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Foster Parenting Questionnaire

Thank you for your interest in foster parenting.

To help us assist you with the information you are seeking, please provide the information listed below.

    First Name:

    Last Name:

    Address:

    Address (cont.):

    City, State, ZIP:

    Phone:

    Email Address:

    School District:

    County:

    How would you like to be contacted?

    EmailPhone

    How did you hear about CONCERN?

    If you selected "Search Engine" or "Other", please specify:

    What ages would you accept into your home? (check all that apply)

    0-6 years7-10 years11-12 years13-18/21 years

    Gender of child(ren) you would accept into your home:

    MaleFemale

    What type of specialized "type of placement" you would consider? (check all that apply)

    Foster-to-AdoptMedical Foster CareMother/BabySiblingsAdoptionCommunity Residential Rehabilitation

    Other pertinent information you feel we should know:

    Foster Parenting Informational Meeting

    Informational meetings are held at each foster care service site.  Contact the site nearest you for more information on upcoming meetings.

    CONCERN Office Locations

    © 2020 CONCERN - Professional Services for Children, Youth, and Families

    Corporate Office
    One West Main Street, Fleetwood, PA 19522
    (610) 944-0445


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