LIFE’S CHECKLISTS · FREE WORKSHEET
Caregiver roles and preferences
Organize administrative questions and next actions. Keep identity numbers, clinical records and children’s identifying information in the responsible organization’s secure process. This is a planning worksheet, not an official application or authorization.
First read the completed example. Then write your own answers in the blank sections. If you do not know an answer, write what you need to ask. Official applications may require their own forms.
Completed example
This is a fictional practice entry. Write your own details in the blank sections below.
- Task requested
- Ride to library
- Person choosing the help
- Grandparent requested this help
- Responsible helper role
- Alex drives if confirmed
- Permission to confirm
- Grandparent agrees to share pickup time only
- Approved contact route
- Call grandparent directly
- Review date
- October 30
Date: ____________________
Item 1
Person choosing the help
Responsible helper role
Permission to confirm
Approved contact route
Review date
Item 2
Person choosing the help
Responsible helper role
Permission to confirm
Approved contact route
Review date
Item 3
Person choosing the help
Responsible helper role
Permission to confirm
Approved contact route
Review date
Item 4
Person choosing the help
Responsible helper role
Permission to confirm
Approved contact route
Review date
Notes: