New Haven Youth and Family Services

    Acknowledgement of Receipt of Processes and Procedures

     

    Youth Name: ______________________________________

    Date of Birth: ______________________________________

     

    The following set of New Haven processes & procedures were provided to me or offered to me at the time of admission:

    X      Contact Information

    X      Placement Agreement

    X      New Haven Code of Conduct

    X      Personal Property Policy, including Cash Resources

    X      Dress Code, Contraband, and Search & Seizure Policies

    X      Emergency Intervention Plan

    X      Phone Use & Visits

    X      AWOL (Runaway) Plan & Protocol

    X     Home Pass Policy & Drop-off Locations

    X     California Department of Education Universal Complaint Procedure

    X     Resident Complaint Procedure

    X     Non-Discrimination and Harassment Statement

     

    By signing below, I acknowledge that the above listed Processes & Procedures, have been explained to me thoroughly and in detail.

     

    ____________________________________              __________

    Signature of Parent, Guardian, or Representative                    Date

     

    ____________________________________              __________

    Signature of Youth                                                                           Date

     

    ____________________________________              __________

    Signature of New Haven Representative                                    Date