This Letter of Intent is a directive of an individual regarding the care of his or her
disabled child in the event of the individual's incapacity or death. The Letter of Intent is
non-binding and assists others in making important decisions regarding the child's
treatment, medical care, housing and education. It also provides information related to
finances and any special funding received by the child. This document serves as a
template for the letter of intent and should be tailored to fit the specific needs of the
individual and child.
LETTER OF INTENT – ESTATE PLANNING
LETTER OF INTENT IN RESPECT OF ___________________ (Name)
To :
This Letter of Intent is a directive from the family of ______________________.
In the event I ________________ become incapacitated or deceased, this Letter of Intent
shall serve as a guideline for care of my daughter/son ______________________, who has the
disability of _________________________.
Finances
The caregivers of ___________________ will be required to be a part of any financial
decisions made regarding his/her living expenses. ___________________ should be allotted a
monthly allowance of no more than _____________ ($_____________) Dollars per month.
______________ will require the assistance and advice to complete the daily financial
transactions and assist in _________________ to make wise decisions for long term financial
planning.
Special Funding and Special Programs and Services
________________ receives financial aid and funding from the following services and
organizations:
(i) ____________________________ in the monthly amount of ____________
($___________) Dollars;
(ii) ____________________________ in the monthly amount of ______________
($___________) Dollars; and
(iii) __________________________ in the monthly amount of _____________
($____________) Dollars.
I have attached a list of addresses and the appropriate contact person/person for each of
the services and organization from which _______________ receives financial aid and funding,
attached as Schedule “A”.
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Currently, the following services provide assistance to _________________ on a regular
basis at the following days and times:
(i) _______________________, which provides assistance in respect of
_________________ on _____________ and __________ at _____________
a.m./p.m.; and
(ii) _______________________, which provides assistance in respect of
_________________ on _____________ and __________ at _____________
a.m./p.m.;
Medical Information and Equipment
___________________ ‘s main physician, who provides care and medical attention, is
Dr. _______________ , whose office is located at _______________________, telephone
number ____________________.
___________________ also obtains medical assistance from other medical specialists
whose names, addresses and contact particulars I have set out on Schedule “B”.
_____________________ requires certain medical equipment and devices to assist
him/her in his/her daily living. The medical equipment and devices _______________ requires
are _________________, ________________________ and _________________.
Currently ______________ requires the medication ____________ and ____________ to
assist him/her with __________________.
Housing