Guardian Angels Sitting Service
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Wathing Over All That Matters and Trusted by Families Since 2009
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Book An Elderly Companion

This form is for if you are requesting an elderly companion in your home or hotel.

*How did you hear about Guardian Angels Sitting Service LLC?
*Location Services Needed for:
Washington DC
*Person Requesting Services Name: ( First and Last)
*Relation to Member:
*Do you have permission to request these services for the member ?
*Elderly Adult First Name:
*Elderly Adult Last Name:
*Home Address:
*Zip Code:
*Cell Phone Number:
*Alternative Phone Number:
Hotel/Resort Name: ( If applicable)
Room Number:
Sitting Location Street Address: (if different then above)
Zip Code:
Dates being Requested

3 hour minimum is required

*Date: (MM/DD/YY)
*Start Time: ( include AM or PM)
*End Time: ( include AM or PM)
Date: (MM/DD/YY)
Start Time: ( include AM or PM)
End Time: ( include AM or PM)
Date: (MM/DD/YY)
Start Time: ( include AM or PM)
End Time: ( include AM or PM)
Date: (MM/DD/YY)
Start Time: ( include AM or PM)
End Time: ( include AM or PM)
*Companion Preferences:
No Preference
Preferred Age Range of Companion: (16+)
Preferred Qualities/Skills/Abilities:
*Elderly Adult Gender: ( Male or Female)
*Elderly Adult Age:
*Elderly Adult Martial Status:
*How can a Guardian Angel companion best help this elderly adult?
Local Outings/Walks Outside
Light Meals (sandwichs/snacks)
Errands ( prescriptions, dry cleaning, movie rentals, post-office)
Grocery Shopping
Doctors Visit
Ambulatory Status: Does this member use an assistive device of any kind to walk? If yes please list type:
Does this member use a wheelchair at any time? If yes when?
Is this member able to transfer in and out of the wheelchair and in and out of a car independently?
Is this member able to fix meals for themselves?
Is this member able to use the restroom independently?
Please list all medical conditions, if any, and any medication taken for that specific condition:
Does this member have any health condition that could be contagious to another person in any way?
Please list any previous surgeries and/or hospitalizations and the date that each took place:
Please list any special needs or diet restrictions:
Please list any hobbies, special interests, including any games or activities that they enjoy playing/doing:
Job directions or Special Instructions:
*Emergency Contact First Name:
*Last Name:
*Cell Phone Number:
Terms and Conditions:

Please note: We are NOT a homecare or nursing agency. Our sitters are NOT responsible for personal hygiene, bathing or assisting the member in the bathroom. All elderly members MUST be independent in the bathroom and be able to ambulate independently with or without an assistive device. If the member is in a wheelchair, they must be able to transfer in and out of the wheelchair, if need be, independently. Anyone taken out to a Doctors visit or outing MUST be independent in transfers in and out of the car as well as independent in ambulation with or without an assistive device. Our sitters are not trained in transfers or ambulation and they are not nurses. Our sitters are professionally screened, have a clear background check and have multiple references that are checked. They have experience and enjoy spending time with the elderly. It is our primary concern that both our sitters and your loved ones remain safe at all times. It is our goal to provide you with a responsible, compassionate, personable, fun-loving sitter who will help enhance and improve the life of your loved one!


I, Applicant, give my permission for this information about my family and my children to be shared with the babysitters that will be caring for my children. I, Applicant understand that the agency is not responsible for any damage or stolen goods that maybe occur from having sitter care for your children. I understand that the agency performs background checks based on the information that the sitter provides to them. The agency is not responsible if the sitter does not provide accurate and true information and is not responsible for any history that may not come up when the background check is completed.
I have read and understand that there is a 24-hour cancellation notice required or cancellation fee of the 4-hour minimum for both the agency and the sitter will apply. The undersigned represents that he or she has read and fully understands that this document is a release of liability.



