School Registration Form Children In Care (Page 3 of 3) in pdf

School Registration Form Children In Care Page 3

CONTACT DATA AND

AUTHORIZATION:

Printed Name of Placing Child

and Family Services Worker: ____________________________________________________

Signature of Placing Child

and Family Services Worker: ____________________________________________________

Date Signed: _________________________________________________________________

Name of Placing Agency Office/Regional Office: ____________________________________

Address of Placing Agency Office/Regional Office:

____________________________________________________________________________

Phone # of Placing Child and Family Services Worker: _______________________________

Printed Name of Agency

E.D. C.E.O. /Regional Office R.D.: ________________________________________________

Signature of Placing Agency

E.D. C.E.O. /Regional Office R.D.: ________________________________________________

Date Signed: _________________________________________________________________

Address of Placing Agency E.D. C.E.O. /Regional Office R.D.:

____________________________________________________________________________

Phone # of Placing Agency E.D. C.E.O. /Regional Office R.D.:_________________________

Printed Name of Parent: _______________________________________________________

Signature of Parent: ___________________________

Date Signed: __________________

Printed Name of Student: ______________________________________________________

Signature of Student: __________________________

Date Signed: __________________

(if 18 or over)

For School/Division Office Use:

Steps

Date

Principal or Designate Signature

Registration Received:

Intake Meeting (as required):

Start Date:

Follow-up/Review Meeting(s)

(as required):

School Registration Form Children In Care Page 3