This form contains 11 fields organized into 3 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Additional Restrictions
Additional Restrictions	Text	Please enter any additional restrictions regarding video contact that may be added by the assigned caseworker.
Agreement Terms
Do not discuss case dynamics	Checkbox	Check this box to confirm agreement not to discuss case dynamics, including progress in services, children's placement, possible return home date, or court hearings, during the video contact.
Do not use profanity or explicit language	Checkbox	Check this box to confirm agreement not to use profanity or explicit language during video contact.
Allow IDOC staff monitoring	Checkbox	Check this box to confirm agreement to allow IDOC staff to monitor the video contact, follow redirection as needed, and understand that contact may be canceled without prior notice.
Allow DCFS caseworker monitoring	Checkbox	Check this box to confirm agreement to allow video contact to be monitored by the DCFS caseworker or their designee, and acknowledge that contact details will become part of the family case file and may be included in reports to the Court.
Video contact info part of IDOC Master File	Checkbox	Check this box to confirm understanding and agreement that video contact information, including observation notes, will become part of the parent's IDOC Master File.
Understand purpose of video contact	Checkbox	Check this box to confirm understanding that the sole purpose of video contact is to maintain and enhance the child and parent relationship.
Parent Information
Parent Name	Text	Enter the full name of the incarcerated parent.
Parent Date of Birth	Date	Enter the date of birth of the incarcerated parent.
Inmate ID Number	Text	Enter the inmate identification number assigned to the parent.
IDOC Facility	Text	Enter the name of the IDOC facility where the parent is incarcerated.

IDOC/DCFS Incarcerated Parent Video Contact Agreement Instructions