Applicant releases and forever discharges Guardian Angels Sitting Service and their officers, directors, agents, from any and all actions, costs, suits, demands, claims, damages, losses and liabilities (including reasonable attorneys fees) of any type or kind whatsoever occurring from or connected with the issuance, receipt, or use of such Information by Guest and Agrees to indemnify, defend, and hold harmless the Released Parties from and against any and all demands, claims, damages to persons, losses and liabilities (including reasonable attorneys fees), arising out of, caused by, resulting from, or in any way related to the issuance, receipt, or use of such information.


Additional Terms and Conditions

1. Agency Referral Services. Applicant and Cardholder, if different, (collectively "Applicant") agrees to pay Guardian Angels Sitting Service, LLC ("Agency") for referring an independent contractor to Applicant or referring an Applicant to an independent contractor. Agency agrees to make its best effort to provide employment referral services ("services") to Applicant under and pursuant to this agreement on a day-to-day, as needed, basis and that Applicant in his/her sole discretion shall determine his/her need, if any, for services or the continuation of services as may be provided by Agency pursuant to this agreement. Agency is a professional referral agency specializing in babysitting, petsitting and elderly companionship referral services Beaufort County in the state of South Carolina and in Savannah, GA.

2. Independent Contractor. The status of each individual ("Independent Contractor") providing temporary services to Applicant is that of an "independent contractor" and not of an agent or employee of Guardian Angels Sitting Service, LLC and, as such, Independent Contractor shall not have the right or power to enter into any contracts, agreements, or any other commitments on behalf of Agency. Childcare, Petcare or Elderly companion worker referred to by the agency in temporary assignments are applicant's employee not the agencies employee. Applicant and Agency agree that should an Independent Contractor be found liable for any loss or damages resulting from a failure to perform any of their obligations including, but not limited to negligence, breach of contract or otherwise, then liability lies with the Independent Contractor and not Guardian Angels Sitting Service, LLC.

3. Compensation. The amount owing to Agency under this agreement reflects the amount of compensation owing Agency pursuant to Applicant's promise in the matter of Agency's services. Credit card information is provided above as payment security, and Applicant authorizes the use of credit card information and further agrees that he/she will automatically be charged for all unpaid fees and charges.

4. Minimum Compensation to Agency. Applicant and Agency agree that payment for Agency services shall be conditioned upon a minimum compensation of a four (4) hour referral charge to Agency and Independent Contractor if Agency schedules services for Applicant and Applicant fails to cancel directly with Agency, not Independent Contractor, said referral within 24 hours of the services to be performed.

5. Commencement, Renewal and Cancellation Provision. This agreement shall be in effect upon receipt of a completed application and payment of the nonrefundable membership dues. All membership dues are payable in advance and considered incurred in full upon commencement. Daily memberships shall expire after one (1) day. Weekly memberships shall expire after seven (7) consecutive days. Monthly memberships shall expire after thirty (30) consecutive days. Annual memberships shall expire one (1) year from the first date of service. Member will be contacted 30 days before membership expiration with choice to renew. Each renewal membership shall be for the same membership period unless otherwise agreed to in writing by the parties.

6. Confidentiality Provision. Applicant and Agency agree that the names of Independent Contractors are and shall remain the exclusive property of Guardian Angels Sitting Service, LLC, are confidential and are of great value to the Agency. Applicant and Agency further agree that all other information used by the Applicant in obtaining the referral services of Independent Contractors including, but not by way of limitation, time sheets, service invoices and the names of Independent Contractors are trade secrets, are confidential and are the valuable property of the Agency, and that any such information obtained by the Applicant during the course of this agreement is and shall remain the property of the Agency. Applicant and Agency further agree that during this agreement and the period of three (3) years immediately after the termination of this agreement, Applicant will not, either directly or indirectly make known or divulge the names, phone numbers and addresses of any of the Independent Contractors, or divulge any confidential information received from the Agency to any person, firm or corporation. Applicant also agrees that during this agreement and the period of three (3) years immediately after the termination of this agreement, the Applicant will not, either directly or indirectly call upon, solicit, divert, or take away any of the Independent Contractors, upon whom the Applicant became acquainted with by referral of the Agency. Applicant and Agency agree that Applicant's unauthorized disclosure or use of Agency's confidential information and trade secrets would irreparably damage the Agency.

