YOUTHVILLE PARENT PACK (Copies of signed forms for parent(s) to keep) O- [gx 4505 Bast 47th Suect South Suite 200 Wichita, Kansas 67210-1651 Tel (316) 529-9100 Fax (316) 529-9851\/ jnited Methodist iv Youthville, inc. TC Packet Acknowledgment Case Name: Case Number: Temporary Custody Court Date: Re: & (Mother's name) (Father's Name) By signing this, I (we) do hereby acknowledge receiving and understanding the information provided and outlined in the initial parent contact following the Temporary Custody Hearing on the aforementioned date. United Methodist Youthville provided me (us) with the following information: * Case Coordinator/Case Manager and Family Support Worker Names and Contact Information; ‘A Parent's Guide to Foster Care, which includes information regarding my rights, the grievance procedure, and UMY services; + Listing of designated agencies and telephone numbers in efforts to complete court orders. (Highlighted agencies from the list represent where my (our) referrals have been sent); A Family Monthly Budget ‘The Visitation Rules to be followed throughout the duration of this case; Authorizations For Release and/or Receipt of Confidential Information; and A copy of the United Way Resource Guide for Community Resources. 1 (We) understand that, although my (our) insurance company may not cover specific court orders, I (we) acknowledge and understand that I (we) are still responsible for obtaining and paying for the services required to meet court orders. Mother's Signature Witness: Name, Position/Credentials i { ‘Name, Position/Credentials Version 013102\/ United Methodist {hf Youthville, nm. UMY VISITATION RULES We believe that a child's ability to maintain contact with family is vital in his/her adjustment to foster care and to the goal of reintegration. We are committed to making visitation occur regularly, in the most home-like setting available in compliance with the structure ordered by the court and recommended by the case planning team. It is essential for you as a parent to demonstrate your commitment to your child(ren). ‘Your child(ren) need you to keep visitation consistent. To benefit you and your child(ren) the following rules have been established: 1. There is to be no discussion of this case with your child (ren) during visitation. Please do not speak another language unless there is an interpreter present. Do not whisper during visitation. If this rule is violated, the visit may be terminated and not rescheduled. 2. Please call if you are going to miss a visit. It will help your child (ren) manage their disappointment if they are prepared and understand why a visit has to be cancelled You are allowed a grace period of 15 minutes. If you arrive after this time, your visit may be cancelled and not rescheduled. If you continue to be late to visitation, you may be required to call ahead of the visit to confirm your attendance. Your worker will determine the amount of time in which you will be required to call ahead. If you do not call, the visit will be cancelled and not rescheduled. Anytime you do not call to cancel a visit and you do not attend, it is documented as a "No Show.” In addition, "No Show” visits are not rescheduled, 3. Ifa scheduled visitation is cancelled due to a conflict with the children’s transportation or the UMY worker's schedule, this visit will be rescheduled for you. However, visitation that has to be cancelled due to bad weather may not be rescheduled. 4. Unless you have prior approval from your UMY worker, do not bring anyone along with you to your visitation. If your children are visiting in their own homes, make certain that only approved persons will be present so you have the opportunity to demonstrate your skills and to interact with your children. In addition, if someone comes to the visit and your child (ren) reacts with fear or anger this person will be asked to leave the visit immediately. Should this person fail to leave the visit, UMY will terminate the visit immediately. 5. Visitations are important opportunities for you to demonstrate the skills you have been working on. It is expected that you parent your child (ren) during all visitations. Itis the role of the worker to observe, provide feedback, and document the interactions during visits. If you experience problems with discipline during a please ask your worker for help or suggestions. This shows your willingness and cooperate with UMY. Approved 5/31/02 Page &