Alberta Regulation 159/2004

Marketing of Agricultural Products Act

ALBERTA MILK PLAN MINIMUM PRICE FOR

SUB-CLASS 1A MILK ORDER

Filed: July 19, 2004

Made by the Alberta Energy and Utilities Board on July 15, 2004 pursuant to

section

5(4) of the Alberta Milk Plan Regulation (AR 150/2002).

1 The minimum price for sub-class 1a milk to be paid by processors

for a hectolitre of sub-class 1a milk is $69.11.

2 The Alberta Milk Plan Minimum Price for Sub-class 1a Milk Order

(AR 102/2004) is repealed.

3 This Order comes into force on August 3, 2004.

--------------------------------

Alberta Regulation 160/2004

Child, Youth and Family Enhancement Act

CHILD, YOUTH AND FAMILY ENHANCEMENT REGULATION

Filed: July 20, 2004

Made by the Minister of Children's Services (M.O. 28/04) on July 19, 2004 pursuant

section 131(2) of the Child, Youth and Family Enhancement Act.

Table of Contents

Definitions

2 Forms

3 Secure services facilities

4 Director's qualifications

Part 1

General Provisions

5 Mediation

6 Post-18 support, financial assistance

7 Duty to keep records

8 Permanent placement plan reports

Section 21.1(6) plan exceptions

10 Supports for permanency

Part 2

Section 105.8 Financial Assistance

Definitions

12 Director may provide financial assistance

13 Application for financial assistance

14 Annual eligibility review form

15 Basic monthly benefit

16 Eligibility requirements

17 Deductions from basic monthly benefit

18 Supplementary benefits

19 Child care costs

20 Out-of-school-care costs

21 School expenses

22 Health services and benefits

23 Annual supplementary enhancement benefit

24 Changes in circumstances

25 Recovery of unauthorized payments

26 Duty to keep documents and records

Part 3

Repeal, Expiry and Coming into Force

27 Repeal

28 Expiry

29 Coming into force

Schedules

Definitions

1(1) In this Regulation, "Act" means the Child, Youth and Family

Enhancement Act.

(2) For the purposes of

Part 1, Division 5 and

Part 2 of the Act,

"qualified person" means

(

a) an individual who is registered on the general register

category of the regulated members register of the Alberta

College of Social Workers, or

(

b) a person who in the opinion of the Minister is qualified

because of the person's education and experience.

(3) For the purposes of the Act, "alternative dispute resolution" means

mediation.

Forms

2 The forms prescribed for the purposes of the Act related to this

Regulation are the forms in

Schedule 1.

Secure services facilities

3 The facilities listed in

Schedule 2 are secure services facilities for

the purposes of the Act.

Director's qualifications

4 For the purposes of this Act, the qualifications required for a person

to be appointed as a director are that the person

(

a) holds a master degree in social work and has 10 years' direct

experience in the delivery of intervention services, or

(

b) has a combination of education and experience considered by

the Minister to be equivalent to that described in clause (a).

Part 1

General Provisions

Mediation

5(1) A person who conducts alternative dispute resolution by

mediation under

section 3.1 of the Act must

(

a) have qualifications or experience, or a combination of both,

satisfactory to a director, and

(

b) be agreed to by all parties to the mediation.

(2) A person who conducts alternative dispute resolution by mediation

must use a process that facilitates the parties to the mediation to make

their own decisions to resolve the dispute.

Post-18 support, financial assistance

6(1) A director may enter into an agreement in Form 12 of

Schedule 1

with a person described in

section 57.3 of the Act with respect to the

provision of support and financial assistance required to assist or

enable the person to establish or maintain an independent living

arrangement if, in the opinion of the director, the support and financial

assistance are not reasonably available to the person from other

sources.

(2) An agreement referred to in subsection (1) must include a plan for

the person's transition to independence and adulthood in Form 9 of

Schedule 1.

(3) An agreement referred to in subsection (1) may provide support

and financial assistance that are required for the health, well-being and

transition to independence and adulthood of the person referred to in

section 57.3 of the Act, including

(

a) living accommodation,

(

b) financial assistance related to necessities of life,

(

c) if the person is less than 20 years of age, financial assistance

related to training and education,

(

d) if the person is less than 20 years of age, health benefits, and

(

e) any other services that may be required to enable the person

to live independently or achieve independence.

(4) No agreement referred to in subsection (1) may be entered into or

remains in force after the person's 22nd birthday.

Duty to keep records

7 For the purposes of

section 127 of the Act, a director must keep

records with respect to a child who is the subject of an investigation,

agreement or order under the Act or any predecessor to the Act.

Permanent placement plan reports

8 A director must report to the Minister regarding the plan for the

permanent placement for a child described in

section 34.1 of the Act at

12 months, 18 months, 24 months, 30 months, 36 months and at every

subsequent 12 months after the date that the child becomes the subject

of a permanent guardianship agreement or order.

Section 21.1(6) plan exceptions

9(1) A director, when developing a plan pursuant to

section 21.1(6) of

the Act,

(

a) is not required to determine an alternative permanent

placement for a child if the child is ordered into the custody

of a director solely for the purpose of authorizing treatment

referred to in

section 22.2(1) of the Act, and

(

b) is not required to describe the services to be provided to

facilitate the return of a child to the custody of the child's

guardian if all the guardians of the child

(

i) are deceased, or

(ii) have consented to the application for a permanent

guardianship order.

(2) A director is not required to develop a plan pursuant to

section

21.1(6) of the Act when a director applies for a temporary

guardianship order with respect to a youth who has entered into an

agreement under

section 57.2 of the Act.

Supports for permanency

10(1) The maximum financial assistance that may be provided in

agreements, pursuant to sections 56.1 and 81 of the Act, in Form 13 of

Schedule 1

(

a) if the annual gross family income is under $60 000, the basic

maintenance rate available for a child in foster care,

(

b) if the child has behavioural or emotional problems,

(

i) the cost of 10 counselling sessions annually,

(ii) the cost of treatment of the child in a residential facility,

satisfactory to a director, if the director is of the opinion

that the placement of the child is likely to break down

without the treatment, and

(iii) $70 weekly to purchase any additional services required

to address the child's behavioural or emotional problem,

(

c) in the case of a child who is an Indian, the cost of

transportation of the child to the child's band for the purpose

of maintaining cultural ties, and

(

d) the cost of parental respite services to a maximum of 576

hours annually per family.

(2) A director must review an agreement referred to in subsection (1)

(

a) annually, and

(

b) within 30 days after receiving a written request for a review

from the other party to the agreement.

(3) If, after a review under subsection (2) or after a director receives

information about changes in circumstances, the director is of the

opinion that

(

a) the needs of the child have changed, or

(

b) the financial ability of the person described in

section 56.1 or

81 of the Act to maintain the child or to provide the services

required to meet the needs of the child has changed,

the director may require that the agreement be varied or may terminate

the agreement immediately or on 30 days' written notice, in

accordance with the terms of the agreement, to the other party to the

agreement.

(4) If, on November 1, 2004, an adoptive parent is a party to a

post-adoption support agreement under

Part 4 of the Adoption

Regulation (AR 37/2002), the adoptive parent may, on the expiry of

that agreement,

(

a) enter into a post-adoption support agreement in accordance

with

Part 4 of that Regulation as it read on October 31, 2004

but the agreement must expire on or before November 1,

2005, or

(

b) enter into an agreement in accordance with subsection (1).

(5) If, on November 1, 2004, an adoptive parent of a child that a

director had acknowledged in writing to have a special need in

accordance with

section 48(2)(

b) of the Adoption Regulation

(AR 37/2002) is not a party to a post-adoption support agreement

under

Part 4 of that Regulation, the adoptive parent may apply to the

director

(

a) prior to October 31, 2005, to enter into an agreement in

accordance with

Part 4 of that Regulation as it read on

October 31, 2004 but the agreement must expire on or before

November 1, 2005, or

(

b) to enter into an agreement in accordance with subsection (1).

(6) Despite subsections (1) to (5), financial assistance shall not be

provided if the child, at the time of the adoption or the making of the

private guardianship order, was the subject of a permanent

guardianship agreement and did not have a disability, as defined in the

Family Support for Children with Disabilities Act.

Part 2

Section 105.8 Financial Assistance

Definitions

11 In this Part,

(a) "basic monthly benefit" means the basic monthly benefit

referred to in

section 15;

(b) "caregiver" means the adult person who cares for a child

within the meaning of

section 105.8 of the Act.

Director may provide financial assistance

12 A director may, in accordance with this Part, provide benefits

under this Part to a caregiver in respect of a child referred to in

section

105.8 of the Act.

Application for financial assistance

13(1) An application by a caregiver for a basic monthly benefit must

be in Form 14 of

Schedule 1 and must be submitted to a director.

(2) If application is made in respect of more than one child under the

caregiver's care, a separate application must be submitted in respect of

each child.

Annual eligibility review form

14(1) A caregiver who receives a basic monthly benefit must provide

an annual eligibility review form in Form 15 of

Schedule 1 to a

director on request.

(2) A separate annual eligibility review form must be submitted for

each child under the caregiver's care in respect of whom a basic

monthly benefit is being paid.

(3) If a caregiver fails to submit the annual eligibility review form as

required under this section, the director may withhold any further

benefits under this Part until the form is submitted.

Basic monthly benefit

15 The caregiver of a child who meets the eligibility requirements of

section 105.8 of the Act and this

Part is entitled to receive financial

assistance in the form of a basic monthly benefit in respect of the child

in an amount equal to,

(

a) in the case of a child who is less than 12 years of age, the

difference between $105 and the total monthly deductions

calculated in accordance with

section 17, and

(

b) in the case of a child who is 12 years of age or older, the

difference between $148 and the total monthly deductions

calculated in accordance with

section 17.

Eligibility requirements

16(1) A basic monthly benefit may be paid in respect of a child if the

child is occupied full-time in one or more of the following:

(

a) employment;

(

b) an education program acceptable to a director;

(

c) an employment training program acceptable to a director.

(2) A basic monthly benefit may not be paid in respect of a child if

any of the following circumstances apply:

(

a) if the child has a monthly gross employment income that

exceeds $1000, unless the child is also attending a full-time

educational program or training program described in

subsection (1);

(

b) if the child is married to the child's caregiver or is living with

the caregiver in a relationship of interdependence as defined

in the Adult Interdependent Relationships Act;

(

c) if the child's caregiver is the child's biological or adoptive

parent.

(3) Despite subsection (1), a director may pay a basic monthly benefit

if the director is satisfied that, due to the child's age or for medical

reasons, the child is unable to be fully occupied with employment or

education or employment training programs described in subsection

(1).

Deductions from basic monthly benefit

17(1) The following monthly income amounts are to be deducted for

the purposes of calculating the amount of the basic monthly benefit:

(

a) payments for the child's benefit from income earned by a

trust account for the child's benefit;

(

b) support or maintenance payments for the child's benefit from

the child's parent or guardian;

(

c) payments received by the child or for the child's benefit

under any of the following:

(

i) the Canada Student Loans Act (Canada);

(ii) the Canada Student Financial Assistance Act (Canada);

(iii) the Student Financial Assistance Act;

(

d) any other grant or bursary received by the child or for the

child's benefit for education or training purposes.

(2) If the total monthly amount referred to in subsection (1) varies

from month to month, the director may calculate an average amount as

the monthly deduction for the purpose of this section.

Supplementary benefits

18 If a caregiver is receiving or is eligible to receive a basic monthly

benefit in respect of a child, a director may, in accordance with

sections 19 to 23, provide supplementary benefits to the caregiver on

behalf of the child.

Child care costs

19(1) If a child attends

(

a) a licensed day care centre under the Social Care Facilities

Licensing Act, or

(

b) a family day home approved by a director for the purposes of

this section,

the director may pay to the child's caregiver child care costs in

accordance with this section.

(2) A director may not pay child care costs under this

section unless

the caregiver establishes a demonstrated need for child care to the

director's satisfaction.

(3) The amount of the child care costs to be paid under subsection

(1) is determined as follows:

(

a) if the caregiver is eligible for the maximum Provincial Child

Care Subsidy in respect of the child, the child care costs to be

paid are an amount that is equal to that part of the child care

costs that is not covered by the Provincial Child Care

Subsidy Program and that the caregiver is required to pay;

(

b) if the caregiver is eligible for less than the maximum

Provincial Child Care Subsidy in respect of the child, the

child care costs to be paid are an amount that is equal to that

part of the child care costs that is not covered by the

Provincial Child Care Subsidy Program and that the

caregiver is required to pay, but in no case shall the amount

of child care costs paid under this

section plus the amount of

the Provincial Child Care Subsidy Program for which the

caregiver is eligible exceed the maximum Provincial Child

Care Subsidy offered in respect of the licensed day care

centre or family day home in respect of a child of the same

age;

(

c) if the caregiver is not eligible for the Provincial Child Care

Subsidy in respect of the child, the child care costs to be paid

are an amount that is equal to the actual child care costs paid

by the caregiver, up to the maximum Provincial Child Care

Subsidy that is offered in respect of the licensed day care

centre or family day home in respect of a child of the same

age.

Out-of-school-care costs

20(1) If a child

(

a) attends

(

i) a school in any of grades one to 6, or

(ii) a school in any of grades 7 to 12 and the caregiver

demonstrates to the director's satisfaction a medical or

developmental need for out-of-school-care for the child,

and

(

b) attends an out-of-school-care centre,

the director may pay to the caregiver in respect of the child's

out-of-school-care costs an amount to be determined as follows:

(

c) if the caregiver is eligible for an out-of-school-care subsidy

from another source in respect of the caregiver's

out-of-school-care costs, the out-of-school-care costs to be

paid are an amount equal to the difference between the total

out-of-school-care costs paid and the amount of the subsidy,

to a maximum of $300 per month;

(

d) if the caregiver is not eligible for an out-of-school-care

subsidy from another source, or there is no such subsidy

available in respect of the caregiver's out-of-school-care

costs, the out-of-school-care costs to be paid are an amount

equal to the total out-of-school-care costs paid, to a

maximum of $300 per month.

(2) The director may refuse to pay an amount under subsection (1) if

the director is not satisfied that the caregiver has applied for and

received all other subsidies for out-of-school-care costs in respect of

the child for which the caregiver or child is eligible.

School expenses

21 If a child is in full-time attendance at a school in an early

childhood services program, as defined in the School Act, or any of

grades one to 12, a director may pay to the child's caregiver an amount

to cover

(

a) lunchroom supervision fees, and

(

b) the actual cost of school expenses, supplies and fees, to an

annual maximum of

(i) $50 if the child is in an early childhood services

program, as defined in the School Act,

(ii) $100 if the child is in grades one to 6, or

(iii) $228 if the child is in grades 7 to 12.

Health services and benefits

22 A director may provide health benefits in respect of a child

pursuant to a Child Health Benefit Program card issued in accordance

with an agreement between officials on behalf of the Department of

Children's Services and the Department of Human Resources and

Employment, if the child is not covered in respect of such benefits

under an insurance plan of the caregiver or the child's parent or

guardian.

Annual supplementary enhancement benefit

23(1) If a director considers it appropriate to do so, the director may

pay to a caregiver an annual supplementary enhancement benefit in the

amount of not more than $200 for the benefit of a child under the

caregiver's care.

(2) A director may pay the amount referred to in subsection (1) in a

lump sum or on a periodic basis.

Changes in circumstances

24 A caregiver who is in receipt of a benefit under this Part must

immediately report the following to a director in writing:

(

a) if there is a change in the caregiver's address or contact

information;

(

b) if a child, in respect of whom a benefit is provided,

(

i) ceases to live with the caregiver,

(ii) ceases to attend a full-time education program or an

employment training program as required under

section

16(1), or

(iii) commences or ceases employment;

(

c) if there is a change in the income earned by the child;

(

d) if there is a change in the income received by the caregiver

on behalf of the child;

(

e) if there is a change in the caregiver's ability to care for the

child;

(

f) if the child's parent moves into the caregiver's home;

(

g) if there is any other change in circumstances that would

affect entitlement to a benefit under this Part or the amount

of it.

Recovery of unauthorized payments

25 If

(

a) a benefit under this

Part is provided to a caregiver who is not

entitled to it, or

(

b) an overpayment of a benefit under this

Part is made to a

caregiver,

the Government may recover in an action in debt the amount of the

unauthorized payment or may make deductions from future benefits

under this Part to the caregiver until the amount of the unauthorized

payment is recovered.

Duty to keep documents and records

26 A caregiver must keep records and documents that are relevant for

the purpose of determining eligibility for or the amount of a benefit

under this Part and must make those records and documents available

for inspection on the request of a director or a person designated by

the director for that purpose.

Part 3

Repeal, Expiry and Coming into Force

Repeal

27 The General Regulation (AR 38/2002) and Qualification

Regulation (AR 40/2002) are repealed.

Expiry

28 For the purpose of ensuring that this Regulation is reviewed for

ongoing relevancy and necessity, with the option that it may be

repassed in its present or an amended form following a review, this

Regulation expires on October 31, 2013.

Coming into force

29 This Regulation comes into force on November 1, 2004.

Schedule 1

Form 1 - Family Enhancement Agreement with a Guardian or

Custodian

Form 2 - Custody Agreement with a Guardian

Form 3 - Permanent Guardianship Agreement

Form 4 - Access or Consultation Agreement

Form 5 - Concurrent Plan

Form 6 - Secure Services Certificate

Form 7 - Secure Services Plan

Form 8 - Home Assessment Report for Private Guardianship

Form 9 - Transition to Independence Plan

Form 10 - Enhancement Agreement with a Youth

Form 11 - Custody Agreement with a Youth

Form 12 - Support and Financial Assistance Agreement

Form 13 - Supports for Permanency Agreement

Form 14 - Application for Child and Youth Support

Form 15 - Annual Eligibility Review

Form 16 - Request for Administrative Review of

a Director's Decision

Form 17 - Notice of Appeal to the Appeal Panel

Form 1

Family Enhancement Agreement with

a Guardian or Custodian

1 Regarding the child(ren):

(Name) , born (date -yyyy/mm/dd) ,ID #

(Name) , born (date -yyyy/mm/dd) ,ID #

(Name) , born (date -yyyy/mm/dd) ,ID #

2 Agreement

This agreement is made according to

section 8 of the Child, Youth and

Family Enhancement Act.

This agreement is between a director and (name) of (address) who

is this child's ? guardian ? custodian.

We agree that this agreement will be effective from (date -

yyyy/mm/dd) to (date -yyyy/mm/dd) unless cancelled earlier.

We agree that to cancel this agreement, one of us may provide a letter

to the other person that sets a date for the agreement to end.

We have read and agree to the Family Enhancement Plan dated (date

-yyyy/mm/dd) that is attached to this agreement.

We understand that we may make changes to the Family Enhancement

Plan if both of us agree.

3 Signatures

(Guardian/Custodian) (date -yyyy/mm/dd)

(Guardian/Custodian) (date -yyyy/mm/dd)

(Director's delegate) (date -yyyy/mm/dd)

Form 2

Custody Agreement with a Guardian

1 Regarding the child(ren):

(Name) , born (date -yyyy/mm/dd) , Personal Health #

(Name) , born (date -yyyy/mm/dd) , Personal Health #

(Name) , born (date -yyyy/mm/dd) ,Personal Health #

2 Agreement

This agreement is made according to sections 9 and 10 of the Child,

Youth and Family Enhancement Act.

This agreement is between a director and (name) , of (address) ,

who is the child's guardian.

We agree that this agreement will be effective from (date -

yyyy/mm/dd) to (date -yyyy/mm/dd) unless cancelled earlier.

We agree that to cancel this agreement, one of us may provide a letter

to the other person that sets a date for the agreement to end.

We agree to the terms set out below.

3 Terms

We agree that on signing this agreement the director assumes custody

of the child during the period of this agreement.

The guardian agrees that the director may:

? decide about the child's daily routine,

? obtain ordinary medical or dental care,

? obtain emergency medical or dental treatment or

emergency surgical procedures.

The guardian agrees that the director may:

? decide about recreational activities

? enroll the child in school or vocational activities

? decide about religious or cultural activities

? consent to employment

consent to obtaining recreational licences and permits

(except a firearms permit or driver's licence)

? other

We agree that the guardian will have the following contact with the

child:

We agree that (name) will have the following contact with the child:

We have seen and agree to the Concurrent Plan dated (date -

yyyy/mm/dd) that is attached to this agreement.

We understand that we can make changes to the Concurrent Plan if

both of us agree.

4 Signatures

(Guardian) (date -yyyy/mm/dd)

(Director's delegate) (date -yyyy/mm/dd)

Form 3

Permanent Guardianship Agreement

1 Regarding the (child's name) , born (date -yyyy/mm/dd) .

2 Introduction

The guardians of this child have asked the director to take guardianship

of the child.

We understand that once we enter this agreement:

? anyone who is now a guardian of the child will no longer be

a guardian;

? the director will become the child's only guardian;

? a guardian may end this agreement within 10 days after

signing it. To end the agreement, the guardian must give the

director a written request.

? I have received independent legal advice regarding this

agreement.

? I have been advised of my right to seek independent legal advice

regarding this agreement but have chosen not to.

3 Agreement

This agreement is made according to

section 11 of the Child, Youth

and Family Enhancement Act.

This agreement is between a director and (names) who are all of

the guardians of the child.

We agree that the director will assume sole guardianship of the child.

4 Signatures

Note: all copies must have original signatures

(Witness) (date -yyyy/mm/dd) (Guardian)

(Witness) (date -yyyy/mm/dd) (Guardian)

(Witness) (date -yyyy/mm/dd) (Director's delegate)

Form 4

Access or Consultation Agreement

1 Regarding the (child's name) , born (date -yyyy/mm/dd) .

2 Agreement

This agreement is made according to:

section 14 of the Child, Youth and Family Enhancement

Act (temporary guardianship order)

section 34 of the Child, Youth and Family Enhancement

Act (permanent guardianship order)

This agreement is between a director and (name) of (address) .

? This agreement replaces the agreement we entered on (date -

yyyy/mm/dd) .

We agree that this agreement will be effective from (date -

yyyy/mm/dd) to (date -yyyy/mm/dd) . (NOTE: the expiry date

may not be after the expiry date of the guardianship order.)

This agreement may be replaced only if both of us agree. To replace

this agreement, we will enter a new agreement.

We agree that to cancel this agreement, one of us may provide a letter

to the other person that sets a date for the agreement to end.

We agree to the terms set out below.

3 Terms

? Terms of Access

We agree that ( name of guardian or former guardian or other person)

may have the following access with this child:

? Terms of Consultation (only if temporary guardianship)

The director agrees to consult on the following matters with the

guardian:

? Other Terms (only if temporary guardianship)

4 Consent to Access by a Child 12 Years of Age or Over

(Complete if this agreement is with someone who is not a guardian)

My name is (name) . I consent to the terms of access in this

agreement.

(Child's signature) (date - yyyy/mm/dd)

5 Signatures

(Guardian or former Guardian or other person) (date - yyyy/mm/dd)

(Director's delegate) (date - yyyy/mm/dd)

Form 5

Concurrent Plan

B.F. Date: (date -yyyy/mm/dd)

Date Completed: (date -yyyy/mm/dd)

Use for a child involved in any one of the following: Custody

Agreement with Guardian, Application for Temporary Guardianship,

Temporary Guardianship Order, Application for Permanent

Guardianship Order.

Child(ren) Name(s): (surname) (first) (middle)

Birthdate: (date -yyyy/mm/dd)

Total # of days in care :

Date days in care recorded: (date -yyyy/mm/dd)

Legal Authority:

I.D. Number:

Part A: Plan to Return Child or Youth to Guardian

Goals:

Tasks: Identify how task will alleviate the intervention concern)

Who will complete?

Signs of Achievement:

Date to be completed: (date -yyyy/mm/dd)

Date completed: (date -yyyy/mm/dd)

Part B: Alternative Permanent Plan

Permanency objective:

? Private Guardianship

? Adoption

? Supported Independent Living

? Other

Goals:

Tasks: Identify how task will alleviate the intervention concern)

Who will complete?

Signs of Achievement:

Date to be completed: (date -yyyy/mm/dd)

Date completed: (date -yyyy/mm/dd)

Signatures reflect agreement to the attached Goals and Tasks (if

signature is not available, state why not).

(Name (print)) (signature) (relationship to child, youth or family)

(Name (print)) (signature) (relationship to child, youth or family)

(Name (print)) (signature) (relationship to child, youth or family)

Copy of Plan to other(s): (specify)

Caseworker's 2-month review:

Caseworker's Initials:

Form 6

Secure Services Certificate

1 Regarding the (child's name) , born (date -yyyy/mm/dd) .

2 Guardian's Consent

I (name) am a guardian of this child.

My child is a subject of a:

? supervision order.

? custody agreement between a director and me.

? family enhancement agreement between a director and me.

I consent to the issuing of a Secure Services Certificate for my child. I

understand that for the duration of the Certificate, my child will be in

the custody of a director and will be confined in a secure services

facility.

(Guardian's signature) (Guardian's signature (if applicable))

3 Certificate

This certificate is issued by a director under

section 43.1 of the Child,

Youth and Family Enhancement Act.

This certificate is the authority for confining this child in a secure

services facility.

The director authorizes any person to confine the child in a secure

services facility from (date -yyyy/mm/dd) to (date -yyyy/mm/dd) .

The secure services facility is (name) at (address) .

4 Affidavit

My name is (name of director's delegate) .

I have the authority to act for a director.

I have reasonable and probable grounds to believe that the child is in a

condition presenting an immediate danger to the child or others, that it

is necessary to confine the child in order to stabilize and assess the

child and that less intrusive measures are not adequate to sufficiently

reduce the danger because:

(Signature of Director's Delegate)

SWORN BEFORE ME at the of )

, in the Province of Alberta, the )

day of , .)

) (witness signature)

(Commissioner for Oaths )

in and for the Province of Alberta) )

Form 7

Secure Services Plan

Secure Services Admission Information

Child Name: (surname) (first) (middle)

Birthdate: (date -yyyy/mm/dd)

Child's ID #

Personal Health Number:

Secure Services Facility:

Admission Date : (date -yyyy/mm/dd)

Legal Authority:

Authorization for Secure Services

? Secure Services Certificate Dated (date -yyyy/mm/dd) .

? Secure Services Order for (up to 7 days) days granted

(date -yyyy/mm/dd) .

? Secure Services Order for (up to 5 days) days granted

on (date -yyyy/mm/dd) .

? Secure Services Order for (up to additional 5 days)

days granted on (date -yyyy/mm/dd) .

? Secure Services Renewal Order for (up to 20 days) days

granted on (date -yyyy/mm/dd) .

State the reasons for maintaining the child in Secure Services and

identify the less intrusive measures that were attempted prior to

requesting confinement:

State any specific concerns (familial, medical, behavioural) respecting

this child that the Secure Services Facility staff should be aware

of:

Complete the following to develop a Secure Services Plan.

Description of Services and Interventions

Stabilization Interventions: Give a comprehensive description of

the services and interventions that will be provided to the child while

residing in a secure services facility to achieve stabilization of the

child.

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Progress:

Signs of Achievement:

Review date(s): (yyyy/mm/dd)

Safety Plan: Describe a plan to directly address the at-risk behaviour

that brought the child into secure services and that identifies who will

be responsible for delivering and ensuring each part of the plan is

completed.

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Progress:

Signs of Achievement:

Review date(s): (yyyy/mm/dd)

Transition Plan: Recommend services to be obtained and provided

to assist the child in the successful transition to their parental home or

other placement on discharge. The services may include, but are not

limited to: ongoing treatment, behaviour management strategies,

support services, educational and vocational supports, health services,

social skills supports and cultural and spiritual supports.

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Progress:

Signs of Achievement:

Review date(s): (yyyy/mm/dd)

Placement on discharge: State where the child will reside on

discharge. Identify both long term goals and interim residential

settings, if applicable.

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Progress:

Signs of Achievement:

Review date(s): (yyyy/mm/dd)

Signatures

(Name of Child) (Signature of Child)

(Date signed (yyyy/mm/dd)

(Name of Guardian (if applicable)) (Signature of Guardian)

(Date signed (yyyy/mm/dd)

(Name of Caseworker) (Signature of Caseworker)

(Date signed (yyyy/mm/dd)

(Name of Key Worker - Secure Services Facility)

(Signature of Key Worker - Secure Services Facility)

(Date signed (yyyy/mm/dd)

(Name of Manager or Clinician - Secure Services Facility)

(Signature of Manager or Clinician - Secure Services Facility)

(Date signed (yyyy/mm/dd)

(Name of Other Support Service (please specify))

(Signature of Other Support Service)

(Date signed (yyyy/mm/dd)

Form 8

Home Assessment Report

for Private Guardianship

To prepare the Home Assessment Report, provide information under

each heading below.

Part 1: Applicant's Information

Provide information about EACH applicant.

? Name on birth certificate

? Other names, if any

? Address, street, city, province,

postal code

? Mailing address if different from

above

? Telephone, residence, business,

cellular, e-mail

? Birthdate, year, month and day,

birthplace

? Marital or Adult Interdependent

Relationship status

? Racial origin

? Ethnic origin

? Registered Indian

? Band Name

? Metis

? Metis settlement name or

community

? Health as supported by medical

? Education

? Employment

? Religion

? Languages spoken

? Brief family history: (include

parenting style, familial

relationships, significant childhood

experiences, views of extended

family on this application)

? Involvement with legal and child

intervention systems: (include criminal

record checks and intervention records

checks within the last six months for

applicants and everyone age 18 or over

living in the home)

? Personality

Part 2: Family Dynamics

Describe the following:

? Family composition

? Relationship dynamics

? Previous marriage(

s) or long

term relationships

? Communication patterns

? Autonomy of individual family

members

? Ability to solve problems and

handle crisis

? Emotional interactions

? Family traditions

? Philosophy on child rearing

? Modes of behaviour control

? Interests and hobbies

? Social support network

Part 3: Home and Community

Describe the following:

? Physical space

? Safe environment assessment

(include safe storage of medications

and weapons, if any)

? Availability of resources

? Community involvement

? Contact with professional

agencies

Part 4: Child Information

? Name of child(ren)

? Date of birth (yyyy/mm/dd)

? Residence

? Ethnic origin

? History of involvement and

relationship between the applicants

and the child

? History of child protection

involvement with child/family

? Acceptability of siblings contact

? Functioning of the child's birth

family

? Relationship/contact with birth

parents/biological/extended family

? Placement history of the child

? Current functioning of the child

(health/physical/emotional and

academically)

? Current and anticipated needs

and services for the child

Part 5: Income

Describe the following:

? The source and level of income

and expenditures (include T4 slips)

? The effect of a placement on

family's finances

Part 6: Understanding and Motivation for Proposed Placement

Describe the following:

? Applicants' understanding of

the legal, social, inter-racial

emotional aspects of proposed

placement

? Applicants' plans to promote

child's cultural/racial/religious

heritage and identity

Part 7: References

? References (3 references regarding each of the applicants' suitability

- include relationship to applicants if any, on what basis judgment is

made about applicants' potential/actual parenting ability and a

summary of the results of interview(s).)

Part 8: Overview of Home Assessment Process

? Date of personal visits (include

amount of time spent at each

interview and location of

interviews)

? Persons interviewed (include

confirmation that each person

living in the home was

interviewed separately and as a

family)

? Applicants' activities in

support of their application

Part 9:

Summary of Outcome of Assessment

? Report prepared by:

? Report reviewed by:

? Position

? Position

? Date report prepared

? Date report reviewed

? Report reviewed by applicants: signature and date

Part 10: Placement Supports

? Needed supports and services

? Will the family be residing or moving out of province

? Arrangements for the provision of the identified supports/services

? If yes, is the other jurisdiction aware of and in agreement with the

proposed order and will they oversee the provision of needed support

and services? If no, explain why

Part 11: Recommendation/Approval of Assessor

? Assessor Recommendation

? Approved

? Not Approved (provide brief

summary)

? Approved by Supervisor

? Opinion of the child in respect to the application (if applicable)

? Opinion of the child's birth parents in respect to the application (if

applicable)

Form 9

Transition to Independence Plan

Use for a child involved in any one of the following: Custody

Agreement with a Youth; Enhancement Agreement with a Youth;

Support and Financial Assistance Agreement; Permanent Guardianship

Order for a youth; Permanent Guardianship Agreement for a youth.

Identifying Information

(Name of Youth (includes a person between the ages of 18 and 22 years))

Date of Birth: (date -yyyy/mm/dd)

Personal I.D. Number:

Legal Authority:

Statement of Youth's Dreams, Goals and Ambitions

The statement below is a general description by the youth of his/her

vision of their future as it relates to overall dreams, goals and

ambitions, including related education, training needs and career

options.

Statement

(If additional space is required, please attach a separate sheet) .

Description of Goals, Tasks and Timeframe of Transition Plan for

Independence

Life Skills Development

(If additional space is required, please attach a separate sheet) .

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Signs of Achievement:

Date to be completed: (date -yyyy/mm/dd)

Date to be reviewed: (date -yyyy/mm/dd)

Education and Employment Development

(If additional space is required, please attach a separate sheet) .

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Signs of Achievement:

Date to be completed: (date -yyyy/mm/dd)

Date to be reviewed: (date -yyyy/mm/dd)

Placement Objective

(If additional space is required, please attach a separate sheet) .

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Signs of Achievement:

Date to be completed: (date -yyyy/mm/dd)

Date to be reviewed: (date -yyyy/mm/dd)

Connections

(If additional space is required, please attach a separate sheet) .

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Signs of Achievement:

Date to be completed: (date -yyyy/mm/dd)

Date to be reviewed (date -yyyy/mm/dd)

Service Supports

(If additional space is required, please attach a separate sheet) .

Goals:

Tasks: (include how the task will contribute toward progress in relation to goal)

Who will complete?

Signs of Achievement:

Date to be completed: (date -yyyy/mm/dd)

Date to be reviewed: (date -yyyy/mm/dd)

Signatures

(Name of Youth) (Signature of Youth)

(Date signed (yyyy/mm/dd)

(Name of Caseworker) (Signature of Caseworker)

(Date signed (yyyy/mm/dd)

(Name of Other (if necessary)) (Signature of Other)

(Date signed (yyyy/mm/dd)

(Copy of Plan to Other(

s) Specify)

(Caseworker and Youth's Quarterly Review (date and initials))

Form 10

Enhancement Agreement with a Youth

1 Regarding the youth:

(Name) , born (date -yyyy/mm/dd) ,ID #

2 Agreement

This agreement is made according to

section 57.2 of the Child, Youth

and Family Enhancement Act.

This agreement is between a director and (name) of (address) ,

who is the youth.

We agree that this agreement will be effective from (date -

yyyy/mm/dd) to (date - yyyy/mm/dd) unless cancelled earlier.

We agree that to cancel this agreement one of us may provide a letter

to the other person that sets a date for the agreement to end.

We have read and agree to the Transition to Independence Plan dated

(date - yyyy/mm/dd) that is attached to this agreement.

We understand that we may make changes to the attached Transition to

Independence Plan if both of us agree.

3 Signatures

(Youth) (date -yyyy/mm/dd)

(Director's delegate) (date -yyyy/mm/dd)

Form 11

Custody Agreement with a Youth

1 Regarding the youth:

(Name) , born (date -yyyy/mm/dd) ,

(Personal Health Number) (Youth ID Number)

2 Agreement

This agreement is made according to

section 57.2 of the Child, Youth

and Family Enhancement Act.

This agreement is between a director and (name) of (address) ,

who is the youth.

I am the youth, and I understand that on signing this agreement a

director assumes custody of me during the period of this agreement.

We agree that this agreement will be effective from (date -

yyyy/mm/dd) to (date - yyyy/mm/dd) unless cancelled earlier.

We agree that to cancel this agreement, one of us may provide a letter

to the other person that sets a date for the agreement to end.

We have read and agree to the Transition to Independence Plan dated

(date - yyyy/mm/dd) that is attached to this agreement.

We understand that we can make changes to the attached Transition to

Independence Plan if both of us agree.

We agree that (name of guardian or other person) will have the

following access with the youth:

3 Signatures

(Youth) (date -yyyy/mm/dd)

(Director's delegate) (date -yyyy/mm/dd)

Form 12

Support and Financial

Assistance Agreement

1 Regarding the person:

(Name) , born (date -yyyy/mm/dd) ,ID #

2 Agreement

This agreement is made according to

section 57.3 of the Child, Youth

and Family Enhancement Act.

This agreement is between a director and (name of person making

this agreement) of (address) .

We agree that this agreement will be effective from (date -

yyyy/mm/dd) to (date - yyyy/mm/dd) unless cancelled earlier.

(NOTE: the expiry date may not go beyond the person's 22nd birthday.)

We agree that to cancel this agreement, one of us may provide a letter

to the other person that sets a date for the agreement to end.

We have read and agree to the Transition to Independence Plan dated

(date - yyyy/mm/dd) that is attached to this agreement.

We understand that we can make changes to the attached Transition to

Independence Plan if both us of agree.

3 Signatures

(Person making this Agreement) (date - yyyy/mm/dd)

(Director's delegate) (date - yyyy/mm/dd)

Form 13

Supports for Permanency Agreement

1 Regarding the child:

(Name) , born (date -yyyy/mm/dd)

? An adoption order was granted respecting this child on (date -

yyyy/mm/dd) .

? A private guardianship order was granted respecting this child on

(date - yyyy/mm/dd) .

2 Agreement

This agreement is made according to sections 56.1 and 81 of the Child,

Youth and Family Enhancement Act.

This agreement is between a director and (name of adoptive parents

("parents") or private guardians) of (address) .

A director will review this agreement within 30 days of receiving a

written request from the parents/private guardians.

We agree that to cancel this agreement, one of us may provide a letter

to the other person 30 days before the date we want the agreement to

end.

We agree to the terms set out below.

The parents/private guardians agree to access all other support

programs prior to receiving services under the Supports for

Permanency Program.

3 Terms: Maintenance

The parents/private guardians require financial support to assist them

to maintain the child in their home.

A director agrees to provide the parents/private guardians with a daily

maintenance rate to maintain the child. The maintenance rate will be:

? (# of days) at $ (daily rate) = $ (amount) per year.

? (# of days) at $ (daily rate) = $ (amount) per year.

Total = $ (amount) per year.

A director agrees to pay $ (total per year) ö 12 months =

$ (amount) each month.

The parents/private guardians agree to inform a director about any

change in their annual gross family income.

If the family's annual gross income exceeds $60,000 the

parents/private guardians understand that the terms set out in

section 3

will terminate immediately.

4 Terms: Financial Assistance for the Purchase of Services

? This child is the subject of an agreement under the Family Support

for Children with Disabilities Act.

In recognition that ? adoption ? private guardianship of the child

has placed an undue burden on the financial resources of the

parents/private guardians, a director agrees to provide the following:

? the cost of respite for the parents/private guardians for (up to 567

hours) hours annually;

? in the case of a child who is an Indian, the cost of transportation of

the child to and from the child's band for the purpose of maintaining

cultural ties:

? to help address the child's emotional or behavioural problems.

? the cost (of up to 10) counselling sessions annually;

? the cost of treatment of the child in (name of residential

facility) for a period of weeks;

The parents/private guardians agree to make sure the child receives the

services a director has agreed to provide.

A director agrees to reimburse the parents/private guardians for the

services they have purchased to meet the child's needs on the

submission of invoices.

The parents/private guardians understand and agree that, on 30 days

written notice to the parents/private guardians, a director may vary or

terminate the terms in

section 4 of this Form if the director determines

that a change in the child's needs has occurred or that the child no

longer places an undue burden on the finances of the parents/private

guardians.

5 Terms: Additional Needs Funds

? A director agrees to provide Additional Needs Funds of $70 per

week to purchase services to address the child's emotional or

behavioural problems.

The parents / private guardians understand and agree that the

Additional Needs Funds may be spent only to purchase services to

address the child's emotional or behavioural problems.

The parents/private guardians agree to keep and, on a director's

request, provide proof of expenditure of the Additional Needs Funds.

The parents/private guardians understand and agree that a director may

immediately terminate the Additional Needs Funds if the director

determines that a change in the child's needs has occurred or that the

child no longer places an undue burden on the finances of the

parents/private guardians.

6 Terms: General

The parents/private guardians agree to inform the director about any

change in the child's needs, and about any change in their financial

ability to provide the services the director has agreed to provide

described above.

The terms set out in this agreement may be changed if both of us agree.

To change this agreement, we will sign a new agreement.

This agreement will be effective from (date -yyyy/mm/dd) to (date

-yyyy/mm/dd) .

This agreement terminates without notice if the parents/private

guardians cease to reside in Canada..

(NOTE: The agreement may not exceed one year or continue after the

child's 18th birthday.)

7 Signatures

(adoptive parent's/private guardian's) (date - yyyy/mm/dd)

(adoptive parent's/private guardian's) (date - yyyy/mm/dd)

(Caseworker's signature) (date - yyyy/mm/dd) .

(Supervisor's signature) (date - yyyy/mm/dd) .

Form 14

Application for Child

and Youth Support

Date of Application: (yyyy/mm/dd)

The information you provide on this form will be used to determine

eligibility for Child and Youth Support Program benefits. The

collection, use and disclosure of your personal information is done

under the authority of the Child, Youth and Family Enhancement Act

and is in compliance with the Freedom of Information and Protection

of Privacy Act. If you have any questions about this information,

please contact your caseworker.

1 Caregiver Information

Name of Caregiver (surname first name middle name)

(date of birth-yyyy/mm/dd) .

What is your relationship to this child? (e.g. grandparent, aunt/ uncle,

cousin, friend, etc.)

Name of Spouse (surname first name middle name)

(date of birth-yyyy/mm/dd) .

Name(

s) of all persons living in the home where the child will reside

(surname first name middle name) (date of birth-yyyy/mm/dd)

(surname first name middle name) (date of birth-yyyy/mm/dd)

Mailing address (include street address, city/town, province and

postal code) (home phone) (work phone) .

Legal Land Description (if different from above) .

Are you living on a Reserve? ? Yes ? No

Residing on a Metis settlement? ? Yes ? No

(Name of Metis settlement)

Are you a Canadian Citizen? ? Yes ? No

If no ? Landed Immigrant ? Refugee status

? Other (please specify)

Does the child reside with you seven days per week? ? Yes ? No

If no, how many days does this child reside with you?

Are you a Private Guardian of the child? ? Yes ? No

If yes, skip to

section 3.

2 Information about Child's Parents/Private Guardian (when private

guardian is not the caregiver)

Parent (Mother) (surname first name middle name)

(date of birth-yyyy/mm/dd)

Address (include street address, city/town, province and postal

code) (phone)

Parent (Father) (surname first name middle name)

(date of birth-yyyy/mm/dd)

Address (if different from above)) (phone)

Private Guardian (surname first name middle name)

(date of birth-yyyy/mm/dd)

Address (if different from above)) (phone)

3 Child's Information

Name of Child (surname first name middle name)

(date of birth-yyyy/mm/dd) .

Other surnames used

? Male ? Female Alberta Personal Health Number (PHN)

Is the child aboriginal? ? Yes ? No

If yes, please specify: ? Status ? Non-status ? Inuit

? Metis ? Potential for registration

Indian Registration Number (band, family, position)

( (band name)

Is the child receiving services under the:

? Child, Youth and Family Enhancement Act

? Family Support for Children with Disabilities Act

4 Income Information

Is child employed or in a job training program? ? Yes ? No

(If yes, request one month of recent pay stubs) If yes, obtain name of

employer or job training program:

Net income from employment as per pay stub $

Paid ? Weekly ? Bi-weekly ? Monthly

Income received on behalf of child (If yes, please attach supporting

documentation)

Yes

Monthly Amount

Income & Employment

Support/Assured Support

$ __________

Maintenance / Child Support

Payments

$ __________

Canada & Alberta Student Loans

$ __________

Personal Injury Award

Settlements

$ __________

Training Allowance

$ __________

Trust Accounts

$ __________

Other income: __________

$ __________

5 Supplementary Benefit Information

Is this child currently attending school? ? Yes ? No

If yes, (grade)

Name of school the child is attending City/Town

Does the child require child care? ? Yes ? No

Number of days a week ________

Type of care (private babysitting, daycare centre, approved family

day home, before and after school care)

Reason for child care

Have you applied for child care subsidy? ? Yes ? No

If yes, are you eligible for subsidy? ? Yes ? No

If yes, what is your parental portion? $

What type of medical coverage is available for this child?

? Dental % of coverage

? Vision % of coverage

? Prescription % of coverage

Which plan is this medical coverage under?

? through caregiver's plan ? through parent's plan

? through Health Canada

? through out-of-province coverage -

out of province health care number_________

Name of insurance company is:

Are there any special concerns or considerations that we should be

aware of (health, education, custody, child interventions, etc.)

(attach a separate sheet if required) .

6 Declaration

? I understand my responsibilities as a caregiver receiving benefits

under the Child and Youth Support Program.

? I confirm the child, if age 12 or older, has been made aware that I am

making this application.

? I am an adult who will provide care to this child.

? I understand I am responsible to immediately report changes in

circumstances that affect my eligibility under the Child and Youth

Support Program to the Child and Youth Support caseworker. Failure

to report changes or providing false information may result in

suspension of benefits or recovery of benefits or criminal charges.

? I understand that I am responsible to complete the Child and Youth

Support Program Annual Eligibility Review Form at least once per

year in order to remain eligible for Child Financial Support benefits.

? If I am not eligible for benefits, I understand I have the right to have

that decision reviewed within 30 days of being told of the decision by

completing an Administrative Review form.

? I understand I may be required to meet with a Child and Youth

Support caseworker at any time.

? I consent to a Child and Youth Support caseworker completing an

Intervention Record check.

? I have read and understand the above statements.

? I declare the information on this application is true and complete.

(Caregiver's signature) (date - yyyy/mm/dd)

(witness's signatures)

(Caregiver's name - please print) (witness's signatures)

(Child's signature - if 12 years or older) (date - yyyy/mm/dd)

Form 15

Annual Eligibility Review

Return your completed form to

(Child and Family Services)

(Return Address)

(Child's name)

(File number)

(Caregiver's name)

(File Number)

Please return the completed Annual Eligibility Review by (date -

yyyy/mm/dd) to the above-noted address to avoid a delay disruption

of the child's financial and medical benefits.

If any of the following information has been checked off, then it must

be submitted together with this completed form:

? Private Guardianship Order

? Custody Order / Agreement

? School Fee Statement or receipts for school supplies/expenses

? Up-to-date attendance report/Report Card

? Pay stubs from child's employment or job training program.

? Documents to verify child's income other than child's employment

? Other: ____ ? Other: ____

If you have any questions, please contact me at the telephone number

below.

Sincerely,

Caseworker's Name Caseworker's Telephone Number

Annual Eligibility Review

? Please complete an Annual Eligibility Review for each child

receiving Child and Youth Support benefits. The information you

provide on this form will be used to determine eligibility for Child and

Youth Support Program benefits. The collection, use and disclosure of

your personal information is done under the authority of the Child, Youth

and Family Enhancement Act and is in compliance with the Freedom of

Information and Protection of Privacy (FOIP) Act. If you have any

questions about the collection of this information, please contact your

caseworker.

? Please complete all questions on this Annual Eligibility Review.

Name and current address:

Home Address: (if different from mailing address, e.g. legal address)

Child's Name (surname first name middle name)

Child's Age ____

Is the child still residing with you 7 days / week? ? Yes ? No

If less then 7 days, state how many? days / week.

1 Education

Is the child currently attending school ? Yes ? No

? If yes, child's grade: _____.

? If yes, attach receipts verifying school supplies and expenses (if not

previously submitted for the current school year).

Name of school: City / Town:

Is the child attending school full time ? Yes ? No

Are there any special educational concerns or considerations that we

should be aware of?

2 Employment

Is the child employed or attending a job-training program?

? Yes ? No

? If yes, please submit one month of recent pay stubs from

employment or job training program.

If yes, Place of Employment Telephone number

Average monthly income after deductions $

? Job training program ___________

3 Income

Has the child, or have you on the child's behalf, received any of the

following income during the past year? If yes, please attach

verification of income.

Yes

Monthly Amount

Income & Employment

Support/Assured Support

$ __________

Maintenance / Child Support

Payments

$ __________

Canada & Alberta Student Loans

$ __________

Personal Injury Award

Settlements

$ __________

Training Allowance

$ __________

Trust Accounts

$ __________

Other: __________

$ __________

4 Family Information

a) What is your relationship to the child (e.g. grandparent, aunt/

uncle, cousin, friend, etc.)?

b) Are you the child's private guardian? ? Yes ? No

c) How long have you cared for the child?

d) How long do you plan to care for the child?

e) Do the parents have any contact with the child? ? Yes ? No

Please provide details:

f) Has there been any change pertaining to guardianship and/or

custody of this child in the last year? ? Yes ? No

Please provide details and submit any new court orders that have

not previously been submitted:

g) Can the parents financially support the child?

? Yes ? No ? unknown

h) Provide the names, current addresses, and phone numbers for each

of the child's parents. If parents are deceased, please indicate.

