2023 Pool Fence Request Assistance Form

2023 Pool Fence Request Form

Kinship Families Only
At this time, BOOST a FOSTER FAMILY only accepts referrals for KINSHIP families experiencing financial hardship or who have other barriers prohibiting them from becoming licensed. Questions? Please contact us here.

IMPORTANT: If this referral is approved, Boost a Foster Family will pay for 50% of the cost of a MESH pool fence that meets the Arizona foster care safety standards.

NOTE: Boost a Foster Family may require you to request a Pool or Spa Fencing Consultation with the Office of Licensing and Regulation.

NOTE: DCS requires pool fencing for children under age seven. Boost a Foster Family will not approve requests for children age 7 and older. For more information download OLR's guide for Pool Fences: CLICK HERE for English; HAGA CLIC AQUI for Spanish.

If you are the family filling out this form STOP RIGHT HERE and have your DCS or Agency Worker complete the form. If the family fills out this application, assistance will be denied.
Family Information

Please provide the following data on the family in need of assistance (all entries are required):
Family Name*

First Name Last Name
Does the family own the home? Proof of ownership will be required.*

YESNO
Due to limited funding, Boost a Foster Family will only consider providing assistance for home owners whose residence is valued at or below $500,000 unless extenuating circumstances exist.

Use this link to put in address of home and report Zillow home estimate value: https://www.zillow.com/
Estimated Value of the Home*
Zillow Home Value Estimate
Family Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
County of Residence*
Family Phone Number*

Area Code Phone Number
Family Email Address*
Is the family intending to pursue AZ licensure to become a foster family for the child/ren in their care? (Will OLR be required to approve this fence?)*

YesNo
If NO, who will approve the fence.
Date pool fence needed
If there is no deadline, enter NONE
Addition Required Information

NOTE: DCS requires fencing for children under age 7 - one child must be under age 7 to receive assistance.
Total Number of Children in Home*
Birth children, adoptive children, foster children and informal placements
Number of Foster Children in Home*
only foster children
Nature of Kinship Relationship*
Where is this Family in the Licensing Process*
Is this family Low-Income (less than twice the federal poverty threshold)*

YesNo
Please explain the Kinship Family's financial situation and why they need assistance.*

List Each Household Member*

	Role	Race Ethnicity	Age*	Veteran?
Person 1
Person 2
Person 3
Person 4
Person 5
Person 6
Person 7
Person 8

Additional Information to help us determine the family's eligibility.
Agency Information
I certify that I work for DCS or a foster care licensing agency in Arizona and that I am filling this out on the behalf of a needy Arizona family. I agree to vouch for the family's financial need.
Select Agency*
If not listed above, please type Agency Name and full address.
Licensing/DCS Worker Name*

First Name Last Name
Licensing/DCS Worker E-mail*
Licensing/DCS Worker Cell Phone Number*

Area Code Phone Number
I have gained permission to share identifying information with Boost a Foster Family*

VerbalEmailSigned Release of Information FormOther
I have explained to the family that this request is for help towards a MESH Pool fence only (not a metal fence) and that the application process WILL NOT move forward until the family has returned an email/text that consents to the following terms:
- Family will pay their portion of the costs first directly to the provider.
- Cancelations must be done prior to 48 hours before installation, or an additional fee will be charged to the family.
- Boost a Foster Family has the right to cancel assistance at any time.
I have explained the above terms*

YesNo
Newsletter

Receive Boost Newsletters (usually sent quarterly)
Please note: We commit to responding to this referral as soon as possible. Sometimes additional information is required in order to fulfill the order. If we do not receive the requested information within 90 days, this referral will expire.
Signing your name here confirms your acceptance of Boost a Foster Family Terms and Conditions *

Clear
Enter the message as it's shown*
Should be Empty:

Family Information

Addition Required Information

Agency Information