What are their ages and gender?

2. How many bedrooms do you have in your home?
One Two Three Four Five Six

3. A foster child must have their own bed/crib, in a room with at least 45 square feet with a window. Do you have such accomodations? Yes No

4. Are you interested in Foster Care Adoption Both

5. What type of child would you like to foster/adopt?

     Age:     Sex: Male Female      No. of Children:   

6. Would you like children with special needs (Medical, Behavorial, Educational, Psychiatric)? Yes No

7. Appointments for children can be as often as weekly. These include family visiting, medical or therapy appointments. Are you able to transport to and from these appointments? Yes No

8.

Monthly or Yearly Income
Work Hours
Occupation

9. Appointments and training classes can be in the daytime or evenings. Which one would you prefer? Day Evening

10. Have you ever been with another Foster Care agency? Yes No

11. If yes, name of agency:

     What year:

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