Please use this form to make inquiries regarding child foster care or child adoption. For all other inquiries, please email us by clicking here.

    Please choose the type of information you are seeking:

    Personal Information

    First Name: Last Name: Date of Birth (mm/dd/yyyy):

    Who Else Lives In Your Home?

    First NameLast NameRelationshipDate of Birth (mm/dd/yyyy)

    Tell Us Where You Live

    Street:Street (cont):City:State:Zip Code:County:

    We Have A Few Questions

    Have You Ever Fostered Before? If Yes: When and Where? Has A Home Study Ever Been Done On Your Home? If Yes: What Was The Agency/County DHR Name? What Was The Social Worker's Name?

    Tell Us Your Contact Information

    Home Phone Number Phone Format: (xxx) xxx-xxxx
    Work Phone #1: Work Phone #2: Email Address: Best Time: Preferred Method: Preferred Language Spoken: If "Other", Please Specify: Preferred Language Written: If "Other", Please Specify:

    Child Preferences

    Gender: Age Range: To

    Special Needs Issues

    As you consider special needs, we want to remember that every child and his or her needs are different. Please read over the accompanying examples (click link to see examples) and select the area(s) of need (if any) you feel your family is capable of meeting:
    Physical Disability: Click for description Emotional/Behavioral Disability: Click for description Mental Disability: Click for description
    Have you visited the photo listing of waiting children on this site? If Yes, was there a specific child or sibling group you are interested in? If Yes, name/case number of children:
    How did you hear about our website? Other, Specify:


    Examples of Level of Physical Disability

    • Mild = May require occasional Doctor visits and regular medication
    • Moderate = May require frequent Doctor visits, involvement with other health professionals, and multiple medications. Some limitations in activities, diet, and/or lifestyle
    • Severe = May require regular intervention by health care professionals, and significant limitations in activities, diet and /or lifestyle.

    Examples of Level of Emotional/Behavioral Disability

    • Mild = May need occasional therapy. Overall good functioning at school, at home and with peers.
    • Moderate = May need assistance at home, at school, and/or with peers. Problems can be treated with medication, behavior therapy or counseling as needed.
    • Severe = May have serious problems getting along with others at home, and at school. Will need regular intervention from mental health professionals. Have a history of risk of harming themselves or others.

    Examples of Level of Mental Disability

    • Mild = May require special education services in a traditional classroom setting. With training and education, most are able to hold jobs and live independently as an adult.
    • Moderate = As a child, may require special education classroom placement. Will be educationally and socially behind same age peers. With training and education, many are able to live and work in supervised settings as an adult.
    • Severe = As a child will require extensive supervision in school, at home and in the community both as a child and as an adult.