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DCF009 06/2017 (Rev.) State of Connecticut Department of Children and Families FOSTER CARE LICENSING PLACEMENT WAIVER REQUEST Page 1 of 10 Foster Parent Last NameProspective Foster Parent Licensed
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Start by reading the adolescent services service agreement thoroughly to understand the terms and conditions.
02
Fill out your personal information accurately in the designated fields. This may include your name, address, contact information, and date of birth.
03
Provide information about your parent or guardian, if applicable, including their name, contact information, and relationship to you.
04
Specify your reasons for seeking adolescent services and what type of services you require.
05
If there are any additional details or specific requirements, make sure to include them in the agreement.
06
Review the agreement once again to ensure all information provided is correct and complete.
07
Sign and date the agreement at the bottom to validate your acceptance of the terms and conditions.
08
Return the filled out agreement to the appropriate authority or organization offering the adolescent services.

Who needs adolescent services service agreement?

01
Adolescent services service agreement is needed by any adolescent (usually aged 13-17) who is seeking specialized services for their individual needs such as counseling, therapy, educational support, or medical assistance.
02
In some cases, the agreement may also be required by the parent or guardian of the adolescent, especially if they are responsible for signing consent forms or making decisions on behalf of the minor.
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The adolescent services service agreement is a contract that outlines the services to be provided to adolescents and their families.
Adolescent service providers are required to file the service agreement.
The service agreement must be completed with all required information including services provided, duration, cost, and signatures of all parties involved.
The purpose of the service agreement is to clearly define the services to be provided, expectations, and responsibilities of all parties involved.
The service agreement must include details such as services provided, names of individuals involved, duration of services, cost, and any other relevant information.
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