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
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: