Forms
Please access these forms as needed. Return forms to your Bethany worker during a home visit, send them in the mail, or create an email attachment. If there are additional forms you would like to see here, please let us know.
Background Clearance Forms
All members of the household age 16 and older must submit a background authorization form for clearance. When completing this form be sure to use BLACK INK ONLY. The Region 4 form is for King County residents. The Region 3 form is for residents of Snohomish, Skagit, Whatcom, San Juan or Island Counties. Please return completed Background Authorization Forms accompanied by a completed Bethany Release of Infomation to your Bethany office.
Region 4 Background Authorization Form
Region 3 Background Authorization Form
Bethany Release of Information Form
Care Givers Forms
Care Giver's Report to the Court
Care Giver's Report to the Court Fact Sheet
Damage Reimbursement
Damage Reimbursement: Complete and return to your Bethany worker for submission to child's caseworker.
Incident Reporting
Incident Reporting: This form may be used to document incidents that occur with the child(ren) in your care.
Respite Information
Medication
Medical and Dental Medication Log
Monthly Healthcare and Medication Log
Daily Medication Log
Mileage
Mileage Log: Return to your Bethany worker for reimbursement. DSHS will calculate totals.
Well Child Exam Forms
Forms can be downloaded from DSHS website. Provide to child's physician. Return completed form to your Bethany worker.
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Type in Form number
13-683 or
Well Child. Scroll down to locate appropriate form.
http://www1.dshs.wa.gov/msa/forms/eforms.html