7. Non-Compete Provision. Applicant and Agency agree that this agreement is important to the reputation, goodwill and successful operation of the Agency. Applicant and Agency agree that during this agreement and the period of two (3) years immediately after the termination of this agreement, Applicant shall not: a) compete against the Agency; or b) own, manage, be employed by, be engaged by, work for, consult for, be an officer or director or partner or manager or employee of, advise, represent, engage in, or carry on any business that competes against the Agency.

8. Indemnity Provision. Although Agency makes every effort to refer Independent Contractors who it believes possesses the highest quality and abilities for each specific assignment, the Agency cannot represent or warrant the actual abilities of each Independent Contractor. Applicant agrees to hold Agency, its officers, agents and employees harmless for all damage, destruction, theft, or accident claims which may arise out of or in connection with the services provided by Independent Contractor to Applicant. The agency does not carry insurance to cover driving risk, nor does it make any representation as to the provider’s driving ability. All responsibility in allowing the applicants child(ren) to drive with the provider is of the applicant. The applicant understands the agency is not liable for any damage or harm done in connection with the child(ren) being in a car/driven with/by the provider. For a fee of $15 the applicant can request the driving record of the applicant with a 48 hour notice.

9. Applicant's Remedies. Applicant and Agency agree that should Agency, and/or its officers, employees and agents, be found liable for any loss or damages resulting from a failure to perform any of its obligations including, but not limited to negligence, breach of agreement or otherwise, then Applicant and Agency agree that Agency, and/or its officers, employees and agents', liability shall be limited to a sum equal to a four (4) hour referral service charge for Applicant.

10. Agency's Remedies. In the event of Applicant's breach of the above Non-Compete and Confidentiality provisions, Applicant and Agency agree that it would be impossible to ascertain the exact damages of Agency and that Agency shall be entitled to receive from Applicant as liquidated damages a sum equal to $3,000.00. This is not meant to be a penalty nor a windfall to the Agency but a method to compensate it for lost profits. This would not limit other damages recoverable by the Agency, or the Agency's right to injunctive relief to enforce this agreement.

11. Legal Fees and Court Costs. Should the Agency resort to the use of an attorney regarding any matter arising from this agreement, the Agency shall be entitled to recover from the Applicant its reasonable attorney's fees, court costs and related expenses.

12. ÔÇ¿In the event of any dispute between the parties which arises under this Agreement, such dispute shall be settled by arbitration in accordance with the rules for commercial arbitration of the American Arbitration Association (or a similar organization) in effect at the time such arbitration is initiated, and subject further to the provisions of the South Carolina Uniform Arbitration Act, incorporated by reference. A list of arbitrators shall be presented to the Claimant and Respondent from which one will be chosen using the applicable rules. The hearing shall be conducted in the City of Hilton Head Island, South Carolina unless both parties consent to a different location. The decision of the arbitrator shall be final and binding upon all Parties.The prevailing party shall be awarded all of the filing fees and related administrative costs. Administrative and other costs of enforcing an arbitration award, including the costs of subpoenas, depositions, transcripts and the like, witness fees, payment of reasonable attorney's fees, and similar costs related to collecting an arbitrator's award, will be added to, and become a part of, the amount due pursuant to this Agreement. Any questions involving contract interpretation shall use the laws of South Carolina. An arbitrator's decision may be entered in any jurisdiction in which the party has assets in order to collect any amounts due hereunder.

13. Governing Law and Venue. The parties agree that this agreement shall be governed by, construed and enforced in accordance with the laws of the State of South Carolina. The venue for any legal action or proceeding shall be in Hilton Head Island, South Carolina.

14. Severability Provision. The provisions in this agreement shall be severable which is to say that should a portion of this agreement be declared invalid or unenforceable, that same would not alter the remaining provisions.

15. Transferability. The rights and obligations under this agreement are personal to Applicant and Agency and may not be assigned or transferred to any other person, firm, corporation or other entity without the prior written consent of the parties.

