Exhibit IX Clothing and Property Inventory.pdf
PDF 190 KB Posted
- Attached to
- Master Agreement AZ|CTR071431
- Contract number
- CTR071431
- Issued by
- Arizona
About this file
This is a Congregate Care Clothing and Property Inventory form issued by the Arizona Department of Child Safety (DCS), dated May 2024. The document is designed for out-of-home care providers to track and document personal clothing and items for children ages 1-18 who are in the state's child welfare system during placement and discharge.
The inventory form provides a comprehensive checklist of clothing items including bathing suits, bathrobes, blouses, boots, undergarments, and other essential clothing pieces. It allows care providers to document what items a child currently has ("Has" column), what items are needed ("Needs" column), the quantity of each item, and associated costs. The form also includes a section for documenting additional personal items not listed in the standard categories. Care providers are instructed to keep receipts for clothing allowances, emergency money, special needs funds, and other auxiliary payments for one year. The document requires signatures from the child (if 12 or older), the out-of-home care provider, and an audit signature to ensure accountability and proper tracking of personal belongings.
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Text version
CONGREGATE CARE
CLOTHING AND PROPERTY INVENTORY
ARIZONA DEPARTMENT OF CHILD SAFETYExhibit IX (05/24)
Item Has Needs Quantity Cost ($)
Bathing suits
Bathrobe
Blouses
Boots
Booties (Infants)
Bra
Dresses
Hat
Jacket
Jeans
Pajamas
Item Has Needs Quantity Cost ($)
Item Has Needs Quantity Cost ($)
Pants/Shorts
Playsuits (Infants)
Shoes
Slippers
Skirts
Socks
Sweater
Tennis shoes
Underpants
Undershirts
T-Shirts
Item Has Needs Quantity Cost ($)
Date o f Birth Placement Date
Date
Date
Date
Date Log StartedOut-of-Home Care Provider's Name
Audit Signature
Child's Signature (if child is 12 years old or older)
Out-of-Home Providers Signature
Use upon placement and discharge to inventory and document all of child's current and needed personal items.
Ages 1-18
Other Items ~ Please list ALL other items belonging to the child NOT listed above.
Child's Name (Last, First, M.I.)
Document all Clothing Allowances given to child and all purchases made with monthly money. Any emergency money, special needs money, graduation money, school supplies and fees money and other auxiliary payments. Receipts must be kept with this log for one (1) year
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