Foster Parent Forms

Below are frequently requested forms for the specific use by foster parents of Summit County Children Services. Click on the individual PDF links to access the forms.  Print and complete the forms and submit them to your Coordinator.

All About Me Booklet – PDF

Applicant Financial Statement (2020) – PDF

Application for Child Placement (8/2022) – PDF

Authorization for Release of Information (Revised 12/14/2023) – PDF

Background Check – PDF

Child Characteristics Checklist for Foster Care and/or Adoption – PDF

Clothing Checklist for SCCS – Foster Children – PDF

Foster Parent Mileage Reimbursement Form 2023 – PDF

Foster Parent Mileage Reimbursement Form 2024 – PDF

Foster/Adoption Parent Caregiver Agreement – PDF

Medication Log (for Prescriptions) – PDF

Medical Statement for Foster Caregiver/Adoptive Applicant and All Household Members (Revised 8/2022) – PDF

Request to Release Social Security Number (Revised 2/11/2020) – PDF

Respite Care (Revised 6/2021) – PDF

SCCS Caregiver Agreement for Discipline, Care, Time-Out, and Prohibition of Seclusion & Restraint – PDF

Travel Form (Revised 5/22/2019) – PDF

Verification for Foster Parents – Employment and School for Caregivers  – PDF

Verification for Foster Parents – Day Care License Enrollment – PDF

Provider Respite Forms

JFS 01218 Basic Infant Information

JFS 01234 Child Enrollment and Health Information

JFS 01236 Child Care Plan for Health Conditions and Medical Procedures

Support Our Mission

Learn how you can help advance the mission of Summit County Children Services

Foster or Adopt

With nearly 800 children in our custody, SCCS relies on the selflessness of our community to foster or adopt children in need.

Volunteer or Donate

We have year-round activities the success of which is dependent on the generosity of our community.

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