Frequently Used Forms For Resource Parents

Approved Resource Parents, please use the forms below. 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.

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

Critical Incident and Injury Report
Use this form to document all accidents, bumps, bruises, and other major incidents, including but not limited to urgent care &ER visits, self-harm, AWOL, aggression, missed medications, etc. Submit the completed form to your Sierra Vista social worker within 24 hours.
 

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

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

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

Medical Summary
To be completed at every appointment.
 

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.
 

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.)
 

Resource Parent Reapproval QuestionnaireIt 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 in to Sierra Vista social worker in December every year.
 

Suspected Child Abuse Report
As a mandated reporter, you will have to file a verbal report to Child Protective Services (CPS) via phone and file this paper form via fax or mail. You can call your Sierra Vista social worker to help you if needed.

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Vehicle Maintenance Inspection

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Resources

Cal-FURS

FURS Services Include:

• A toll-free hotline is available 24 hours a day, 7 days a week for current and former foster youth and resource families

• County Mobile Response and Stabilization Teams are also available 24 hours a day, 7 days a week

• In-home de-escalation, stabilization, conflict resolution, and support services and resources

• Ongoing support services beyond the initial mobile response

• Hotline and mobile response staff trained in working with children and families who have experienced trauma

Phone Number: (833) 939-3877
Website: Cal-FURS.org
E-Mail: info@cal-furs.org

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Suicide & Crisis Lifeline

The Lifeline provides 24/7, free and confidential support for people in distress, prevention and crisis resources for you or your loved ones, and best practices for professionals in the United States.

Phone number: 988

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The Trevor Project

Crisis counselors are trained to answer calls, chats, or texts from LGBTQ young people who reach out to this free, confidential, and secure 24/7 service for issues such as coming out, LGBTQ identity, depression, and suicide.

Phone number: (212) 695-8650

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Community Provider List

Community Provider List pdf

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California Foster Care Ombudsperson

The California Office of the Foster Care Ombudsperson serves foster youth in California by investigating and resolving complaints about foster youth rights, care, placement, and services. They also provide foster care verification letters and other resources.

Phone Number: 1-877-846-1602

Website: www.fosteryouthhelp.ca.gov

E-Mail: fosteryouthhelp@dss.ca.gov

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Foster Youth Education Rights

Foster Youth Education Rights pdf

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Foster Youth Personal Rights

Foster Youth Personal Rights Handbook English pdf

Foster Youth Personal Rights Handbook Spanish pdf

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Stanislaus County Child Protective Services Hotline

To report suspected child abuse.

 Phone number: (800)-558-3665