Instructions
Caretaker/Provider Agreement (JFS 01634)

1.    Print 3 copies of the form.

2.    Complete and sign each copy. 

3.    Keep one copy for your records. 

4.    Give one copy to the parent or
       caretaker.

5.    Return one copy to your Home Provider
       Specialist within 3 days of placement by
       either:
       Mail:     Job and Family Services
                  222 East Central Parkway
                  Cincinnati, Ohio 45202
                  Attn: Child Care Provider Program

       Fax:      (513) 946-1102

Be sure to write your Home Provider Specialist's name on any forms you mail or fax. 

Click here for form