<p> Alternate Caregivers/Respite Care DD Child Foster Home Children with Developmental Disabilities</p><p>Family name: Date: As a foster parent, you will need to arrange for safe and responsible childcare. Your certifier must have the approved clearances in your file. No one may care for your foster child(ren) without the required clearances. At a minimum, alternate caregivers will need to consent to a fingerprint based criminal history check and child abuse screening. This process can take several months. State licensed daycare businesses will already have the required clearances as part of their licensing procedure. It is important for you to obtain any other clearances before your first child is placed. Please complete the following information regarding child and respite care, so that you are prepared when a child is placed in your home. Primary caregiver: Work hours: Secondary caregiver(s): Work hours: Hours requiring childcare in AM: Hours requiring childcare in PM: Childcare provider’s name: Address: Phone: E-mail: Respite care is intended to give the foster provider a break, rather than substituting for the foster provider during work hours. Some families do not need childcare during work hours. All foster families need to have a plan for occasional or regular relief from caring for the foster child. Respite care provider’s name: Address: Phone: E-mail: Additional respite care providers: Respite care provider’s name: Address: Phone: E-mail: Respite care provider’s name: Address: Phone: E-mail: </p><p>SDS 4511 (2/11)</p>