Referrals

Current CT State Climate

We are aware that with budget cuts many State agencies, including DCF are feeling the pinch and we at The Guardian are sensitive to this. We strive to ensure all services are completed with the highest possible quality and our follow up and reporting is timely, in order to help support you in your roles.

DATE
MM slash DD slash YYYY
CASE NAME
LINK
SW NAME
PHONE NUMBER AND NEXTEL
SWS NAME
PHONE NUMBER AND NEXTEL
CHILD (REN)
Car Seat Y or N
Type
DOB
Car Seat Y or N
Type
Car Seat Y or N
Type
Car Seat Y or N
Type
Car Seat Y or N
Type
PRIMARY LANGUAGE
CHILD (REN) STRENGTHS
CHILD (REN) BEHAVIORS
MEDICAL ISSUES/MEDICATIONS/SPECIAL NEEDS
TRANSPORTATION FOR CHILDREN BY
- DCF
- FOSTER PARENT
- OTHER
IF OTHER, PLEASE SPECIFY
FOSTER PARENT(S) NAME/PHONE # (home, work and cell)
AUTHORIZED PERSON TO LEAVE CHILD WITH AT DROP OFF
PICK UP ADDRESS
DROP OFF ADDRESS
DATE OF VISIT
MM slash DD slash YYYY
Time

: Hours

Minutes

AM/PM
LOCATION OF VISIT
REASON FOR SUPERVISION
GOALS OF VISIT
From
To
PEOPLE ALLOWED TO VISIT/RELATIONSHIP TO CHILD (REN)
CONVERSATIONS TO REFRAIN FROM
DRUGS/ALCOHOL CONCERNS/BY WHOM
RESTRAINING ORDERS
- YES
- NO
WHOM/RELAT
Name
This field is for validation purposes and should be left unchanged.

10 Signs of Child Abuse for Parenting

Child Abuse and Neglect

Types of Child Abuse

Referrals

CHILD (REN)

DOB

GOALS OF VISIT

Mentoring Overview

Mentoring Referral Form

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