Wellness Contract and Plan of Care

October 23, 2023

Fred Victor Respite Services is a program that supports and assists program participants in achieving their
goal of self-sufficient independent living. Fred Victor Respite Staff will continue to support you as you
continue to work towards your identified goal(s).

During your stay in the program, staff have addressed with you the concerns of employment search and
securing a job, decline in mental health, behavioral matters, and observed excessive use of marijuana and
other substances.

However, we (staff) want to continue to serve and support you. We have agreed to keep you in the
program based on your agreement to establish a contract. However, failure to comply with the terms of
the contract will result in automatic discharge from the program to a better-suited program.

I, Lance De Leon, understand that Fred Victor Respite Services is a safe environment for everyone who
resides here. In order to ensure that I abide by both my rights and responsibilities during my stay at the
Respite I agree to the following terms and conditions:

 I will work in collaboration with Narmatha to focus on employment, securing a job, and
training.
 I will attend job fairs, network, and commit to training to advance my job chances.
 I will collaborate with my OW case worker and attend certified training in a month
 I will attend the job services with Fred Victor this week on October 25, 2023
 I will work with Narmatha to figure out my financials and arrears with CRA and OSAP

Client Signature: _________________________ Staff Name: ______________________________

Date: ___________________________________ Date: _____________________________________