Respite and Substitute Care Request Form
This form must be filled out by THE FOSTER PARENT using the respite/substitute care and SUBMITTED WITHIN 10 DAYS prior to using respite.

The requirements for respite care (temporary care in a licensed foster home that is different from the home the child was placed in) are as follows: 

  1. Respite must be provided in a LICENSED FOSTER PROVIDER'S home. 

The requirements for Short-term Substitute Care are as follows (less than 72 hours of care inside the foster home by someone who is not the foster parent): 

  1. The foster parent and the placing agency must agree the short-term substitute caregiver is able to meet the needs of the foster child.
  2. Must complete and submit documentation of medical equipment training on the equipment used to care for the foster child, if the child has medical needs.
  3. Must complete and submit documentation for Sudden Unexpected Infant Death (SUID) and Abusive Head Trauma (AHT) if providing care for foster children through age 5.
  4. Must complete and submit documentation for Child Passenger Restraint Training (CARS) prior to providing care for children under age 8.
  5. Proof of automobile insurance PRIOR to providing care, if transporting children 

The requirements for Long-term Substitute Care are as follows (more than 72 consecutive hours of care inside the foster home by someone who is not the foster parent): 

  1.  A completed and cleared background study
  2.  Must complete and submit documentation of Children’s Mental Health training
  3.  Must complete and submit documentation of Fetal Alcohol Spectrum Disorders training
  4.  Must complete and submit documentation of Sudden Unexpected Infant Death (SUID) & Abusive Head Trauma (AHT) trainings if providing care to children through age 5
  5. Must complete and submit documentation for Child Passenger Restraint Training (CARS) prior to transporting foster children under age 8
  6. Proof of automobile insurance PRIOR to providing care, if transporting children

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Email *
Foster Parent requesting respite or substitute care: *
Foster parent address: *
Foster Parent phone number: *
Foster Parent email: *
Name of Respite Care or Substitute Care provider: *
Address of Respite Care or Substitute Care provider: *
Phone number of Respite Care or Substitute Care provider: *
Has the Substitute Care provider completed all necessary training to provide respite care or substitute care (see above requirements)? *
Has the Respite Care or Substitute Care provider completed a background study (if applicable)? *
Requested Dates of respite care or substitute care: *
Will respite or substitute care take place at the foster home, or at the respite/substitute provider's home? *
Names of all children who will be placed in respite care or substitute care: *
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