Welf. & Inst. Code, § 16503.5

(a) A placing agency shall provide a caregiver placement agreement to the child’s or nonminor dependent’s caregiver at the time of the child’s placement with that caregiver.

(b) (1) For purposes of this section, “caregiver placement agreement” means a written agreement between the placing agency and the child’s or nonminor dependent’s caregiver. The department shall approve the format and content of the placement agreement form to be used by a placing agency.

(2) For purposes of this section, “nonminor dependent” means an individual described in subdivision (v) of Section 11400.

(c) The agreement shall describe the terms and conditions of the placement and any agreements made by the placing agency and the child’s or nonminor’s caregiver.

(d) The agreement shall provide, at a minimum, the contact information for the placing agency’s social worker and the worker’s supervisor, including, but not limited to, telephone numbers, facsimile numbers, and identifying information about the child or nonminor, including, but not limited to, the child’s or nonminor’s social security number, if available, the child’s or nonminor’s Medi-Cal number or group health plan number and information, if available, and the child’s or nonminor’s State Department of Social Services identification number.

(e) A county placing agency may modify the forms to meet local needs by adding to the form requirements for information, but may not delete the form’s core elements as determined by the department.