GENDER SPECIFIC PROGRAM
ADMISSIONS CRITERIA
AGENCY PACKET

Click on the name to download a printable PDF form

School Records Release Form

Medical Consent Form

Activity Consent Form

Adopt a Highway Program Release Form

Documents required prior to or the day of placement.

Documents required:

  • Individual Child Care Agreement that must be dated the day of placement occurs.
  • Court entry placing the child at the GSP. Must also state what agency holds custody during placement and what school is financially responsible.
  • Medical and activity consents signed by Custodian. School records release and Adopt-A-Highway consent signed by parent. *AAHW consent is optional.

Copies of:

  • Birth certificate
  • Social security card
  • Immunizations
  • Medical insurance
  • A list of priors charges
  • Case plan when completed
  • And if applicable: IEP, psychological and/or psychiatric evaluations

Other information needed upon admission:

  • Approved visitors
  • Approved individuals for phone contact
  • Approved individuals for mail contact
  • No contact orders if Applicable
  • Current charge that we will be holding the child on

Personal Items
We provide basic hygiene items and bedding.Each resident will be required to wear District pants as provided but should have some to change into when leaving the building.The following list is a minimum of what they will need upon intake.If you will be unable to visit for several weeks please send additional pants. For a full list of the maximum amount of Personal Items please click here.

Things a Child needs upon intake:

Medication

3 pair of pjs

7 pair of underwear, 2 bras, 7 socks

1 pair of jeans, 1 pair of sweats, athletic pants or shorts
(seasonally appropriate)

Weather appropriate shoes & outer wear

Sneakers

7 shirts

The following items are not required but may make your child feel more comfortable in a new environment:

Pictures

You own bedding

Make up, straightener etc.

Radio, cd player or mp3 player (as long as it cannot connect to the internet)

Spending money up to $40

You own hygiene items

Stuffed animals etc

**We advise against bringing anything expensive or of personal value, as we are not responsible for replacement if it is lost, broken or stolen.

Things you cannot bring:

Cell phone

TV etc

Tablets or computers

Video games or systems

Drugs, alcohol, tobacco

Weapons


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errors, omissions or discrepancies. Moreover the Belmont Harrison Juvenile District is not responsible for the content nor endorses any site which has a link from this site.
© Copyright 2016, Belmont Harrison Juvenile District