1. George Department of Human Resources
WAIVER OF ADMINISTRATIVE HEARING – PLACEMENT
I, the undersigned, do hereby waive my right to an Administrative Hearing.
I, understand that:
The following social service will be denied, reduced or terminated, effective
Visitation or transportation to visitation will be denied, reduced or terminated, effective
Other
Explain:
Signature of Witness Signature of Parent
Date Signature of Parent
Date
FC_130 Waiver of Administrative Hearing (Revised 09/06) Page 1 of 1