Mother's name:

Mother's address:

Mother's phone number:

Father's name

Father's address:

Father's phone number:

i) Is the child currently receiving services though any other

government or community agency? ? Yes ? No

(e.g. Family Support for Children with Disabilities Act or Child

Intervention, under the Child, Youth and Family Enhancement Act)

If yes, please provide a brief description of the services the child is

receiving.

If the child is 16 years of age or older, would the child like to discuss

future plans with a caseworker? ? Yes ? No

5 Health Benefits

Does the child have additional health coverage (aside from the Alberta

Child Health Benefit Program) through you or the parents?

? Yes ? No

If yes, specify insurance company and coverage provided (insurance

company) (coverage) .

Are there any special health concerns or considerations that we should

be aware of?

? Yes ? No. Please provide details:

6 Other Comments

_____________________________________________________

7 Declaration

? I am able and willing to continue providing care for this child.

? I am aware that I must keep receipts and provide supporting

documents relating to Child and Youth Support supplementary

benefits. (e.g. Child Care, school expenses and annual supplementary

enhancement).

? I will immediately report any changes with respect to the child's

situation to the caseworker.

? I understand that giving incomplete or false information or failing to

report changes may result in suspension of benefits or recovery of

benefits or criminal charges.

? I understand I may be required to meet with a Child and Youth

Support caseworker at any time.

? I understand my responsibilities as a caregiver receiving benefits

under the Child and Youth Support program.

? I have read and understand the above made statements.

? I declare the information on this Annual Eligibility Review is true

and complete.

(Caregiver's signature) (date - yyyy/mm/dd) (phone no.)

(Child's signature - if 12 years or older) (date - yyyy/mm/dd)

(Phone no.)

Form 16

Request for Administrative Review

of a Director's Decision

1 My name is

(name) . My phone number is (telephone no.) .

I am ? a child ? a guardian ? a caregiver

for more than 6 of the 12 months preceding a director's decision

? a foster parent for more than 6 of the 12 months preceding a

director's decision

? I am between the ages of 18 and 22 years and am receiving or have

been refused support and financial assistance from a director.

My address is:

2 Directions for requesting a review:

1. Fill out and sign this form. Give the top 3 copies of this form to a

director within 30 calendar days of the date when you were told about

the director's decision. Two senior staff members will review the

decision. The two senior staff members will receive your information

either in writing or in person. They will provide you with a copy of

their written decision within 15 calendar days after you submit this

request.

2. You may bring a support person(

s) with you to the Administrative

Review.

3. After the reviewers make their decision, you may choose to appeal

their decision to the Appeal Panel.

4. If you decide to file an appeal following the Administrative

Review decision and you qualify to appeal under

section 120 of the

Act, fill out a Notice of Appeal to the Appeal Panel form. You must

give the director the Notice of Appeal to the Appeal Panel form not

more than 30 days after the copy of the Administrative Review

Decision is given to you. If you did not receive a copy of the

Administrative Review decision, give the director the Notice of Appeal

to the Appeal Panel form within 45 calendar days from the date when

you submitted your request for an Administrative Review.

3 Request for a Review

I have been directly affected by a decision of a director.

I was told about the decision of a director on (date - yyyy/mm/dd) .

The decision was about the child or youth: (child's/youth's name)

(child's/youth's birthdate) (date - yyyy/mm/dd)

The decision I want to have reviewed is:

The reason I want decision reviewed is:

(if you require additional space, please attach a separate sheet.)

(Signature of the requesting person) (date - yyyy/mm/dd)

Form 17

Notice of Appeal to the Appeal Panel

1 My name is .

My address is My telephone number is .

2 Right to Appeal

? I am a child.

? I am a guardian of a child.

? I am a person who has had continuous care of the child for more

than 6 of the 12 months immediately preceding the decision of a

director.

? I am between the ages of 18 and 22 years and am receiving or

have been refused support and financial assistance from a director.

? I applied to a director to become a foster parent and my

application was refused.

? I was approved by a director as a foster parent and my approval

has been rescinded.

? I applied to a licensed adoption agency to have a child placed in

my home for the purpose of adopting the child and my application was

refused.

? I hold an adoption agency licence or I have applied for an

adoption agency licence.

? I hold a residential facility licence or I have applied for a

residential facility licence.

3 Notice

I have been affected by the decision of ? a director

? a licensed adoption agency ? the Minister

? I did not request an administrative review of the decision and I

was given notice about the decision on (date - yyyy/mm/dd) .

? I requested an administrative review of the decision on (date -

yyyy/mm/dd) , and

? I received a written response on (date - yyyy/mm/dd) or

? I never received a written response.

The decision was about (if the decision was about a child, give the

child's name and birthdate) .

The decision I am appealing is .

(Signature of person appealing) (date - yyyy/mm/dd)

Schedule 2

The following are secure services facilities:

(

a) Youth Assessment Centre (High Prairie);

(

b) Youth Assessment Centre (Lac La Biche);

(

c) Youth Assessment Centre (Red Deer);

(

d) Yellowhead Youth Centre (Edmonton);

(

e) Hull Child and Family Services (Calgary).

Alberta Regulation 161/2004

Child, Youth and Family Enhancement Act

RESIDENTIAL FACILITIES LICENSING REGULATION

Filed: July 20, 2004

Made by the Minister of Children's Services (M.O. 29/04) on July 19, 2004 pursuant

section 131(2) of the Child, Youth and Family Enhancement Act.

Table of Contents

Interpretation

Part 1

Licensing of Foster Homes

2 Definition

3 Application

4 Conditions precedent to issuing licence

5 Issuance of licence

6 Number of children

7 Licence not transferable

8 Notice of changes

9 Prohibitions

10 Incident

11 Duties of licence holder

Part 2

Licensing of Child and Youth Facilities

12 Definition

13 Application

14 Conditions precedent to issuing licence

15 Issuance of licence

16 Licence not transferable

17 Notice of changes

18 Conditions relating to staff

19 Records

20 Other records

21 Notice of policies and procedures

22 Providing information about facility

23 Prohibitions

24 Isolation of child

25 Incident

26 Emergency procedures

27 Safety of facility

28 Provision of food

29 Medications

30 Storage of medication

31 Dangerous items in facility

Part 3

Coming Into Force and Expiry

32 Coming into force

33 Expiry

Schedule

Interpretation

1(1) In this Regulation,

(a) "Act" means the Child, Youth and Family Enhancement Act;

(b) "child and youth facility" means any residential facility as

defined in

section 105.1 of the Act, except a foster home;

(c) "child and youth facility licence" means a licence authorizing

the holder to operate a child and youth facility;

(d) "foster child" means a child who is in the custody or under

the guardianship of a director and is residing in a foster

home;

(e) "foster home" means a residential facility as defined in

section 105.1 of the Act

(

i) that is the home of the holder of a foster home licence,

and

(ii) in which care is provided to foster children in a family

setting;

(f) "foster home licence" means a licence authorizing the holder

to operate a foster home.

(2) For the purposes of

Part 3 of the Act, "residential facility licence"

means

(

a) a foster home licence, or

(

b) a child and youth facility licence.

Part 1

Licensing of Foster Homes

Definition

2 In this Part, "licence holder" means the holder of a foster home

licence.

Application

3(1) An application under

section 105.3 of the Act for a foster home

licence or a renewal of a foster home licence may be made only by an

adult individual.

(2) An application for an initial foster home licence must be

accompanied with the following:

(

a) subject to subsection (3), the results of a criminal record

check, dated not earlier than 6 months prior to the date of the

application, with respect to the applicant and any other adult

residing with the applicant;

(

b) a written consent, in a form satisfactory to the Minister, from

the applicant and any other adult residing with the applicant

authorizing the Minister to obtain information from any

jurisdiction in which that person has resided in the 5 years

immediately preceding the date of the application for the

purpose of determining if that person has caused a child to be

in need of intervention in that jurisdiction;

(

c) a reference from a physician or registered nurse concerning

the general physical and mental health of the applicant;

(

d) references from 3 individuals concerning the ability of the

applicant to operate a foster home;

(

e) any other information the Minister considers necessary to

enable the Minister to assess the ability of the applicant to

operate a foster home.

(3) Where a foster home is being operated immediately before the

coming into force of this Regulation, the results of the criminal record

check to be provided under subsection (2)(

a) may be dated up to 3

years prior to the date of the application.

(4) An application for a renewal of a foster home licence must be

made to the Minister at least 60 days before the expiry of the licence

and must be accompanied with any information the Minister considers

necessary to enable the Minister to assess the ability of the applicant to

continue to operate a foster home.

Conditions precedent to issuing licence

4 Before issuing a foster home licence or a renewal of a foster home

licence, the Minister may

(

a) conduct an assessment of the applicant and prepare a report

in the form set out in the

Schedule for the purpose of

determining the applicant's ability to operate a foster home,

(

b) require the applicant to provide the results of a new criminal

record check with respect to the applicant and any other adult

residing with the applicant if the most recent criminal record

check was carried out more than 3 years prior to the date of

the application,

(

c) require the applicant to complete training with respect to the

operation of a foster home, and

(

d) require the applicant to provide evidence that the foster home

to be operated is in compliance with applicable health and

safety legislation.

Issuance of licence

5 The Minister may issue a foster home licence or a renewal of a

foster home licence if the Minister is satisfied that

(

a) neither the applicant nor any other individual residing with

the applicant poses a risk to children,

(

b) the applicant is suitable to operate a foster home,

(

c) the environment of the foster home is conducive to the

health, safety and well-being of children, and

(

d) the applicant will comply, or has complied, with the Act, this

Regulation and any terms or conditions imposed by the

Minister.

Number of children

6 The maximum number of foster children that may reside in a

licensed foster home

(

a) includes children who are placed in the foster home by a

child welfare authority outside Alberta, and

(

b) does not include foster children placed in the foster home on

a temporary basis, as determined by the Minister, where there

is a need to provide temporary respite to the licence holder of

the foster home where those foster children normally reside.

Licence not transferable

7 A foster home licence is not transferable.

Notice of changes

8(1) A licence holder shall notify the Minister of the following:

(

a) any significant change to the residence of the licence holder,

including

(

i) a change of location, and

(ii) a change that alters the living space of the residence;

(

b) any change in the residents of the foster home;

(

c) any change in circumstances that may affect the ability of the

licence holder to continue to operate a foster home.

(2) A notification under subsection (1)(

a) of a change in location of

the licence holder's residence must be provided to the Minister within

a reasonable time prior to the date of relocation.

(3) If the Minister has been notified of a change under subsection

(1)(a), the Minister may require the licence holder to provide to the

Minister updated evidence that the foster home is in compliance with

applicable health and safety legislation.

(4) If the Minister has been notified of a change under subsection

(1)(b), the Minister may require the licence holder to provide to the

Minister the results of a criminal record check with respect to any new

resident of the foster home.

Prohibitions

9 A licence holder shall not, with respect to a foster child residing in

the foster home,

(

a) inflict or permit to be inflicted any form of physical

punishment, verbal or physical degradation or emotional

deprivation,

(

b) deny any basic necessities, or

(

c) practise or permit to be practised any disciplinary measure

expressly prohibited by the Minister.

Incident

10(1) In this section, "incident", in respect of a foster child residing in

a foster home, means

(

a) a serious illness of or injury to the child,

(

b) a serious change in the child's health,

(

c) an error in the administration of prescribed medication to the

child,

(

d) an adverse reaction to medication by the child,

(

e) the death of the child,

(

f) an unauthorized absence of the child from the foster home,

(

g) the commission by the child of an offence under

an Act of

Canada, or

(

h) any other occurrence that may seriously affect the health or

safety of the child.

(2) A licence holder shall report each incident to the Minister in the

manner required by the Minister.

Duties of licence holder

11 A licence holder shall ensure that

(

a) the licence holder maintains first aid certification,

(

b) the foster home and grounds are maintained in a manner that

ensures the safety of children,

(

c) meals and snacks are provided to foster children in

accordance with the Canada Food Guide or a similar food

guide, and are provided at appropriate times and in sufficient

quantities in accordance with the needs of each child,

(

d) non-prescription medication and toxic chemicals are stored in

a safe manner and are not readily accessible by children,

(

e) prescription medication other than medication that is

self-administered by a child is stored in a locked container

that is inaccessible by children,

(

f) all firearms are trigger locked,

(

g) all ammunition is stored in a locked container separate from

any firearm and that the container is inaccessible to children,

(

h) emergency evacuation procedures are practised regularly,

and

(

i) fire extinguishers and smoke alarms are installed and

maintained in the foster home in accordance with applicable

legislation.

