Common use of DISCLOSURE BOOKLET Clause in Contracts

DISCLOSURE BOOKLET. I have been provided with a copy of the Disclosure Statement and the Type C Residency Agreement, which set forth and explain the rights, duties and responsibilities of Sponsor, Sponsor’s employees and agents, including the Medical Director, and the Resident. I have read and understand these documents and have had an opportunity to review them with an attorney, financial advisor or other representative of my choice. I hereby appoint the following individual(s) as my representative(s) to act on my behalf in all situations where participation of a representative is described in the Disclosure Statement or Type C Residency Agreement. Representatives shall act jointly, unless otherwise indicated. In the event of a disagreement among the representatives, the decisions of the first named representative shall control. Xxxxxxx agrees that I may change my representative at any time. Representative’s Name Representative’s Name Representative’s Address Representative’s Address Representative’s Telephone Number Representative’s Telephone Number In witness whereof, the parties hereto have executed this Agreement on this day of , . Resident Resident

DISCLOSURE BOOKLET. I have been provided with a copy of the Disclosure Statement and the Type C A Residency Agreement, which set forth and explain the rights, duties and responsibilities of Sponsor, Sponsor’s employees and agents, including the Medical Director, and the Resident. I have read and understand these documents and have had an opportunity to review them with an attorney, financial advisor or other representative of my choice. I hereby appoint the following individual(s) as my representative(s) to act on my behalf in all situations where participation of a representative is described in the Disclosure Statement or Type C A Residency Agreement. Representatives shall act jointly, unless otherwise indicated. In the event of a disagreement among the representatives, the decisions of the first named representative shall control. Xxxxxxx agrees that I may change my representative at any time. Representative’s Name Representative’s Name Representative’s Address Representative’s Address Representative’s Telephone Number Representative’s Telephone Number In witness whereof, the parties hereto have executed this Agreement on this day of , . Resident ResidentNumber

DISCLOSURE BOOKLET. I have been provided with a copy of the Type B Disclosure Statement and the Type C B Residency Agreement, which set forth and explain the rights, duties and responsibilities of Sponsor, Sponsor’s employees and agents, including the Medical Director, and the Resident. I have read and understand these documents and have had an opportunity to review them with an attorney, financial advisor or other representative of my choice. I hereby appoint the following individual(s) as my representative(s) to act on my behalf in all situations where participation of a representative is described in the Type B Disclosure Statement or Type C B Residency Agreement. Representatives shall act jointly, unless otherwise indicated. In the event of a disagreement among the representatives, the decisions of the first named representative shall control. Xxxxxxx agrees that I may change my representative at any time. Representative’s Name Representative’s Name Representative’s Address Representative’s Address Representative’s Telephone Number Representative’s Telephone Number In witness whereof, the parties hereto have executed this Agreement on this day of , . Resident ResidentNumber