknowledgement

Cleaning Supplies and Toiletries Acknowledgement

Medication Policy Acknowledgement

Level of Care Limitation Acknowledgement

No Refund Policy Acknowledgement

Camera Disclosure Acknowledgement

Personal Property Disclaimer Acknowledgement

Inspection Rights Acknowledgement

Final Agreement Confirmation
Signatures
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