Part 2

Licensing of Child and Youth Facilities

Definition

12 In this Part, "licence holder" means the holder of a child and

youth facility licence.

Application

13(1) An application under

section 105.3 of the Act for a child and

youth facility licence or a renewal of a child and youth facility licence

may be made only by

(

a) an adult individual,

(

b) a partnership, or

(

c) a body corporate.

(2) An application for an initial child and youth facility licence must

be accompanied with the following:

(

a) the results of a criminal record check, dated not earlier than 6

months prior to the date of the application, with respect to the

following:

(

i) if the applicant is an individual, the applicant;

(ii) if the applicant is a partnership, the partners;

(iii) if the applicant is a body corporate, the chief executive

officer;

(

b) if the applicant is a body corporate, confirmation that the

results of a criminal record check with respect to each board

member, dated not earlier than 6 months prior to the date of

the application, have been obtained by the applicant;

(

c) if the applicant is an individual,

(

i) a written consent, in a form satisfactory to the Minister,

from the applicant authorizing the Minister to obtain

information from any jurisdiction in which the applicant

has resided in the 5 years immediately preceding the

date of the application for the purpose of determining if

the applicant has caused a child to be in need of

intervention in that jurisdiction, and

(ii) references from 3 individuals concerning the ability of

the applicant to operate a child and youth facility;

(

d) a list of contract and staff positions, including a job

description for each position and the qualifications and

experience required for each position;

(

e) a written description of the applicant's proposed program and

procedures, including

(

i) the goals and objectives of the program;

(ii) the applicant's organizational structure;

(iii) program, financial and personnel administration;

(iv) recruitment and screening of employees and volunteers;

(

v) admission and discharge criteria;

(vi) planning, monitoring and evaluation of care to be

provided to children;

(vii) maintenance of records of children residing in the

facility;

(viii) any health or educational services available to children

residing in the facility;

(ix) supervision of children;

(

x) security of children and staff;

(xi) disciplinary measures and use of restraints;

(xii) use of isolation;

(xiii) emergency procedures;

(xiv) handling of allegations of abuse by staff and volunteers;

(xv) administration of medication;

(xvi) orientation process for children;

(

f) any other information the Minister considers necessary to

enable the Minister to assess the ability of the applicant to

operate a child and youth facility.

(3) An application for a renewal of a child and youth facility licence

must be made to the Minister at least 60 days before the expiry of the

licence and must be accompanied with the following:

(

a) if there has been a change in any of the information referred

to in subsection (2)(

d) or (

e) since that information was last

provided by the applicant, a statement of the changes;

(

b) if the applicant is a partnership or body corporate, any

change in the partners, board members or chief executive

officer since that information was last provided by the

applicant;

(

c) any other information the Minister considers necessary to

enable the Minister to assess the ability of the applicant to

continue to operate a child and youth facility.

Conditions precedent to issuing licence

14 Before issuing a child and youth facility licence or a renewal of a

child and youth facility licence, the Minister may require the applicant

to provide

(

a) if the applicant is a partnership or body corporate, evidence

of the applicant's partnership or corporate status, and

(

b) evidence that the child and youth facility to be operated is in

compliance with applicable zoning, health and safety

legislation.

Issuance of licence

15 The Minister may issue a child and youth facility licence or a

renewal of a child and youth facility licence if the Minister is satisfied

that

(

a) the applicant and the individuals who will be associated with

the operation of the child and youth facility are suitable to

operate a child and youth facility,

(

b) the environment of the child and youth facility is conducive

to the health, safety and well-being of children,

(

c) the premises of the child and youth facility provide children

with adequate space for activities of normal daily living, and

(

d) the applicant will comply, or has complied, with the Act, this

Regulation and any terms or conditions imposed by the

Minister.

Licence not transferable

16 A child and youth facility licence is not transferable.

Notice of changes

17(1) A licence holder shall notify the Minister forthwith of the

following:

(

a) if the licence holder is a partnership or a body corporate, any

change in the partners, board members or chief executive

officer;

(

b) any significant change in the licence holder's program and

procedures.

(2) If the Minister has been notified of a change under subsection

(1)(a), the Minister may require the licence holder to provide to the

Minister

(

a) the results of a criminal record check with respect to the new

partner or chief executive officer, or

(

b) confirmation that a criminal record check with respect to the

new board member has been obtained by the licence holder.

Conditions relating to staff

18(1) A licence holder shall ensure that each staff member who works

directly with or has unsupervised access to children residing in the

facility and each volunteer who has unsupervised access to children

residing in the facility

(

a) is an adult,

(

b) provides character references satisfactory to the licence

holder,

(

c) provides a criminal record check and an intervention record

check to the licence holder, both dated not earlier than 6

months prior to commencing work at the facility, and every 3

years thereafter,

(

d) has, within 3 months of commencing work at the facility,

completed a first aid course that includes CPR training,

(

e) maintains the first aid certification referred to in clause (d),

and

(

f) has received information with respect to safety precautions to

be followed when working alone.

(2) In subsection (1)(c), "intervention record check" means a review

of records by a director to determine if an individual has caused a child

to be in need of intervention.

Records

19 A licence holder shall, in a manner satisfactory to the Minister,

(

a) maintain a record of admissions to the facility and discharges

and absences from the facility, and

(

b) maintain personnel records of all employees and volunteers.

Other records

20(1) A licence holder shall maintain a record for each child who is in

the custody or under the guardianship of a director and residing in the

facility for the period during which the child resides in the facility.

(2) A record referred to in subsection (1) must include the following:

(

a) the name, birth date and gender of the child;

(

b) the date of and reason for admission or discharge;

(

c) the name, address and telephone number of a director's

delegate who is responsible for the child;

(

d) the facility's plan of care for the child;

(

e) a record of all case conferences, including admission,

planning, family and discharge conferences;

(

f) records of any medical, dental, optical, physical,

developmental or emotional conditions relevant to the care of

the child;

(

g) an immunization and health care history of the child,

including appointment dates, reasons for referral, names of

physicians and follow-up required;

(

h) a record of any therapeutic diet prescribed for the child by a

physician;

(

i) a record of the child's school attendance, including the

child's report cards and a contact name and phone number

for the school the child is attending;

(

j) daily observations and comments by employees and

volunteers about the child;

(

k) a record of any isolation of the child in accordance with

section 24;

(

l) a record of any physical restraint of the child;

(

m) a list of approved contacts for the child;

(

n) any other information relative to the child considered

appropriate by the licence holder or provided or required by a

director.

(3) The Minister may exempt a licence holder from the requirements

of subsection (1) in respect of a child who is placed in the child and

youth facility on a temporary and short-term basis.

Notice of policies and procedures

21 A licence holder shall keep a copy of facility policies and

procedures on the premises of the facility, and shall make the policies

and procedures available to employees, volunteers, residents,

guardians of children and the Minister.

Providing information about facility

22 A licence holder shall ensure that on admission to a child and

youth facility, a child receives information appropriate to the child's

developmental age with respect to

(

a) the rules of the facility, and

(

b) the complaint process of the facility.

Prohibitions

23 A licence holder shall not, with respect to a child residing in the

facility,

(

a) inflict or permit to be inflicted any form of physical

punishment, verbal or physical degradation or emotional

deprivation,

(

b) deny any basic necessities,

(

c) use or permit the use of face-down restraints,

(

d) use or permit the use of any other form of physical restraint

unless the purpose is to protect the child or others and, in that

case, only to the degree and duration necessary,

(

e) encourage or condone punishment of the child by any other

child,

(

f) exclude or permit the exclusion of the child from entry to the

facility as a form of punishment, or

(

g) practise or permit to be practised any disciplinary measure

expressly prohibited by the Minister.

Isolation of child

24(1) A licence holder shall not establish a room for the purpose of

isolating a child without the approval of the Minister.

(2) A licence holder shall ensure that

(

a) a child is isolated only to ensure the child's safety or the

safety of others,

(

b) a child is not kept in an isolation room without adult

supervision,

(

c) the name of the child, the length of isolation and the reason

for isolation are recorded and placed on the child's file, and

(

d) procedures approved by the Minister for the isolation of

children are followed.

Incident

25(1) In this section, "incident", in respect of a child who is in the

custody or under the guardianship of a director and residing in a child

and youth facility, means

(

a) a serious illness of or injury to the child,

(

b) a serious change in the child's health,

(

c) an error in the administration of prescribed medication to the

child,

(

d) an adverse reaction to medication by the child,

(

e) the death of the child,

(

f) an unauthorized absence of the child from the facility,

(

g) the commission by the child of an offence under

an Act of

Canada, or

(

h) any other occurrence that may seriously affect the health or

safety of the child.

(2) A licence holder shall

(

a) report each incident to the Minister forthwith in the manner

required by the Minister, and

(

b) institute any corrective measures that may be required to

prevent a similar incident from occurring in the future.

Emergency procedures

26 A licence holder shall ensure that

(

a) emergency telephone numbers and procedures are posted in a

prominent place in the facility, and

(

b) emergency evacuation procedures are made known to all

employees, volunteers and children.

Safety of facility

27 A licence holder shall ensure that the facility and grounds are

maintained in a manner that ensures the safety of children.

Provision of food

28 A licence holder shall ensure that

(

a) staff and volunteers are aware of any food allergies or special

dietary requirements of the children residing in the facility;

(

b) meals and snacks are provided to the children residing in the

facility in accordance with the Canada Food Guide or a

similar food guide, and are provided at appropriate times and

in sufficient quantities in accordance with the needs of each

child.

Medications

29(1) A licence holder shall ensure that

(

a) a record is kept of all medications prescribed to a child by a

physician,

(

b) subject to subsection (2), prescription medications are

administered to a child only under the general supervision of

a staff member, and in accordance with the prescription

instructions, and

(

c) a record is kept of all medication administered to each child,

other than self-administered medication, including

(

i) the type of medication,

(ii) in the case of prescription medication, the period for

which the medication is prescribed, and

(iii) the dosage to be administered, when each dosage is

administered and the name of the staff member who

administered the dosage.

(2) A licence holder may allow a child to assume responsibility for

self-administration of medication if authorized by the child's guardian.

Storage of medication

30 A licence holder shall ensure that

(

a) all prescription medication other than medication that is

self-administered is stored in a locked container that is

inaccessible by children,

(

b) non-prescription medication and toxic substances are stored

in a safe manner and are not readily accessible by children,

and

(

c) universal precautions are followed by staff and volunteers.

Dangerous items in facility

31 A licence holder shall ensure that firearms, weapons, ammunition

and explosive substances are not permitted in the facility.

Part 3

Coming into Force and Expiry

Coming into force

32 This Regulation comes into force on the date on which

section 94

of the Child Welfare Amendment Act, 2003 is proclaimed in force.

Expiry

33 For the purpose of ensuring that this Regulation is reviewed for

ongoing relevancy and necessity, with the option that it may be

repassed in its present or an amended form following a review, this

Regulation expires on October 31, 2013.

Schedule

Home Assessment Report for

Foster Home Applicant

Part 1: Applicants' Information

Applicant: Provide information about each applicant

? Name on birth certificate

? Other names, if any

? Address, street, city, province, postal code

? Telephone (residence, business, cellular), e-mail

? Birthdate (year, month and day), birthplace

? Marital or adult interdependent relationship status

? Racial origin

? Ethnic origin

? Registered Indian

? Band name

? Metis

? Metis settlement name or community

? Health as supported by medical

? Education

? Employment

? Religion

? Languages spoken

? Brief family history: (include parenting style, familial

relationships, significant childhood experiences, views of

extended family on this application)

? Involvement with legal and child intervention systems: (include

criminal record checks and intervention record checks within the

last 6 months for applicants and everyone aged 18 or over living

in the home)

? Personality

Part 2: Family Dynamics

Describe the following:

? Family composition

? Relationship dynamics

? Previous marriage(

s) or long-term relationships

? Communication patterns

? Autonomy of individual family members

? Ability to solve problems and handle crisis

? Emotional interactions

? Family traditions

? Philosophy on child rearing

? Modes of behaviour control

? Interests and hobbies

? Social support network

Part 3: Home and Community

Describe the following:

? Physical space

? Safe environment assessment (includes safe storage of

medications and weapons, if any)

? Availability of resources

? Community involvement

? Contact with professional agencies

Part 4: Child Desired

? Is assessment for a specific child? If yes, describe relationship

and involvement with child and birth family

? Age

? Male / Female

? Racial origin

? Sibling group

? Acceptable background characteristics

? Acceptable special needs

? Acceptability of birth family contact

? Acceptability of sibling contact

? Acceptability of an abandoned child with no background

information

? Acceptability of a child who has lived in an institution

? Acceptability of legal risk placements

? Compatibility of applicants and child desired

? Does assessment worker agree with applicants' choices?

