Intake Form

If you are interested in becoming a Foster Caregiver please fill out the intake form below. Once you submit your intake form, we will contact you by your preferred method within 2 business days.

First Name *

Last Name *

Phone Number *

Email *

Address *

Address Line 2

City *

Postal Code *

Preferred Method of Contact *

Where did you hear about the need for foster caregivers? Select all that apply. *

Family / Friend
MCFD Website
fosterconnections.ca
Friendship Centre
Community
Google / Internet
TV / News Storey
Radio
Newspaper
Recruitment Material (Poster)
Advertisement
Other

Family Status *

Age Range *

Does anyone in your home have an Indigenous Heritage? *

Are you interested in fostering Indigenous Children? *

What type of parenting experience do you have? *

If other, what type?

Are you currently parenting? *

Info on children in the home (age, gender, etc.)

Info on those older than 19 in the home (relationship, etc.)

Captcha *

Comment

c/o Indigenous Perspectives Society: Centre of Excellence in Community Education 664 Granderson Road Langford BC Canada V9B 2R8 250.391.0007

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