Treatment Foster Care Application

Foster Home Information

Foster Parent Names (Required):


Home Telephone Number (Required):

Email (Required):

Address (Required):

Family Information

Applicant 1

Date of Birth (Required):

Place Of Employment:

Telephone:

Email:

Date of Birth (Required):

Place Of Employment:

Telephone:

Email:

Date/ Place of Marriage or cohabitation:

Child(ren)

Other person(s) residing in the Home

Are you able to ensure a smoke free environment?YesNo

Have you ever been charged with an offense under the criminal code?YesNo

Describe your home:

Have you had any training or experience in caring for a child other than your own?YesNo

Have you fostered in the past or are you currently applying to foster for other agencies at the present time?YesNo

The Child/Children you wish to foster

How old are they:
Are they male or female?:

Comments:

Fostering Options:

Would you and your family be willing to consider fostering a child on a short term or emergency basis?YesNo

Would you be willing to consider short-term relief placements? Such occasional weekends for a child in another foster family?YesNo

Would you be willing to consider a child that required intensive supports? i.e. A Clinical support Worker in the home 24 hours per day?YesNo

Are you willing to have one foster parent not work outside of the home?YesNo

Would you consider fostering sibling groups?YesNo

Type in what you see before submitting. Thank you