Part 5: Income

Describe the following:

? The source and level of income and expenditures (include T4

slips)

? The effect of a placement on family's finances

Part 6: Understanding and Motivation for Proposed

Placement

Describe the following:

? Applicants' understanding of the legal, social, inter-racial,

emotional aspects of proposed placement

? Applicants' plans to promote child's cultural/racial/religious

heritage and identity

Part 7: References

? References (3 references for each applicant, regarding

suitability) - include relationship to applicant if any, on what

basis judgement is made about applicant's potential/actual

parenting ability and

summary of results of interview(s).

Part 8: Overview of Home Assessment Process

? Date of personal visits (include amount of time spent at each

interview and location of interviews)

? Persons interviewed (include confirmation that each person

living in the home was interviewed separately and as a family)

? Parent preparation training date completed

? Applicants' training and activities in support of their application

Part 9:

Summary of Outcome of Assessment

? Report prepared by

? Position

? Date report prepared

? Report reviewed by

? Position

? Date report reviewed

? Report reviewed by applicants: signature and date

Part 10: Placement Supports

? Needed supports and services

? Arrangements for the provision of the identified

supports/services

Part 11: Recommendation/Approval of Assessor

? Assessor Recommendation

? Approved

? Not Approved (provide brief

summary)

? Approved by Supervisor

? Opinion of the child in respect of the application (if applicable)

? Opinion of the child's birth parents in respect of the application

(if applicable)

--------------------------------

Alberta Regulation 162/2004

Local Authorities Election Act

RED DEER ELECTION REGULATION

Filed: July 27, 2004

Made by the Lieutenant Governor in Council (O.C. 330/2004) on July 27, 2004

pursuant to

section 160 of the Local Authorities Election Act.

Table of Contents

1 Definition

2 Modification of s74

3 Modification of s75

4 Modification of s78

5 Expiry

Definition

1 In this Regulation, "Act" means the Local Authorities Election Act.

Modification of s74

Section 74 of the Act is modified for use by the City of Red Deer to

the extent provided as follows:

(

a) the notice referred to in

section 74(1) must include a

statement that blind voter templates will only be available at

advance voting stations and will not be available on election

day.

Modification of s75

Section 75 of the Act is modified for use by the City of Red Deer to

the extent provided as follows:

(

a) the returning officer referred to in

section 75 must make

blind voter templates readily available at advance voting

stations.

Modification of s78

Section 78 of the Act is modified for use by the City of Red Deer to

the extent provided as follows:

(

a) notwithstanding

section 78(5), an elector who is blind must

vote in accordance with

section 78(1) or (3);

(b)

section 78(5) is considered to be repealed;

(c)

section 78(7) is considered to read as follows:

(7) When a ballot has been marked pursuant to this section, the

deputy shall enter in the voting register opposite the name of

the voter the words "voter assistance".

Expiry

5 For the purpose of ensuring that this Regulation is reviewed for

ongoing relevancy and necessity, with the option that it may be

repassed in its present or an amended form following a review, this

Regulation expires on October 31, 2009.

--------------------------------

Alberta Regulation 163/2004

Municipal Government Act

REGIONAL SHOPPING CENTRE ALLOCATION

OF ASSESSMENT REGULATION

Filed: July 27, 2004

Made by the Lieutenant Governor in Council (O.C. 331/2004) on July 27, 2004

pursuant to

section 603 of the Municipal Government Act.

Table of Contents

Definitions

2 Purpose

3 Application of regulation

4 Application for allocation of assessment

5 Calculation of allocation of assessment

6 Effect of allocation of assessment

7 Provision of information

8 Charges

9 Recalculation

10 Review

11 Repeal

12 Expiry

13 Coming into force

Definitions

1(1) In this Regulation,

(a) "Act" means the Municipal Government Act;

(b) "allocation of assessment" means the allocation of the total

assessment of a regional shopping centre among the

components of the regional shopping centre;

(c) "anchor tenant" means a tenant in a regional shopping centre

that is prescribed as an anchor tenant in a Ministerial Order

referred to in subsection (2);

(d) "assessed person" means the assessed person of the regional

shopping centre;

(e) "commercial retail unit" or "CRU" means a retail or service

premises in a regional shopping centre, other than the

following:

(

i) anchor tenant premises;

(ii) free-standing premises;

(iii) office premises;

(iv) hotel premises;

(

v) the exterior common area and interior common area;

(f) "component" of a regional shopping centre means the

following:

(

i) each anchor tenant premises;

(ii) the aggregate of the CRU premises;

(iii) each free-standing premises;

(iv) the aggregate interior common area;

(

v) the aggregate exterior common area;

(vi) each premises that is not included in any of subclauses

(

i) to (v), including office premises and hotel premises;

(g) "exterior common area" includes that part of a regional

shopping centre that consists of pavement, parking structures

and land;

(h) "interior common area" means that part of the gross building

area of a regional shopping centre that is not gross leasable

area;

(i) "office premises" means any area within a regional shopping

centre that consists of more than 6 offices and is specifically

designated to be used for office purposes;

(j) "regional shopping centre" means, subject to

section 3(3), a

shopping centre that is prescribed as a regional shopping

centre in a Ministerial Order referred to in subsection (2);

(k) "total assessment" means the assessment shown for the

regional shopping centre on the municipality's assessment

roll, but where

section 3(3) applies, excludes that part of the

total assessment that is attributable to the addition referred to

in that subsection.

(2) The Minister may by Ministerial Order prescribe

(

a) the regional shopping centres to which this Regulation

applies, and

(

b) the tenants of each regional shopping centre that are the

anchor tenants for the purposes of this Regulation.

Purpose

2 The purpose of this Regulation is to provide an allocation of

assessment for use by regional shopping centres for the purpose of

internal allocation of property taxes among the components of

regional shopping centres.

Application of regulation

3(1) This Regulation applies only in respect of the taxation years 1999

to 2008 inclusive.

(2) This Regulation applies in respect of a regional shopping centre in

respect of a taxation year only where

(

a) at least one lease agreement between an anchor tenant and

the assessed person provides for the allocation of the

property tax payable in respect of the regional shopping

centre based on either separate assessments or on the

methodology used by the municipality to derive the

assessment for the regional shopping centre,

(

b) the assessment for the regional shopping centre as

determined by the municipality for the taxation year is based

chiefly on the income approach to value, and

(

c) the assessed person applies in writing to the municipality not

later than December 31 preceding the taxation year for an

allocation of assessment under this Regulation.

(3) Where the building footprint or envelope of a regional shopping

centre changes by reason of an addition to the shopping centre that is

completed after December 31, 1997, the addition shall not be

considered to be part of the regional shopping centre for the purposes

of this Regulation.

Application for allocation of assessment

4 An application referred to in

section 3(2)(

c) must be in a form

acceptable to and contain the information prescribed by the

municipality.

Calculation of allocation of assessment

5(1) If the conditions in

section 3(2) are met with respect to a regional

shopping centre, the municipality shall do the following:

(

a) determine the value of each component by using the

assessment method that was used by the municipality in the

year preceding the first year in which an assessment using the

income approach to value is prepared;

(

b) prepare an allocation to each component of the total value of

all components determined under clause (

a) by

(

i) dividing the value for each component determined

under clause (

a) by the total value of all components so

determined to determine the percentage that the value of

each component is of the total value, and

(ii) multiplying the percentage determined under subclause

(

i) for each component by the total assessment prepared

using the income approach to value;

(

c) annually prepare an allocation of the total assessment to each

component by using the same income approach to value that

was used in preparing the assessment;

(

d) prepare an annual allocation of assessment for each

component by

(

i) determining the difference in valuation for the

component as calculated under clauses (

b) and (c), and

(ii) increasing or decreasing the allocation of value for the

component calculated under clause (

b) for each taxation

year set out in the Table at the end of this

section by a

yearly increment equal to the corresponding percentage

of the difference or valuation that is specified for that

year in column 2 of that Table.

(2) Where the assessed person first makes application under

section

3(2)(

c) in respect of a year after 1999, the percentage increments for

the purposes of subsection (1)(d)(ii) are set out in Column 3 of the

Table at the end of this section.

(3) Subject to

section 9(1), the percentages determined under

subsection (1)(b)(

i) shall remain constant for all taxation years to

which this Regulation applies.

Table

Column 1

Column 2

Column 3

Taxation Year

Percentage Increment

(section 5(1)(d)(ii))

Percentage Increment

(section 5(2))

10.00%

N/A

20.00%

11.1111%

30.00%

12.5000%

40.00%

14.2857%

50.00%

16.6666%

60.00%

20.0000%

70.00%

25.0000%

80.00%

33.3333%

90.00%

50.0000%

100.00%

100.0000%

Effect of allocation of assessment

6(1) An allocation of assessment for a component that is prepared in

accordance with

section 5(1)(

d) is deemed to be a separate assessment

of the component for the purposes of an agreement referred to in

section 3(2)(a).

(2) Nothing in this Regulation affects an assessed person's liability to

pay taxes under the Act.

Provision of information

7 In each taxation year in which this Regulation applies in respect of

a regional shopping centre, the municipality shall, not later than the

date on which it sends the tax notice in respect of the regional

shopping centre to the assessed person, provide to the assessed person

(

a) a

schedule setting out the allocations of assessment in respect

of the components of the regional shopping centre for the

taxation year, together with the details of how the allocations

of assessment were calculated, and

(

b) sufficient information to disclose the details as to how the

total assessment and other valuations used for the purposes of

this Regulation were calculated.

Charges

8(1) A municipality may impose a reasonable charge on the assessed

person for

(

a) the preparation and provision of the material referred to in

section 7, and

(

b) making a recalculation under

section 9

and the charge may, without limitation, include a charge for the time

spent by the municipality's employees or agents in the preparation and

provision of the material or the making of the recalculation.

(2) A municipality may add the reasonable charge authorized under

subsection (1) to the tax roll of the regional shopping centre.

Recalculation

9(1) Where property forming part of a regional shopping centre is

destroyed or is the subject of a subdivision, or where a change in the

component breakdown of the regional shopping centre occurs, the

municipality shall recalculate the allocations of assessment for the

remaining applicable taxation years referred to in

section 3(1).

(2) Where the assessment for a regional shopping centre for a taxation

year changes as a result of the operation of

Part 11 or 12 of the Act, the

municipality shall recalculate the allocations of assessment for that

taxation year.

(3) On making a recalculation under subsection (1) or (2), the

municipality shall forthwith comply with

section 7.

Review

10(1) The assessed person may, not later than August 31, apply to the

Minister for a review of any or all of the following with respect to the

taxation year:

(

a) any amount determined under

section 5(1), other than the

amount of the assessment for the regional shopping centre

that is shown on the municipality's assessment roll and uses

the income approach to value;

(

b) a recalculation of allocations of assessment under

section 9;

(

c) the charge imposed on the assessed person under

section 8.

(2) An application must contain the information required by and be in

a form acceptable to the Minister.

(3) In a review, the Minister may make any changes in the allocations

of assessment, recalculation or charges that the Minister considers

appropriate.

(4) The Minister's decision on a review is final.

Repeal

11 The Regional Shopping Centre Allocation of Assessment

Regulation (AR 249/2002) is repealed.

Expiry

12 This Regulation is made under

section 603(1) of the Act and is

subject to repeal under

section 603(2) of the Act.

Coming into force

13 This Regulation comes into force on November 25, 2004.

Alberta Regulation 164/2004

Regional Health Authorities Act

REGIONAL HEALTH AUTHORITY MEMBERSHIP REGULATION

Filed: July 27, 2004

Made by the Lieutenant Governor in Council (O.C. 337/2004) on July 27, 2004

pursuant to

section 23 of the Regional Health Authorities Act.

Table of Contents

Definitions

2 Membership

3 Appointment of members

4 Nomination process

5 Eligibility for nomination

6 Eligibility for appointment

7 Disqualification

8 Transitional - contributions

9 Transitional - membership

10 Consequential

11 Repeals

12 Expiry

Definitions

1 In this Regulation,

(a) "Act" means the Regional Health Authorities Act;

(b) "member" means a member of a regional health authority;

(c) "Minister" means the member of the Executive Council

designated under the Government Organization Act as the

Minister responsible for the Act.

