Adoption/Foster Care Inquiry Form

Please use this form to make inquiries regarding child or adult foster care or child adoption.
For all other inquiries, please email us by clicking on this link.

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Please choose the type information you are seeking:   I would like information about Child Foster Care I would like information about Adult Foster Care I would like information about Child Adoption I would like information about Both Foster Care/Adoption - Child

Your First Name

Your Last Name

Your Date of Birth

 

	Please list the following information on all persons living in your home (up to space available)
	First Name	Last Name	Relationship	Date of Birth

 

	Address
	Street:
	Street (cont):
	City:
	State:
	Zip Code:
	County:

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Have you ever fostered / adopted before?   Yes No

If Yes:     When and Where?  


Has a homestudy ever been done on your home?   Not Sure No Yes

If Yes:

What was the agency / county DHR name?  

What was the social worker's name?  

 

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	Contact Information	Select Contact Preference
Home:			Using the buttons  to the left, please  indicate where you  would prefer we  contact you
Work #1:
Work #2:
E-Mail:
	Best Time:      Morning Afternoon Evening

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Preferred Language spoken:		English Spanish Other,Specify
Preferred Language written:		English Spanish Other, Specify

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If you are inquiring only about Adult Foster Care, you can click here to proceed to the "Send This Inquiry" button
 

You need to complete the section below ONLY if you are inquiring about Child Foster Care or Child Adoption

Child Preferences

	Gender:	Choose One Male Female No Preference
	Age Range:	Minimum    -    Maximum

 

	Special Needs Issues As you consider special needs, we want to remember that every child and his or her needs are different. Please read over the accompanying examples (click link to see examples) and select the area(s) of need (if any) you feel your family is capable of meeting:
	Physical Disability    None Mild Moderate Severe   (click for description)
	Emotional/Behavioral Disability   None Mild Moderate Severe   (click for description)
	Mental Disability    None Mild Moderate Severe   (click for description)

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Have you visited the photolisting of waiting children on this site? Yes No

If yes, was there a specific child or sibling group you are interested in? Yes No

If yes, name/case number of child/children:

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	How did you hear about our website?

    

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Examples of Level of Physical Disability [back]

Mild = May require occasional Doctor visits and regular medication
Moderate = May require frequent Doctor visits, involvement with other health professionals, and multiple medications. Some limitations in activities, diet, and/or lifestyle
Severe = May require regular intervention by health care professionals, and significant limitations in activities, diet and /or lifestyle.

Examples of Level of Emotional/Behavioral Disability [back]

Mild = May need occasional therapy. Overall good functioning at school, at home and with peers.
Moderate = May need assistance at home, at school, and/or with peers. Problems can be treated with medication, behavior therapy or counseling as needed.
Severe = May have serious problems getting along with others at home, and at school. Will need regular intervention from mental health professionals. Have a history of risk of harming themselves or others.

Examples of Level of Mental Disability [back]

Mild = May require special education services in a traditional classroom setting. With training and education, most are able to hold jobs and live independently as an adult.
Moderate = As a child, may require special education classroom placement. Will be educationally and socially behind same age peers. With training and education, many are able to live and work in supervised settings as an adult.
Severe = As a child will require extensive supervision in school, at home and in the community both as a child and as an adult.