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Short Term Break Scheme -
Registration of Interest

This form is CONFIDENTIAL. We will not release this information to any third party without your prior consent.

Name: D.O.B.: Gender:
Name: D.O.B.: Gender:
Telephone (optional) - Day: Eve:
E-mail*:
Where did you hear about fostering (e.g. from a friend, press ad., leaflet etc.)?
Who are the other members of your household (adults and children)? Please provide names, gender, date of birth & their relationship to you.
Do you have space in your home for another child (e.g. spare bedroom)?
How would you describe your ethnic background/culture?
Religion (are you practising or nominal)?
Why do you want to foster?

*Please read our privacy policy.

 
© Foster Care Services North West 2005 All rights reserved
Foster Care Services - 65 Higher Hillgate, Stockport, Cheshire, SK1 3HD, 0161 477 0004
Registered office 65 Higher Hillgate, Stockport, Cheshire, SK1 3HD
Company reg. no. 5448746 registered in England and Wales