Membership

2 Each regional health authority consists of the number of members

determined by the Minister by order.

Appointment of members

3(1) The Minister shall appoint all of the members of a regional health

authority.

(2) The Minister shall, with respect to each regional health authority,

designate one of the members as chair.

(3) The members may designate the other offices of the regional

health authority and appoint from among themselves persons to those

offices and prescribe their duties.

Nomination process

4 The Minister may provide for a nomination procedure or any other

method for selecting persons from among whom appointments may be

made under

section 3.

Eligibility for nomination

5(1) In this section, a reference to spouse or adult interdependent

partner does not include such a person who is living apart from the

other party if the parties have separated pursuant to a written

separation agreement or if their support obligations and family

property have been dealt with by a court order.

(2) A person may be nominated as a candidate for appointment under

this Regulation if, at the time that person is nominated, that person

(

a) is 18 years of age or older,

(

b) is a Canadian citizen,

(

c) has been a resident of Alberta for the 6 consecutive

immediately preceding months,

(

d) is a resident in the health region in which that person is being

nominated, and

(

e) is not otherwise ineligible or disqualified.

(3) Subject to subsection (5), a person is not eligible to be nominated

as a candidate for appointment under this Regulation if, at the time that

person is nominated, that person

(

a) is an employee of the regional health authority for which the

person is nominated;

(

b) is an employee of the Government who is under the

administration of the Minister;

(

c) is an independent health service provider who, directly or

indirectly through a corporation, partnership or other

association, receives from the Government of Alberta or the

regional health authority for which the person is nominated,

or both, income through the provision of health services, or is

an employee of such an independent health service provider;

(

d) is a director, officer or employee of a health service

organization that receives 50% or more of its ongoing

funding from either or both of the following:

(

i) the Government of Alberta through the

Department of Health and Wellness;

(ii) the regional health authority for which the person

is nominated;

(

e) is a director, officer or employee of a corporation,

partnership or other association (other than a corporation,

partnership or association referred to in clause (d)) that

receives 50% or more of its gross annual income from either

or both of the following:

(

i) the Government of Alberta through the

Department of Health and Wellness;

(ii) the regional health authority for which the person

is nominated;

(

f) alone or with the person's spouse or adult interdependent

partner, beneficially owns

(i) 50% or more of the voting shares of a corporation

referred to in clause (e), or

(ii) at least a 50% interest in a partnership or other

association referred to in clause (e);

(

g) receives 50% or more of his or her gross annual income

through contracts with the regional health authority for which

he or she is nominated;

(

h) is a spouse or adult interdependent partner of a person

referred to in any of clauses (

a) to (

e) or (g);

(

i) holds office as or is nominated for office as a member of the

Legislative Assembly of Alberta, the House of Commons or

the Senate of Canada;

(

j) is a judge of a court.

(4) A person is not eligible to be nominated as a candidate for

appointment under this Regulation if that person has been convicted of

(

a) an offence under

section 123, 124 or 125 of the Criminal

Code (Canada), or

(

b) an offence that is punishable by imprisonment for 5 or more

years,

and no absolute discharge or pardon has been granted in respect of the

offence.

(5) A person who is ineligible under subsection (3) may nevertheless

be nominated as a candidate for appointment under this Regulation if,

in the nomination application, the person undertakes to eliminate the

circumstances that constitute the ineligibility before being appointed.

(6) The Minister may appoint as a member a person who eliminates

the circumstances constituting his or her ineligibility in accordance

with subsection (5).

Eligibility for appointment

6 A person is not eligible to be appointed as a member unless the

person meets the eligibility requirements in

section 5 on the date of the

appointment.

Disqualification

7 A member is disqualified from being a member if the member

ceases to meet any of the eligibility requirements in

section 5.

Transitional - contributions

8 A person who, on the coming into force of this Regulation, holds a

surplus of contributions over expenses under

section 11.6(1) of the

Election and Appointment of Regional Health Authority Members

Regulation (AR 57/2001) shall, within 90 days after the coming into

force of this Regulation, transfer that surplus to the regional health

authority for which the person was nominated, or its successor, as

determined by the Minister.

Transitional - membership

9 A person who on the coming into force of this Regulation has been

appointed as a member of a regional health authority and is still a

member is deemed to have been appointed under this Regulation, and

that person continues as a member until his or her appointment is

terminated or expires, or he or she is reappointed, as the case may be.

Consequential

10 The Regional Health Authorities Regulation (AR 15/95) is

amended by repealing

section 2.92 and substituting the following:

Organizational meeting

2.92 Where

(

a) the members of the regional health authority of a newly

established health region are appointed, or

(

b) more than half of the members of a regional health authority

are replaced at the same time or substantially the same time,

the regional health authority shall hold an organizational meeting not

later than 15 days after the last of the new appointments or

replacement appointments is made.

Repeals

11 The following regulations are repealed:

(

a) the Election and Appointment of Regional Health Authority

Members Regulation (AR 57/2001);

(

b) the Regional Health Authorities Election Forms Regulation

(AR 60/2001).

Expiry

12 For the purpose of ensuring that this Regulation is reviewed for

ongoing relevancy and necessity, with the option that it may be

repassed in its present or an amended form following a review, this

Regulation expires on October 31, 2014.

--------------------------------

Alberta Regulation 165/2004

Agriculture Financial Services Act

AGRICULTURE FINANCIAL SERVICES AMENDMENT REGULATION

Filed: July 27, 2004

Made by the Lieutenant Governor in Council (O.C. 338/2004) on July 27, 2004

pursuant to

section 37 of the Agriculture Financial Services Act.

1 The Agriculture Financial Services Regulation

(AR 99/2002) is amended by this Regulation.

2 The following is added before

section 10:

Loans and guarantees to connected persons

9.1(1) For the purposes of this section, a person is connected to

another person if, in the Corporation's opinion,

(

a) the person is an affiliate of the other person, or

(b) 2 or more of the following conditions are or would be met in

respect of loans to those persons:

(

i) the loans would be, in substance, a single loan or would

serve substantially the same purpose;

(ii) the expected source of repayment of the loans is or

would be wholly or substantially dependent on a

common source of money;

(iii) the loans would be wholly or substantially dependent on

the same security.

(2) Notwithstanding subsection (1), persons who, in the

Corporation's opinion, are financially independent of each other to

a material extent are not connected persons for the purposes of this

section.

(3) For the purposes of calculating loan and guarantee limits under

section 29(1)(

c) of the Act in respect of a proposed loan to a person

or a guarantee of a loan to a person,

(

a) a loan of the Corporation's own funds to a person who is

connected to that person in respect of the proposed loan or

guarantee must, for the purposes of

section 29(1)(c)(ii) of the

Act, be considered as a loan to that person, and

(

b) the Corporation's liability under a guarantee of a loan to a

person who is connected to that person in respect of the

proposed loan or guarantee must, for the purposes of

section

29(1)(c)(iii) of the Act, be considered as a guarantee of a loan

made to that person.

Project limits

9.2 The Corporation must not make a loan or execute a guarantee

in respect of a project if the sum of

(

a) the proposed advance of the Corporation's own funds or the

amount of the Corporation's liability under the proposed

guarantee, as the case may be,

(

b) the outstanding balance of all other loans of the

Corporation's own funds for substantially the same project,

as determined by the Corporation, and

(

c) the amount of the Corporation's liability under any other

guarantee of loans for substantially the same project, as

determined by the Corporation

would exceed the lesser of $10 000 000 or 80% of the value of the

project, as determined by the Corporation.

--------------------------------

Alberta Regulation 166/2004

Provincial Offences Procedure Act

PROCEDURES AMENDMENT REGULATION

Filed: July 27, 2004

Made by the Lieutenant Governor in Council (O.C. 340/2004) on July 27, 2004

pursuant to

section 42 of the Provincial Offences Procedure Act.

1 The Procedures Regulation (AR 233/89) is amended by

this Regulation.

Section 2(p.01) is repealed and the following is

substituted:

(p.01) Tobacco Tax Act, sections 3(1), 4(2)(b), (3), (4) and (5) and

4.1;

Schedule 2,

Part 21.01, is repealed and the following is

substituted:

Part 21.01

Tobacco Tax Act

1 The specified penalty payable in respect of a contravention of

section 3(1) of the Tobacco Tax Act is $500.

2(1) The specified penalty payable in respect of a contravention of

section 4(2)(

b) of the Tobacco Tax Act for the purchase,

possession, storing, selling or offering for sale of 1000 cigarettes or

grams of tobacco or less is $1000.

(2) Where the person purchases, possesses, stores, sells or offers

for sale more than 1000 cigarettes or grams of tobacco in

contravention of

section 4(2)(

b) of the Tobacco Tax Act, the person

is required to appear before a justice without the alternative of

making a voluntary payment.

3(1) The specified penalty payable in respect of a contravention of

section 4(3) of the Tobacco Tax Act

(

a) for the purchase or possession of 400 cigarettes or

grams of tobacco or less is $250, and

(

b) for the purchase or possession of more than 400

cigarettes or grams of tobacco but not more than 1000

cigarettes or grams of tobacco is $500.

(2) Where the person purchases or possesses more than 1000

cigarettes or grams of tobacco in contravention of

section 4(3) of

the Tobacco Tax Act, the person is required to appear before a

justice without the alternative of making a voluntary payment.

4(1) The specified penalty payable for the contravention of

section

4(4) of the Tobacco Tax Act for the possession of 1000 cigarettes

or grams of tobacco or less over the permitted amount is $250.

(2) Where a person is charged with a 2nd or subsequent offence

for the contravention of

section 4(4) of the Tobacco Tax Act for the

possession of 1000 cigarettes or grams of tobacco or less over the

permitted amount, the person is required to appear before a justice

without the alternative of making a voluntary payment.

(3) Where a person is charged with possession of more than 1000

cigarettes or grams of tobacco over the permitted amount in

contravention of

section 4(4) of the Tobacco Tax Act, the person is

required to appear before a justice without the alternative of

making a voluntary payment.

5(1) The specified penalty payable for the contravention of

section

4(5) of the Tobacco Tax Act is $500.

(2) Where a person is charged with a 2nd or subsequent offence

for contravening

section 4(5) of the Tobacco Tax Act, the person is

required to appear before a justice without the alternative of

making a voluntary payment.

6(1) The specified penalty payable in respect of a contravention of

section 4.1 of the Tobacco Tax Act for the possession of

(a) 2000 cigarettes or less,

(b) 2000 grams of tobacco or less or cigars containing 2000

grams of tobacco or less, or

(

c) any combination containing 2000 grams of tobacco or

less,

over the permitted amount is $1000.

(2) Where a person possesses more than

(a) 2000 cigarettes,

(b) 2000 grams of tobacco or cigars containing 2000 grams

of tobacco, or

(

c) any combination containing 2000 grams of tobacco,

over the permitted amount in contravention of

section 4.1 of the

Tobacco Tax Act, the person is required to appear before a justice

without the alternative of making a voluntary payment.

--------------------------------

Alberta Regulation 167/2004

Marketing of Agricultural Products Act

ALBERTA MILK MARKETING AMENDMENT REGULATION

Filed: July 27, 2004

Made by the Alberta Agricultural Products Marketing Council on July 27, 2004

pursuant to sections 26 and 27 of the Marketing of Agricultural Products Act.

1 The Alberta Milk Marketing Regulation (AR 151/2002) is

amended by this Regulation.

Section 19(1)(

c) is amended by striking out "months" and

substituting "weeks".

3 The following is added after

section 19:

Quota transfer exchange

19.1(1) Subject to

section 20, Alberta Milk may, by

administrative order, provide for a quota transfer exchange.

(2) Without limiting the generality of subsection (1), an

administrative order may include provisions respecting

(

a) dates, times, policies and procedures respecting

transfers of quota,

(

b) the surrender of quota,

(

c) increasing or reducing quota,

(

d) service charges,

(

e) forms, and

(

f) any other matter Alberta Milk considers necessary to

effect the orderly transfer of quota.

Section 20 is amended

(

a) by adding the following after subsection (1):

(1.1) Alberta Milk shall not approve a transfer of quota if, in

the opinion of Alberta Milk, the transferee or transferor is in

contravention of the Dairy Industry Act, the regulations under

that Act, this Regulation, the Alberta Milk Plan Regulation

(AR 150/2002), the Canadian Dairy Commission Act

(Canada), the regulations under that Act or Alberta Milk's

administrative orders or directives.

(

b) by repealing