Potential & Current Resource Parent Forms
Potential Resource Family Forms
Below are the preapproval forms that need to be completed and submitted during the process of becoming an Approved Resource Family. Each form can be completed and submitted electronically. Please contact the Resource Family Recruiter/Trainer as needed with questions or more information at (209)491-0872. All forms may be emailed to forms@sierravistacares.org.
Preapproval Forms
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Resource Family Approval Home & Documents Checklist
Applicants can use this form to track progress in completing the necessary paperwork and tasks through the approval process.
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Resource Family Application
Resource Family Application (Spanish)
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FF-RT Annual Walk-Through
The Recruiter/Trainer will complete this with you but you may use this form to begin preparing your home for your Home Assessment.
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Live Scan Form will need to be handed out as a physical form.
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Health Screening
Each Applicant should complete this form and submit.
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Floor Plan & Emergency Plan Instructions
Instructions for creating a floor plan, identifying emergency shut off valves, exits, etc. This must be maintained and up to date in your home to be used in the event of an emergency.
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Criminal Record Statement
Each individual 18 years and older in the home needs to complete and submit this form.
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Employment Verification
Each Applicant must complete and submit.
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Code of Ethics Acknowledgement
Please read the Code of Ethics Policy below and submit acknowledgment.
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Code of Ethics Policy
Each Applicant will read and sign the Code of Ethics Acknowledgement above.
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Foster Child Personal Rights
Read the Foster Youth Rights. Each Applicant will sign the first page of the document and submit it.
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Admission Policy and Procedures
Each Applicant will review, sign, and submit.
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Noncorporal Punishment & Nondiscrimination Agreement
Each Applicant will sign both sections and submit.
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Mandated Reporting Obligations
Each Applicant will sign and submit.
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Questionnaire for Single Parent Home
Complete and return questionnaire for single parent applicants.
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Questionnaire for Two-Parent Home
Complete and return questionnaire for two-parent applicants.
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Resource Family Approval Adoptive Health Screening Questionnaire
Each Applicant will need to complete.
Resource Family Approval Flow Chart
Use this to follow your progress and know what to expect next.
Live Scan Forms will be provided by the Recruiter/Trainer for use at a Live Scan location (PDF)
Approved Resource Family Forms
Approved Resource Parents, please use the forms below. They can be completed and submitted electronically before, during, or after a visit with your social worker. These forms can also be printed and carried with you to complete appropriate documentation for the children that have joined your family, i.e., visits to the doctor, school meetings, fire drills, etc. If you need assistance with completing these forms, have questions, or for more information, please contact your Sierra Vista Social Worker at (209) 491-0872. All forms may be emailed to forms@sierravistacares.org.
Frequently Used Forms
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CHDP Physician Physical Report
Use this form for your child’s first doctor appointment and yearly physical.
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Client Personal Rights
This form must be signed when the child first joins your family and annually. You can refer back to this form if you wonder what rights the child in your care has.
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Critical Incident and Injury Report
Use this form to document all accidents, bumps, bruises, and other major incidents, including but not limited to self-harm, AWOL, aggression, missed medications, etc. If the incident falls into one of the categories, complete this form and send it to your Sierra Vista Social Worker within 24 hours.
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Emergency Plan for Resource Homes
This is a state form that must be completed and posted in your home.
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Fire Drill Evaluation
To be completed every 6 months and kept posted in the home.
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Fire Extinguisher Tracking Log
To be completed monthly and turned into Sierra Vista social worker December every year.
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Medical Summary
To be completed by the youth’s physician at each appointment.
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Monthly Progress Report
To be completed each month for each child who has joined your family. Must be turned incompletely filled out and signed by the Resource Parent, youth/child, and Sierra Vista social worker.
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PRN Authorization Letter
Have the youth’s physician complete this form at their first physical, so you can administer any over-the-counter medication the youth may need (i.e., Tylenol for a headache, cough medicine for cough, etc.)
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Smoke Detector Test and Battery Replacement Log
To be completed monthly and turned into Sierra Vista social worker December every year.
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Suspected Child Abuse Report
As a mandated reporter, you will have to file a verbal report via phone and file this paper form via fax or mail. You can call your Sierra Vista social worker to help you if needed.
Annual Reapproval Forms
Approved Resource Parents will need to complete these forms yearly to maintain your approval as a Resource Parent. Remember, these are due on, or before, your reapproval date. If you need assistance with completing these forms, have questions, or for more information, please contact your Sierra Vista Resource Family Recruiter/Trainer at (209) 491-0872. All forms may be emailed to forms@sierravistacares.org.
Annual Forms
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Fire Drill Evaluation
To be completed every 6 months and kept posted in the home.
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Fire Extinguisher Tracking Log
To be completed monthly and turned into Sierra Vista social worker December every year.
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Resource Parent Reapproval Questionnaire
It needs to be completed yearly to help the Sierra Vista social worker update your home study.
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Smoke Detector Test and Battery Replacement Log
To be completed monthly and turned into Sierra Vista social worker December every year.