Resource Family Placement During COVID-19
This 3-minute survey is for approved Resource Families in Ventura County. The purpose of this survey is to find out your current availability to help care for court dependent children. Even if you are not available, it is important for us to know the most up to date information about your home during this public health emergency. All information shared is confidential. Please email us at homeswithheartvc@ventura.org with any questions. You can also go to http://homeswithheartvc.org/updates/ for information about Children and Family Services response to COVID-19. Thank you for your help with this very important survey and for your willingness to be a home with heart.
Sign in to Google to save your progress. Learn more
Name: *
Approving Agency: *
Number of dependent children currently in the home. *
City: *
ZIP/Postal Code: *
Email Address: *
Phone Number: *
Are you able to care for additional children full time - this means you have the physical space, parenting capacity and support to  take more placements. *
Are you able to care for additional children temporarily (a few hours or days) to provide respite for another resource family? *
If yes to either full time or respite care, how many more children could you serve? *
If you are able to serve more children during this crisis, are you comfortable accepting a child into your home who is symptomatic with a cough or fever, but is not known to be positive for COVID-19? *
If you are able to serve more children during this crisis, are you comfortable accepting a child into your home who may have been exposed to the virus, but does not have symptoms? *
If you are able to serve more children during this crisis, are you comfortable accepting a child into your home who may have been exposed to the virus and is on quarantine status? *
If you are able to serve more children during this crisis, are you comfortable accepting a child into your home who has a confirmed diagnosis of COVID-19? *
Please feel free to add any comments or clarifications to your answers here. Let us know if there are supports that would be useful to your family during this time.
Thank you very much for your help with this important information and for all you to to help children in need. Please stay in touch with your Social Worker or Agency so we know that you are okay. For updated information, please visit the Homes with Heart Ventura County webpage at http://homeswithheartvc.org/covid19-2/
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms