Welcome to your Circuit 15 Resource Page. Here you will find various forms, tools, community resources and contacts specific to child welfare staff in Palm Beach County. We encourage you to check back here often to view forms and resources that have been recommended for this page by your local administrators.

Circuit 15 Key Contacts
Dennis Miles
DCF Regional Managing Director
Circuits 15, 17 & 19
111 S. Sapodilla Ave
West Palm Beach, FL  33401
(561) 837-5078
Clay Walker
DCF Circuit Community Development Administrator
111 S. Sapodilla Ave
West Palm Beach, FL 33401
(561) 837-5078
Kimberly Welles
Director of Family & Community Services
1400 W. Commercial Blvd. Room 210-P
Fort Lauderdale, FL 33309
(954) 812-8249
Robert Shea
DCF Regional Family Safety Operations Manager
Circuits 15 & 19
111 S. Sapodilla Ave.
West Palm Beach, FL 33401
Office: 561-227-6668
Cell: 772-216-3300
Larry Rein
Executive Director
ChildNet Palm Beach
4100 Okeechobee Blvd,
West Palm Beach, FL 33406

Circuit 15

Safety Methodology Information and Resources
Present Danger Assessment
Safety Plan Template
Safety Methodology Reference Guide
FFA worksheet Short Version
FFA Worksheet Long Version
CFOP 170-5 New Investigative Guidelines
Facility Intake Packets
A Place of Hope - Shelter
A Place of Hope - Cottage for Girls
Genesis Placement Agreement
Grandma's Place
Hibiscus Children's Center - Vero Beach
Hibiscus House - Jensen Beach
Kids In Distress - Wilton Manors
Seven Stars Place of Hope for Boys
The Grove
The Haven
Vision Quest
File Jacket Forms
Acknowledgement Form (All Pamphlets and Brochures)
Chronological Notes
CPI Rights and Responsibilites
CPI Rights and Responsibilites - Creole
CPI Rights and Responsibilites - Spanish
Food Stamp Flyer
HIPAA Policy (English)
HIPAA Policy (Spanish)
HIPAA Policy (Creole)
ICWA Form - Spanish
PBC Community Resources (2015)
Release of Medical Information - Parental Permission
Release of Medical Records - Children's Records
SACC Release Form
Water Safety Survey
Operational Forms
Case Opening Document (March 2016)
Circuit 15 Letterhead
Communication Assistance Request/Waiver
Diligent Search - Affidavit (Jan 2010)
Diligent Search - Request Form
Drug Testing Referral Form
Emergency Intake - Psychotropic Medications Consent
Family Safety Contract for Sexually Reactive Children
Fingerprint Demographic Form
Fingerprints for Caregivers Instructions
Firearm Aknowledgement Form
Grid Check Request (2016)
In-Home Non-Judicial Case Management Request Form
In-Home Non-Judicial Services Agreement
Mileage Log
Other Parent Home Assessment
Police Report Request (2016)
Pool Safety Form
Relative Caregiver Brochure
Safe Sleep Flyer
School Confidentiality
Sudden Unexplained Infant Death Prevention
Unified Home Study
HHS/Deaf and Hard of Hearing Forms
HHS CPI Checklist
HHS Sample Mockup Forms
Communication Assessment - Instructions
Communication Assessment (English)
Communication Assessment (Spanish)
Communication Assessment (Creole)
Customer Feedback (English)
Customer Feedback (Spanish)
Customer Feedback (Creole)
Request for Waiver (English)
Request for Waiver (Spanish)
Request for Waiver (Creole)
Referral Forms
FIT Parent Brochure (March 2016)
FIT Referral Form
FIT Team Referral Flyer
FIT Team Referral Process
Chrysalis Referral Form
Additional Circuit 15 Resources

Behavioral Health Services Network Providers List
CBC Lead Agency Operations Contacts
Community Contacts
Law Enforcement Numbers
Child Care Facilities
Home Child Care
Local Services Directory
Palm Beach County 2016-2017 School Schedule
Palm Beach County 2015-2016 Directory of Schools and Principals
Palm Beach County 2015-2016 Alternative Schools Directory
Palm Beach County 2014-2015 After-School Programs Directory