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RESPITE CARE 118

RESPITE CARE 118

Variety Children & Family Services

(Human Services agency)

RESPITE CARE

Respite Care is a cushion that allows certified foster parents to go on emergency errands for brief period of time ranging from 2 hours to 72 hours thereby leaving their foster child in the care of a responsible adult who have ben cleared through criminal record check. Any period beyond 72 hours MUST be reported to the primary Social Worker for clearance.

RESPITE CARE

Certified Foster Family Name :

Certified Foster Family Name :

First

First

Last

Last

DATE :

ADDRESS:

PHONE NUMBER:

Respite Information # 1:

NAME:

NAME:

First

First

Last

Last

ADDRESS:

PHONE NUMBER :

CELL PHONE :

Respite Information # 2:

NAME:

NAME:

First

First

Last

Last

ADDRESS:

PHONE NUMBER:

CELL PHONE:

If you are human, leave this field blank.

Please note that Respite providers Must also meet the following government and agency requirements:
1. Police Clearance
2. Criminal Record Statement Signed
3. T B Test Result within one year.

If you have further questions regarding respite care, please feel free call the office.

©VCFS 0085/12-14