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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:

Volume:

X

Forms

Chapter:

A

Forms

3-29-2010

Subchapter:

1

Forms

Issuance:

11.34

CP&P Form 11-34, Child's Summary - Infant Development

 

Double click here to view or print CP&P Form 11-34, Child's Summary-Infant Development.

 

Instructions 3-29-2010

 

PURPOSE AND USE

The form, for the adoptive family, is used to:

·         detail the child's motor, social, coordination, and speech developments; and

·         describe the child's personality characteristics; and

·         outline the child's eating and sleeping habits and daily activities.

INSTRUCTIONS FOR COMPLETING THE FORM

The Child's Summary - Infant Development is prepared by the Worker when adoption is determined to be the case goal.  The Worker provides the information by writing directly on the form.

Name

Enter the child’s name.

Birth date

Enter the child’s date of birth.

Case ID#

Enter the child’s case ID number.

 

Complete each line with yes/no or appropriate description of response and indicate the date, if known/relevant.

Remove any identifying data from copy given to the adoptive parent at the time of the child's placement.

DISTRIBUTION

Original          -           Adoptive parent

Copy               -           Child's case record