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 for more information at (209)491-0872. All forms may be emailed to referrals@sierravistacares.org.

 

Preapproval Forms

  1. 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.
     

  2. 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.
     

  3. Live Scan Form will need to be handed out as a physical form.
     

  4. Health Screening
    Each Applicant should complete this form and submit.
     

  5. TB Screening Questionnaire
    Each Applicant will need to complete, attach TB test results, and submit.
     

  6. 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.
     

  7. Facility Sketch
     

  8. Emergency Disaster Plan for Foster Family Homes
     

  9. Fire Drill Evaluation
     

  10. Vehicle Maintenance Inspection
     

  11. Criminal Record Statement
    Each individual 18 years and older in the home needs to complete and submit this form.
     

  12. Budget Information
     

  13. Employment Verification
    Each Applicant must complete and submit.
     

  14. Code of Ethics Acknowledgement
    Please read the Code of Ethics Policy below and submit acknowledgment.
     

  15. Code of Ethics Policy
    Each Applicant will read and sign the Code of Ethics Acknowledgement above.
     

  16. Foster Child Personal Rights
    Read the Foster Youth Rights. Each Applicant will sign the first page of document and submit.
     

  17. Admission Policy and Procedures
    Each Applicant will review, sign and submit.
     

  18. Noncorporal Punishment & Nondiscrimination Agreement
    Each Applicant will sign both sections and submit.
     

  19. Mandated Reporting Obligations
    Each Applicant will sign and submit.
     

  20. Questionnaire for Single Parent Home
    Complete and return questionnaire for single parent applicants.
     

  21. Questionnaire for Two-Parent Home
    Complete and return questionnaire for two-parent applicants.
     

  22. 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 ie. 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 referrals@sierravistacares.org.

Frequently Used Forms

  1. CHDP Physician Physical Report
    Use this form for your child’s first doctor appointment and yearly physical.
     

  2. 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 are wondering what rights the child in your care has.
     

  3. Community Resources
     

  4. 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 to your Sierra Vista Social Worker within 24 hours.
     

  5. Emergency Plan for Resource Homes
    This is a state form that must be completed and posted in your home.
     

  6. Fire Drill Evaluation
    To be completed every 6 months and kept posted in the home.
     

  7. Fire Extinguisher Tracking Log
    To be completed monthly and turned into Sierra Vista social worker December every year.
     

  8. Medical Summary
    To be completed by the youth’s physician at each appointment.
     

  9. Monthly Progress Report
    To be completed each month for each child who has joined your family. Must be turned in completely filled out and signed by the Resource Parent, youth/child, and Sierra Vista social worker.
     

  10. 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 (ie. Tylenol for headache, cough medicine for cough, etc.)
     

  11. Smoke Detector Test and Battery Replacement Log
    To be completed monthly and turned into Sierra Vista social worker December every year.
     

  12. 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 referrals@sierravistacares.org.

Annual Forms

  1. Budget Information
     

  2. Fire Drill Evaluation
    To be completed every 6 months and kept posted in the home.
     

  3. Fire Extinguisher Tracking Log
    To be completed monthly and turned into Sierra Vista social worker December every year.
     

  4. Resource Parent Reapproval Questionnaire
    Needs to be completed yearly to help the Sierra Vista social worker update your home study.
     

  5. Smoke Detector Test and Battery Replacement Log
    To be completed monthly and turned into Sierra Vista social worker December every year.
     

  6. TB Screening Questionnaire
    Each Applicant will need to complete and attach TB test results and submit.
     

  7. Vehicle Maintenance Inspection

 
 
 

Keep up to date

receive periodic emails from us

Stay connected

  • Facebook Social Icon
  • Instagram Social Icon
  • YouTube Social  Icon
Sierra Vista Child and Family Services
100 Poplar Avenue
Modesto, CA 95354
Main: 209-523-4573
Fax:   209-550-5866
Sierra Vista Child and Family Services © 2019. All rights reserved.
Website by Practical Creative