Foster and Adoptive Information Form

*Full Name(s) both parents:

*Home Phone
(format:xxx-xxx-xxxx):

*Email Address
(no work emails please):

*Ethnicity :

*Address
(Place you will live in for home study & to raise the child in):

*County:

*How did you hear about us?

*Select a program:

*What age range of child would you like to help?

*Select your marital status:

*What is your current home type:

*What are the number of bedrooms?

*What is the number of additional adults living in the home?

*Number of youth under 18 living in the home?

*Do you have a vehicle that can hold your family and an extra child?
(Yes/No)

*Are you currently employed?
(Yes/No)

*Do you all produce enough Income to support your family and
an additional child if placed in your home?
(Yes/No)

*Assistance from Government such as Food Stamps, Section 8
housing or unemployment?
(If yes, please explain)

*Does anyone in the house have any arrests or felonies?
(If yes, please explain)

*Are you each U.S. citizens? If not, what is your status?

*Have you lived in FL for the past 5 years? If not, what state and when?

*Valid driver’s license?

*Has either caregiver or anyone in your home been involved in an abuse investigation with the Department of Children and Families?

*Do you run an Air BNB or other rental property in your home or on your property?