Register Your Interest In Fostering
1
Personal Details : First Applicant / Enquirer
Title
----Please select----
Miss
Mr
Mrs
Ms
Other
First Name
Last Name
Maiden Name or Previous Name(s)
Date Of Birth
Day
--- Please Select ---
1
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31
Month
--- Please Select ---
January
February
March
April
May
June
July
August
September
October
November
December
Year
--- Please Select ---
2003
2002
2001
2000
1999
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1955
1954
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1952
1951
1950
1949
1948
Relationship Status
----Please select----
Civil partnership
Divorced
Married
Living with Partner
In a relationship
Single
Ethnicity
----Please select----
White British
White Irish
Any other White background
Traveller or Irish Heritage
Gypsy / Roma
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Indian
Pakistani
Bangladeshi
Any other Asian background
Caribbean
African
Any other Black background
Chinese
Any other ethnic group
Prefer not to say
Employment Status
----Please select----
Employed (Full Time)
Employed (Part-Time)
Self-Employed
Unemployed
Retired
Other
If you have selected 'Other', please enter the description
Occupation
Hours worked per week
Are you a registered Childminder?
Yes
No
Required field!
Date of Registration
is there a second applicant?
Yes
No
Required field!
2
Personal Details : Second Applicant / Enquirer
Title
----Please select----
Miss
Mr
Mrs
Ms
Other
First Name
Last Name
Maiden Name or Previous Name(s)
Relationship Status
----Please select----
Civil partnership
Divorced
Married
Living with Partner
In a relationship
Single
Date Of Birth
Day
--- Please Select ---
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
--- Please Select ---
January
February
March
April
May
June
July
August
September
October
November
December
Year
--- Please Select ---
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
Ethnicity
----Please select----
White British
White Irish
Any other White background
Traveller or Irish Heritage
Gypsy / Roma
White and Black Caribbean
White and Black African
White and Asian
Any other mixed background
Indian
Pakistani
Bangladeshi
Any other Asian background
Caribbean
African
Any other Black background
Chinese
Any other ethnic group
Prefer not to say
Employment Status
----Please select----
Employed (Full Time)
Employed (Part-Time)
Self-Employed
Unemployed
Retired
Other
If you have selected 'Other', please enter the description
Occupation
Hours worked per week
Are you a registered Childminder?
Yes
No
Required field!
Date of Registration
3
Household Details
House Name Or Number
Street
Town
County
Postcode
How long have you lived at this address?
Number of bedrooms in the property
Required field!
Number of spare bedrooms
Required field!
Is this your own home(i.e. where you plan to live when fostering)?
Yes
No
Required field!
Are there any smokers in the household?
Yes
No
Required field!
Are there any other household members?
Yes
No
Required field!
Have you or any member of your family had Social Care Involvment in the past?
Yes
No
Required field!
3.1
Add all the names of the household members
Name
Relation to Carer
Name
Relation to Carer
No household members to show...
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
Home Telephone
Mobile Telephone
Work Telephone
Email Address
5
Contact Preference
Telephone
Email (please check that you have provided an email address above)
Post
Required field!
6
Other Information
Have you seen or heard any marketing about Fostering with Worcestershire County Council?
Yes
No
Required field!
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
Please specify other
7
Consent
I consent to you retaining my information and contacting me
Required field!
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
Required field!
Thank you for providing your contact details.
We will be in touch soon via your preferred method of contact
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