PLACEMENT INFORMATION FOR FOSTER PARENTS  

CHILDREN 6-18 YEARS OLD

Below is a list of questions to ask when preparing to place a child in your home.

TODAY’S DATE: _________________

 

Child’s Name:                                                                                   Date of birth:

Gender:  __ male     __ female                    Age:                                     Ethnicity:

In foster care since (date):

Social Security Number:

 

Child’s Child’s Social Worker  Name:                                                  

Email:                                               Office phone:                                    Mobile Phone:

Child’s Child’s Social Worker Supervisor        Name:                                                  

Email:                                                                                        Office phone:             

Child’s Child’s Guardian Ad Litem  Name:                                                  

Email:                                                                                        Phone:             

Previous Foster Parent(s)  Name:                                              

Email:                                                                                        Phone:             

 

FAMILY INFORMATION

Mother’s name:                                                           Father’s name:

Siblings and their ages:

Other family members close with this child:

 

Does the child have regularly scheduled visitations with his/her parents and family members?

DAY                           FREQUENCY                             LOCATION                             TIME                                DESCRIPTION

 

 

MEDICAL INFORMATION

Doctor’s name:                                                     Office name and location:

 

Dentist’s name:                                                     Office name and location:

Does the child see a mental health professional?  __ Yes __ No              If so, who and how often?

Mental health professional’s  name:                                                    

Office name and location:

Allergies:

Medications:

Medical concerns:


ABOUT THE CHILD

Child’s weight:

Shirt size:                           Pant size:                      Shoe size:                   

 

School Information

NAME & LOCATION                                                              TIME DROPPED OFF  /  TIME PICKED UP

 

CONTACT PERSON                                                          DO THEY NEED ANY ITEMS WHEN DROPPED OFF?

 

 

Before and After School Care Information

NAME & LOCATION                                                          TIME DROPPED OFF  /  TIME PICKED UP

 

CONTACT PERSON                                                          DO THEY NEED ANY ITEMS WHEN DROPPED OFF?

 

 

Does this child have a driver’s license?        ___ YES          ___ NO

 

Normal Weekday Schedule:

MORNING ROUTINE - Please include wake up time and activities

 

EVENING ROUTINE - Please include typical dinner time, bath time, activities and sleep time

 

Normal Weekend Schedule:

MORNING ROUTINE  - Please include wake up time and activities

 

DAYTIME   - activities

 

EVENING ROUTINE  - Please include typical dinner time, bath time, activities and sleep time

 


 

CHILD’S STRENGTHS, NEEDS & INTERESTS

 

What are the child’s strengths, interests and activities?

 

Does the child have behavioral issues or other needs?

 

Does the child do any of the following?

__ swear   __ hit        __ bite    __ kick        __ run away        __ soil pants        __ wet bed         Other:

Favorite foods:

Least favorite foods:

Favorite shows:

Favorite activities:

General house rules in previous home:

 

Any other notes about this child that will make it easy for their transition?

Please feel free to include as much information as you wish!

 

 


FOSTER PARENT CHECKLIST

Your child’s social worker should deliver the following. Make sure to follow up on these items if you do not receive them.

__ Placement Letter       __  Medical Card             __  Clothing Allowance            __ Monthly Allowance

 

When is the next court hearing for this child?   Date:                                   Time:

Does this child have a life book started?  

 

 

FOSTER PARENT INFORMATION FOR CHILD’S SOCIAL WORKER

Foster parent name:

Email:                                                                                        Phone:          

Foster parent name:  

Email:                                                                                        Phone:          

 

Foster parent since (date):

Licensing Social Worker and contact information:

Any other information you would like the child’s social worker to know?  

 

 

FOR MORE RESOURCES, VISIT WWW.FOSTERINGFAM.ORG