No Waiver of Breach and Entire Agreement. TIME IS OF THE ESSENCE IN THIS AGREEMENT. The failure of either party to this agreement to insist upon the performance of any of the terms and conditions of this agreement, or the waiver of any breach of any of the term and conditions of this agreement, shall not be construed as thereafter waiving any such terms and conditions, but the same shall continue and remain in full force and effect as if no such forbearance or waiver had occurred. This agreement constitutes the entire agreement between the parties and any prior understanding or representation of any kind preceding the date of this agreement shall not be binding upon either party except to the extent incorporated in this agreement. Modifications of this agreement shall be binding only if evidenced in writing signed by Applicant and Agency.


Type of Booking
Daily: Valid for the date of the job only.
Weekly: Valid for seven (7) consecutive days from the first date requested. 
Monthly: Valid for thirty (30) consecutive days from the first date requested.

Consultation Fee – $20 (Paid in cash to the sitter at the time of consultation
Meet the sitter for 15/20 minutes prior to booking to go over all details of the job. This fee can vary depending on location of the consultation and travel time it takes for the sitter. Consultation is set up by request only.

Four (3) hour consecutive minimum per sitting period (No exceptions)

Booking Fees and Hourly Rates: Booking fee is charged at the time application is submitted/Non Refundable.
Daily : $20 Fee/Hourly Rate: $23 per hour
Weekly: $45  Fee/Hourly Rate: $23 per hour
Monthly: $90 Fee/Hourly Rate: $23 per hour

Holiday Rates: *Add $4 per hour to the hourly rate above
Holidays – – New Year's Eve, New Year's Day, President's Day (Observed), Valentine’s Day, St Patrick’s Day, Good Friday, Easter Sunday, Memorial Day, (Observed), Mother's Day, Father's Day, Independence Day, Labor Day, Columbus Day, Thanksgiving, Christmas Eve, and Christmas Day
Overnight/Vacation: please contact agency for the rates.

Rate Breakdown: 
SITTERS ARE PAID - $14.00 per hour, plus mileage fees paid in cash at end of job 

Transportation/ Mileage and Parking Fees:
Paid to the sitter in Cash; Sitter will make family aware of parking fees if applicable. 
Mileage - .25/mile (paid to sitter) up to $10 max/job plus parking or if a gate fee is applied. 
*In some of our locations; ride sharing fees may be charged, due to the location or parking situation of the job; 
an additional mileage fee may need to be added due to the distance of the location or 
a parking fee or gate fee may be required. All of these expenses will need to be reimbursed to the sitter.

AGENCY IS PAID: Daily/ Weekly/ Monthly fees at time of booking and then after services an $8 per hour for Daily, Weekly, Monthly jobs. Upfront Booking fees are charged to card on file prior to service and Hourly Agency fees are charged to credit card on file after service 

Same day/ after hours-booking fee: Additional $10 charge for same day bookings when application is received during office hours.  For last minute bookings after business hours, on holidays and on Weekends an additional $15 will be charged.

-If the member cancels within 24 hours of the start time of the job Guardian Angels will collect the entire four -hour minimum for both the agency and sitter. 
-If member cancels prior to 24 hours of the start time there will be no charge.

Please take into consideration the time that the sitter arrived for their job. 
Sitters arriving before 12:00 p.m. should be provided with lunch
Sitters arriving before 5:00 p.m. should be provided with dinner  

Payment Terms:

Applicant (Cardholder if different) acknowledges and accepts full responsibility and guarantees payment for all service requested, either verbally or in writing, whether or not such services are authorized by applicant, (or cardholder if different). Applicant (or cardholder if different) agrees that Guardian Angels Sitting Service LLC. May pursue all avenues of collection, including use of collection agencies, and authorizes GASS to prepare and submit credit card charges using any of the charge cards listed above to recover all charges and all other unpaid amounts due including failure to pay on time for services rendered through membership, damages for returned check charges in the amount of $30.00 per check and cancellation fees.

*I the applicant, have read, understand and agree to rates, procedures, credit card authorization and all terms and conditions listed above. ( Full Name)
*Credit Card Type:
Visa      Mastercard      Discover      American Express
*Name on the Card:  *Credit Card Number:   
*Expiration Date:   *Security Code:    
*Billing Street Address:        
*Billing City:   *State:   *Zip:
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