AGENCY/FOSTER PARENTS AGREEMENT 

 

In consideration of mutual obligations and in order to promote a clear understanding of the factors 
involved in providing foster care, the following agreement is being entered into by Foster Parent(s): 
(and Supervising Agency) 
and Supervising Agency: 
(undefined) 
. 

 

 THE FOSTER PARENTS AGREE:

 

• to allow the representative of the supervising agency to visit the home in conjunction with licensing 
procedures, foster care planning, and placement; 




 

• to accept children into the home only through the supervising agency and not through other 
individuals, agencies, or institutions; 




 

• to treat a child placed in the home as a member of the family, and when so advised by the agency, to 
make every effort to support, encourage, and enhance the child's relationship with the child’s parents 
or guardian; 




 

• to maintain continuous contact and exchange of information between the supervising agency and the 
foster parents about matters affecting the adjustment of any child placed in the home. The foster 
parents shall agree to keep these matters confidential and to discuss them only with supervising 
agency staff members, or with other professional people designated by the agency; 




 

• to obtain the permission of the supervising agency if the child is to be out of the home for a period 
exceeding two nights; 




 

• to report to the agency any changes in the composition of the household, change of address, or change 
in the employment status of any adult member of the household; 




 

• to make no independent plans for a child to visit the home of the child’s birth parents, guardian, or 
relatives without prior consent from the supervising agency; 




 

• to adhere to the agency's plan of medical care, both for routine care and treatment and for emergency 
care and hospitalization; 




 

• to provide any child placed in the home with supervision at all times while the child is in the home, 
not leave the child unsupervised, and adhere to the supervision requirements specified in the Out-of-
Home Family Services Agreement or Person-Centered Plan; 




 

• to cooperate with the Out-of-Home Family Services Agreement or Person-Centered Plan. 




 


THE SUPERVISING AGENCY AGREES: 

 

• to assume responsibility for the overall planning for the child as specified by the parent or guardian or 
custodian, and to assist the foster parents in meeting their day-to-day responsibilities toward the child; 




 

• to inform the foster parents concerning the agency's procedures and financial responsibility for 
obtaining medical care and hospitalization; 




 

• to pay the foster parents a per diem rate of $
(to pay the foster parents a per diem rate of) 
. This payment includes room and 
board, and payment for therapeutic services (if therapeutic foster parent) and other payments 
(specify)
(specify) 
; 




 

• to discuss with the foster parents any plans to remove a child from the family foster home, and to give 
the foster parents notice before removing a child from the foster home; 




 

• to visit the family foster home and child according to the Out-Of-Home Family Services Agreement 
or Person-Centered Plan, and to be available to give needed services and consultation concerning the 
child's welfare; 




 

• to respect the foster parents' preferences in terms of sex, age range, and number of children placed in 
the home; 




 

• to provide or arrange for training for the foster parents; 




 

• to include foster parents as part of the decision-making team for a child; and 




 

• to allow foster parents to review and receive copies of their licensing record. 

 




: Other Provisions

 

 

 

 

 

 

 

We have read the foregoing statements and have retained a copy of this document. Signatures: 

 

 Foster Parent: Foster Parent: 
(text) 
Date: 
(Date) 
(text) 
Date: 
(Date) 
_

 Foster Parent: Foster Parent: 
(text) 
Date: 
(Date) 
(text) 
Date: 
(Date) 
_

 

Child Placing Agency Representative: 
(text) 
Date: 
(Date) 


 Signature and Title 

 

 

DSS-1796 (Rev. 09-01-07) 

North Carolina Division of Social Services 

Family Support and Child Welfare Services