Foster Parent Intake Form Today's date: Name * First Last * Last Phone * Email * Address * City * Postal Code * Preferred Method of Contact * Phone Email Either Family Status * Single Married Common-Law Age Range * 19 - 29 30 - 39 40 - 49 50+ What motivated you to inquire about fostering? * Family/Friends MCFD Website Online Video Friendship Centre Google Search/Internet Community TV/News Story Radio Newspaper/Magazine Bus advertisement Social media post I have always wanted to foster a child Do you self-identify as Indigenous (First Nations, Métis or Inuit)? * Yes No Does anyone in your home self-identify as Indigenous (First Nations, Métis or Inuit)? * Yes No Do you have a preference to foster for the Ministry of Children and Family Development or an Indigenous Child and Family Service Agency? * Please select an option...Ministry of Children and Family DevelopmentIndigenous Child and Family Service AgencyNo preference If you would prefer to foster for an Indigenous Child and Family Service Agency, do you have a preference which agency receives your intake? * Yes, please forward my intake form to the agency I have specified below No preference Indigenous Child and Family Service Agency Do you have any parenting experience? * Yes No Check all that apply: Biological Adopted Step Foster Other Other - please explain: Are you currently parenting? * Yes No Information on children in the home (ex. age, gender, etc.) Info on those older than 19 in the home (ex. relationship): It is a requirement that foster caregivers and anyone in your home 18 years or older, consent for a records review to see if there has been any prior involvement with a child welfare agency. Will you and others in your home over the age of 18 consent to this review? * Yes No Will you and others in your home over 18 years of age consent to a Criminal Records Check? * Yes No Why do you want to become a foster caregiver? * Are you prepared to provide temporary care to a child while working with their family to support the goal of returning the child to the family? This is the primary goal of foster care. * Yes No Are the primary caregivers in your home willing to commit to participating in and completing the mandatory caregiver training that will be made available to you? * Yes No Captcha If you are human, leave this field blank.