MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION RESPITE CARE PROVIDER APPROVAL
DVN
Resource Parent	Resource Parent
Address	County
The minimum standards for the care of foster children have been explained to me and I agree to adhere to them. These standards include the following policy concerning discipline: "Discipline shall be fair, consistent, related and in proportion to the offense so as to be a positive, educational tool to help children develop inner controls. Harsh and humiliating punishment, including physical, emotional, and verbal abuse is prohibited. Positive corrective procedures shall be used as disciplinary measures. These measures include, but are not limited to: Loss of privileges Time out (usually the age of the child plus two minutes) Grounding to a certain area Redirecting the child's activity Developing a behavioral contract Extra chores Restitution by child of other persons' property damaged or destroyed by child Certain types of punishment shall not be used. These include, but are not limited to: Corporal punishment Slapping, striking, or hitting the child's face Hitting with a fist Shaking the child Chemical, drug, or mechanical restraints Use of instruments (i.e., belts, switches, extension cords, etc.) I further state that no member of my household has been convicted of a felony or misdemeanor involving: 1) a sex related crime; 2) serious intentional, reckless or negligent physical injury, danger or death of any person; 3) a crime against a child; 4) major intrusion upon property or use of weapon to secure property; 5) arson; or 6) manufacture, sale, distribution or possession of controlled substance, opiates, illegal, addictive or narcotic drugs.
These standards have been explained and I agree to abide by the Division's rules and regulations.
Signature	Date	Signature	Date
The Missouri Children's Division has evaluated and approved the above named respite care applicant as a respite care provider.
Children's Service Worker Signature	Date	Circuit Manager/Supervisor	Date