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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective

Date: 2-5-2018

Volume:

X

Forms

Chapter:

A

Forms

Revised Date: 2-4-2019

Subchapter:

1

Forms

Issuance:

5.5

CP&P Form 5-5, Resource Family Parent Agreement

 

Click here to view or print the CP&P Form 5-5.

 

Click here to view or print this form in Spanish, CP&P Form 5-5(S).

 

WHEN TO USE IT

 

The Resource Family Support Worker, or designee, completes the CP&P Form 5-5:

 

      At an initial placement (emergency or regular);

      At the end of the time frame for completing the corrective action plan, if necessary; and

      Whenever a reevaluation is completed.

 

Use this form to identify:

 

      Responsibilities of CP&P to the child, parent and the resource family parent caregiver;

      Responsibilities of the resource family parent in providing care.

 

The form also provides an acknowledgement of these responsibilities by both CP&P and the resource family parent.

 

INSTRUCTIONS FOR COMPLETING THE FORM

 

The RFSW reviews and explains the entire agreement, discussing point by point in language which is clear and can be readily understood, or reads the form aloud to the resource parent(s). The RFSW encourages questions, and provides answers.

      Enter the name(s) of the resource family parent(s) at the top of the first page.

      Enter the name, address, and telephone number of the Resource Family Support Unit at the bottom of the last page, and the effective date of the agreement.

 

Each resource family parent signs and dates the agreement.

The Resource Family Support Worker, or designee signs and dates the agreement.

 

DISTRIBUTION

 

Original          -

Resource family home record

Copy              -

Resource family parent(s)

Copy              -

Office of Licensing