Foster Care Child Discharge Form
Please complete this form to document a child’s discharge from foster care. Fill in all required details accurately.
Child’s Full Name
*
First Name
Last Name
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Discharge Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Discharge
*
Please Select
Reunification with family
Adoption
Aged out of care
Transfer to another placement
Other
Placement After Discharge
*
Please Select
Parent/Guardian
Relative/Kinship Care
Adoptive Family
Independent Living
Other
Caseworker Name
*
First Name
Last Name
Agency/Organization Name
*
Discharge Summary / Comments
Submit
Should be Empty: