Foster Parent Inquiry Form
Thank you for your interest in foster parenting with Safe Haven. This short form helps us contact you and learn a little about your interests.
Contact Information
Name
First Name
Last Name
E-mail
example@example.com
Phone Number
-
Area Code
Phone Number
City/County
Application Type
Individual Applicant
Joint Applicants (Two Adults Applying Together)
Do You Have Adult Children In Your Home?
Please Select
YES
NO
Preferred Method of Contact
Phone
Text
Email
Foster Care Interest
Are you interested in becoming a:
Therapeutic Foster Care
Kinship/Relative Caregiver
Not sure/would like more information
Have you ever been a foster parent before?
Yes
No
Placement Preference
(Preferences help us understand your comfort level and do not guarantee placement.)
Age Range(s) you’re open to (check all that apply):
0-5
6-10
11-14
15-17
Gender Preference:
No preference
Male
Female
Placement Type (check all that apply):
Therapeutic Foster Care
Respite/Short-Term Placement
Emergency Placement
Non-Traditional Placement
Not sure/would like more information
Would you like to be contacted about next steps or an info session?
Yes
No
Submit
Should be Empty: