Foster Care Inquiry Form

Please complete this form if you're interested in providing foster care in Vermont or helping in other ways.

---

First & Last Name *

What town/city do you live in? *

Which county is this in? *

Addison

Bennington

Caledonia

Chittenden

Essex

Franklin

Grand Isle

Lamoille

Orange

Orleans

Rutland

Washington

Windham

Windsor

Which best describes your situation? *

I'm ready to do foster care! Please contact me ASAP.

I'm not quite ready to do foster care but could do respite care. Please contact me at your earliest convenience.

I'm interested in learning more about foster and respite care. Please contact me at your earliest convenience.

If you want to do foster care, who would you foster? Check all that apply.

Child birth to age 3

Child age 4 to 7

Child age 8 to 12

Teen age 13 to 18

Sibling group

Child from a different race, ethnicity or culture

Child with complex medical or developmental needs

Child who identifies as LGBTQ

Child who needs short-term, urgent care

Teen transitioning from residential care back to the community

Email Address *

Phone Number *

List the best phone number to reach you, including the area code.

What's the best way to reach you? *

Email

Phone

If you answered phone, what time is best?

How did you find out about the need for foster parents? *

Poster/brochure/flyer/bookmark

Front Porch Forum

Social media (e.g., Facebook, Twitter, YouTube)

Radio

Television

Newspaper

Event/display at an event

Foster parent (current or former)

Word of mouth

DCF contacted me

Raise A Child Campaign

School

DCF website

Lund

Presentation at my church, club, etc.

If you'd like to get an information packet, provide your full mailing address below.

OPTIONAL:

	Yes	No
Are you at least 21 years old?	Are you at least 21 years old? - Yes	Are you at least 21 years old? - No
Can you make sure no one smokes in your home or car?	Can you make sure no one smokes in your home or car? - Yes	Can you make sure no one smokes in your home or car? - No
Are you open to providing short-term care with very little notice?	Are you open to providing short-term care with very little notice? - Yes	Are you open to providing short-term care with very little notice? - No

Tell us if you are responding to a post about a specific child and any other information you'd like us to know: