Register Your Interest In Fostering

1
Personal Details : First Applicant / Enquirer
Are you a registered Childminder? 
YesNo
is there a second applicant? 
YesNo
3
Household Details
Is this your own home(i.e. where you plan to live when fostering)? 
YesNo
Are there any smokers in the household? 
YesNo
Are there any other household members? 
YesNo
Have you or any member of your family had Social Care Involvment in the past? 
YesNo
4
Fostering Interests
What sort of fostering are you interested in?( select all that apply)
Short-Term
Long-Term
Respite
Parent and Child
Brothers and Sisters Teenagers
Children with additional needs
Unaccompanied Asylum-Seeking Children (UASC)
Gender (select all that apply)
Male
Female
Age Ranges (select all that apply)
0 to 4 Years
5 to 10 Years
11 to 15 Years
16 + Years
5
Contact Details 
5
Contact Preference
Telephone
Email (please check that you have provided an email address above)
Post
6
Other Information
Have you seen or heard any marketing about Fostering with Worcestershire County Council? 
YesNo
How did you hear about us?
Please select all that apply
Newspaper Advert
Word of Mouth
Poster/ Flyer/ Leaflet
Newspaper/ Magazine Article
Internet/ Social media/ Online Advert
County Council Website
Council Tax Booklet
Radio/ TV
Referral from another agency/ authority
Promotional Stand
Google Search
Online Directory
Yellow Pages
BAAF Website
Other
7
Consent
I consent to you retaining my information and contacting me
I consent for the information I have provided to be used by Worcestershire Fostering. This may include marketing the information appropriate to Fostering for Worcestershire and I agree for my information being shared with other related organisations