Orchards Foster Care and Adoption Web Inquiry

Orchards Children's Services Information Request
Here is my contact information:
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Street Address
E-mail
City
State
Zip
I am interested in finding out more about:
How did you hear about Orchards?

Please complete this pre-orientation questionnaire and once you click submit, the invitation for the next upcoming orientation will be emailed to you.
How did you hear about Orchards?

Website/Internet SearchSocial MediaFriend/Family MemberOrchards EmployeeChurch/Religious OrganizationFlyer/BookmarkFoster ParentOrganization/Agency/Foster Care NavigatorsMetro Parent Email/Informational EmailCommunity EventOther
If you are interested in Foster Care, please pick a date for an initial orientation.
Here is some additional information that may assist you with my request:
2. If you heard about Orchards from a licensed foster parent at Orchards, enter their name below:
3. Please write out applicant #1's full name:

PrefixLegal First NameMaiden NameLast Name
Please write out applicant #2's full name:

PrefixLegal First NameMaiden NameLast Name
4. Marital Status:
5. Please write out your home address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
6. Primary Phone:

Area CodePhone Number
Primary Email Address:
example@example.com
7. Please list ALL persons living in the home. Please list each individual’s name, role (father, mother, daughter, etc.):

First NameLast NameRole/Relationship
First NameLast NameRole/Relationship
First NameLast NameRole/Relationship
First NameLast NameRole/Relationship
First NameLast NameRole/Relationship
First NameLast NameRole/Relationship
10. Are you a current licensed foster parent?
If yes, what is the name of the agency?
11. What are your licensing and placement interests? (select all that apply)

Fostering children ages 0-3Fostering children ages 4-9Fostering children ages 10-12Fostering children ages 13-17Independent Living Program (Children ages 16+)Adoption only, children ages 10+Fostering or adopting a specific child or relative. If so, please add their name in "other" belowI am interested in caring for a child/youth with medical needsI am interested in caring for a child/youth with emotional/mental health or other special health needsI am interested in caring for a child/youth with behavioral needsTemporary foster care with birth parent visitsTemporary foster care with birth parent visits and hopes to adopt in the futureOther
12. How many bedrooms do you have in your home?
Which Orientation are you interested in attending?
Enter the message as it's shown*
How did you hear about Orchards?

Website/Internet SearchSocial MediaFoster ParentOrchards EmployeeFriend/Family MemberDaimler Chrysler/Detroit Diesel EventChurch/Religious OrganizationFlyer/BookmarkOrganization/Agency/Foster Care NavigatorsMetro Parent Email/Informational EmailCommunity EventOther
Should be Empty:

Orchards Children's Services Information Request

Here is my contact information:

How did you hear about Orchards?