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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: 8-5-2019

Subchapter:

1

Forms

Issuance:

5.5a

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

 

 

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

 

Click here to view or print the Spanish CP&P Form 5-5a(S).

 

WHEN TO USE IT

 

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

 

·         At the initial placement (emergency or regular) of a minor parent and child;

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

·         Whenever a re-evaluation is completed.

 

Use this form to identify responsibilities of the resource family parent in providing care to the minor parent and child.

 

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

 

HOW TO USE IT

 

The RSFW 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 RFSW, Supervisor and/or designee signs and dates the agreement.

 

 

DISTRIBUTION

 

Original          -          Resource family home record

 

Copy              -          Resource family parent(s)

 

Copy              -          Office of Licensing