Foster Care Application

A Foster
Care Story

Please complete this online application.

Today's Date:

*Your First & Last Name:

Your Date of Birth:

Your Spouse's Name (if applicable):

Your Spouse's Date of Birth (if applicable):

Street Address:

City:

State:

Zip Code:

Country:

*Daytime phone (M-F 8a-5p):
xxx-xxx-xxxx

Other phone:
xxx-xxx-xxxx

*Email address:
Please enter a valid Email Address, if email is not available, please enter NONE.

Current marital status:

Single

Married

Divorced

Number of years married/divorced:

Names & ages of other children living in your home:

Names of other adults living in your home:

Languages spoken in your home:

Interests:

Adoption

Foster Care

Foster Care & Adoption

Unsure

Will you foster or adopt a sibling group?:

Yes No

Maximum number of children you are willing to foster:

Maximum age of child you are willing to foster:

Gender of children you are willing to foster or adopt:

Boy Girl Either

Ethnicity of child you are willing to foster or adopt:

Have you ever applied to foster or adopt before:

Yes No

If so, when and where:

Describe your family (optional):

How were you referred to our web site (check all that apply):

Radio

Brochure

Billboard

Other Web Site

Presentation

Newspaper

Foster Parent

Adoptive Parent

Self search for foster care or adoption

Other (describe):

The Children's Home of Lubbock
P.O. Box 2824
Lubbock, Texas 79408
806-762-0481
Contact Us by Email