Form Soc 156 - Agency - Foster Parents Agreement - Child Placed By Agency In Foster Home Page 2
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
I have read the foregoing and agree to meet these requirements. The terms of this agreement shall remain in force until changed by
mutual agreement of all parties or when this child is removed from home.
SIGNATURE OF CHILD PLACEMENT WORKER
SIGNATURE OF FOSTER MOTHER
TITLE
NAME OF AGENCY
SIGNATURE OF FOSTER FATHER
ADDRESS
ADDRESS
PHONE NUMBER
DATE
PHONE NUMBER
DATE
(
)
(
)
Long-Term Placement Intent
I have read the foregoing and agree to meet these requirements. The terms of this agreement shall remain in force until changed by
mutual agreement of all parties or when this child is removed from home. In signing this section, the agency, foster parents and foster care
child signify their desire that this child remain in this home as a permanent member of this family.
SIGNATURE OF CHILD PLACEMENT WORKER
SIGNATURE OF FOSTER MOTHER
TITLE
SIGNATURE OF FOSTER FATHER
NAME OF AGENCY
ADDRESS
ADDRESS
PHONE NUMBER
(
)
PHONE NUMBER
DATE
SIGNATURE OF FOSTER CARE CHILD
(
)
SOC 156 (12/11) - NO SUBSTITUTE PERMITTED
PAGE 2 OF 2
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