Clothing Monies Sent

Triad Family Services

MONTHLY CLIENT REPORT

Please turn in this completed form to your Social Worker for each child the first week of the following month.

Child’s Name: / Month/Year:
Home: / FCSW:

Clothing Allowance (All children in care receive a MINIMUM of $30 a month for clothing. Diapers, backpacks, school supplies, hygiene products, and school gym clothes are not included. Copies of receipts must be provided to your FCSW.

Items / Date / Amount Spent / Balance Remaining / Child’s Initials / F.P. Initials
□ Underwear/sleepwear
□ Tops/shirts
□ Pants/shorts/skirts
□ Dress outfits/Dresses
□ Shoes
□ Jackets/ coats/ sweaters
□ Accessories
□ School uniforms
□ Other
□ Other
Amount / Child Initials / F.P. Initials
The foster parent has given the child money to purchase their own clothing

Allowance/Savings (all children in care receive a MINIMUM of $20 a month for allowance)

Type / Amount
Specify / Date / Balance Remaining / Child’s Initials / F.P. Initials
□ Weekly Allowance / □ $5 or
□ Monthly Allowance / □ $20 or
□ Savings
□ ILP Monies
□ Gift
□ Other

Other Information

Reminders / Comments
Any Incidents?
Any School issues?
Any Health Care visits?
Copy of Medical/dental/ Psychiatric Verification form
Any medications given?
Copy of prescription
Copy of Daily Medication Record
Copy of Centrally Stored Medication form

Updated 09142012