Foster Care Inquiry Form

Please complete this form if you are interested in providing foster care in Vermont. All fields that are marked with a red asterisk* are mandatory.

First Name

Last Name

Town/City Where You Live

What county is that in?

CONTACT INFORMATION

What's the best way to reach you?

By email

By phone

Email Address

Phone Number

(include the area code)

If you provided a phone number, what's the best time to call you?

Another way to reach you

(e.g., email address or phone number)

What best describes your situation?

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

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

Please provide the full name of the foster parent who referred you to the foster care program.

If you learned about foster care another way, please describe it below.

INFORMATION PACKET

I would like to get an information packet.

To get an information packet, provide your full mailing address below.

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

ADDITIONAL INFORMATION

Is there anything else you'd like us to know? (e.g., you're interested in fostering a specific child)

OPTIONAL QUESTIONS

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

CAPTCHA

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