IL Parent Provider Agreement

Parent/Provider Partnership Agreement

Parent or Guardian First Name*
Parent or Guardian Last Name*
Phone Number*
Email Address*
Early Intervention is designed to support and inform caregivers and parents.

PROVIDERS AGREE TO:
- Use the toys and materials that are already available to the child and incorporate them into strategies for learning.
- Avoid cell phone use for the duration of the session.
- Encourage parents and caregivers to try suggested strategies during sessions, offer feedback and provide support that will build confidence.
- Ask the family questions about daily activities and routines at each session to more effectively embed strategies in the family’s lifestyle.
- Create an interactive environment where parents, siblings, caregivers and others who are important to the child are valued and engage during sessions.
- Accompany children and their caregivers to locations inside and outside of the home, as agreed upon by the team, where learning strategies can be incorporated.
PARENTS/CAREGIVERS AGREE TO:
- Be actively involved in each Early Intervention session. During the session, practice the strategies suggested by the Provider to get feedback and support.
- Ask questions. Share your concerns and challenges about your daily routines with your Provider.
- Identify the routines that are important to your family so that strategies can be identified to support your needs.
- Feel free to tell the Provider when strategies will not fit into your routines and lifestyle. Help come up with solutions and alternative strategies.
- Agree to identify other important people in the child’s life who participate in the family routines so that strategies can be shared to support the family’s needs.
- Agree to inform the Provider of changes, needs, priorities, and/or routines so that recommendations can be revised to support the changes.
Caregiver's Name
Child's Name
Date
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