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PCG Disclosure Form - Community Ties of America Inc 2026

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The document is a Primary Caregiver Disclosure Form for Community Care Foster Family Home, requiring caregivers to provide personal and household information. It includes questions about physical and mental health, household composition, medication use, and the ability to meet client needs. The form emphasizes the importance of honest responses and outlines the responsibilities of caregivers in integrating clients into daily life activities.

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Click ‘Get Form’ to open the PCG Disclosure Form in the editor.
Begin by filling out your personal information in the application section, including your name, date of birth, age, address, phone number, and email. Ensure accuracy for effective communication.
In Section 1, answer all health-related questions honestly. This includes any physical or mental conditions that may affect your caregiving abilities. Use the text fields to provide detailed explanations where necessary.
Proceed to Section 2 and provide information about your household. Indicate the number of residents, ages of children under 18, and any medical treatments household members are undergoing.
Complete additional questions regarding employment and household routines. Be sure to check 'Yes' or 'No' as applicable and provide details where prompted.
Finally, review all entries for accuracy before signing at the bottom of the form. Your signature confirms that all information is truthful and complete.

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