PLACEMENT INFORMATION FOR FOSTER PARENTS  

CHILDREN 0-5 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:                                                  

Email:                                               Office phone:                                    Mobile Phone:

Child’s Child’s Social Worker Supervisor:                                                  

Email:                                                                                        Office phone:             

Child’s Child’s Guardian Ad Litem:                                                        

Email:                                                                                        Phone:             

Previous Foster Parent:                                                  

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                                                         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:                   Diaper size:

 

If the child is enrolled in daycare, where do they go?

LOCATION                                                                         TIME DROPPED OFF  /  TIME PICKED UP

 

CONTACT PERSON                                                          DO THEY NEED ANY ITEMS WHEN DROPPED OFF?

 

 

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

 

Does the child have behavioral issues or other special needs?

 

Does the child do any of the following?

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

 

Normal Weekday Schedule:

MORNING ROUTINE - Please include wake up time and activities

 

DAYTIME - Nap 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   - Nap time and activities

 

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

 

Favorite foods or formula brand:

Favorite books:

Favorite shows:

Favorite activities:

 

General house rules:

 

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

 

 

 

FOSTER PARENT CHECKLIST

__  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:

Any other information you would like this social worker to know?

FOR MORE RESOURCES, VISIT WWW.FOSTERINGFAM.ORG