contact us

foster parent resources

foster youth

You can complete and submit this inquiry electronically, OR send an e-mail directly to JButts3@dhr.state.md.us OR call 410-897-3950.  Thanks! 

Prospective Resource Parents
Name:
Address:
City/Town:
State:
Zip:
Phone:
E-mail:
Are you an Anne Arundel County resident?
Yes No
Are you over the age of 21?
Yes No
What is your local High School?
Source of Inquiry
How did you hear about our program? (Please be as specific as possible)
TV/Radio
Friend
Newspaper
Pennysaver
Foster Parent
Recruitment Activity
Internet
Other
Why did you contact us today?
What services are you intrested in providing?
Foster Care
Adoption
Respite (holidays, school breaks, weekends)
A Specific Child (restricted)
If so, child's name
Worker's name
What age range intrests you?
-
What is your gender preference?
M F
How many children would you like to accept into your home?
How many people live in your house?
How many bedrooms do you have?
What are the ages and genders of your other children?
Age    Gender
   
   
   
   
   
Do you speak a language other than English?
Yes No
If yes, what other language(s)?
Do you know Sign Language?
Yes No
Safety Questions:
Do you have a pool?
Yes No
If yes, is it:
above ground or in-ground
Do you live on the water?
Yes No
Are you CPR certified?
Yes No
Comments: