Therapeutic Foster Care Parent Application

Welcome

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Get In Touch

Email: support@total.com

Phone: 1-800-Total-Theme

Address: Las Vegas, Nevada

Our Location

380 SUWANNEE TRAIL STREET BOWLING GREEN, KY 42103

Name of Prospective Parent 1*
Age*
Name of Prospective Parent 2
Age
Length of Marriage

If Applicable
Address*
Street Address City State ZIP Code
Cell Phone: Prospective Parent 1*
Cell Phone: Prospective Parent 2*
Home Phone*
Work Phone*
Email*
Children in the Home*
Name of Child Age

Please list all children's names and ages.
I am Interested in Fostering:*
Age(s) Gender(s) Ethnicity(s)
About Perspective Parents & Home
Are prospective parent(s) employed?*
- Yes
- No
Name of First Parent's Employer*
Length of First Parent's Employment*
First Parent's Employer Phone*
What prompted your interest in becoming a Therapeutic Foster Care Parent?*
Is your home in good repair?*
Is your home kept clean?*
How many bedrooms and people per bedroom are currently in your home?*
How many bathrooms are in your home?*
How many people are currently living in your home?*
Age Gender

Please list the age and gender of each person living in your home.
Additional Information:
Please add other important information not already mentioned.
Strengths & Needs Checklist
Do you have current certifications in CPR and First-Aid?*
- Yes
- No
Is there adequate bedroom space for a foster child and those that are currently residing in the home?*
- Yes
- No
Is there adequate drawer and closet space in the bedrooms?*
- Yes
- No
Is there adequate play space (inside and outside)?*
- Yes
- No
Is there adequate living space for all family members?*
- Yes
- No
Are firearms kept unloaded and locked away?*
- Yes
- No
- Not Currently
- N/A
Is ammunition stored separately and locked away?*
- Yes
- No
- Not Currently
- N/A
Are harmful substances such as ammonia based household cleaning products stored appropriately?*
- Yes
- No
- Not currently, but I can and will make this change
Are necessary safety precautions taken regarding swimming pools, trampolines, weight lifting equipment, four wheelers, etc.?*
- Yes
- No
- Not Currently
- N/A
Are there working smoke detectors near each bedroom?*
- Yes
- No
- Not Currently
Is there a fire extinguisher in the kitchen?*
- Yes
- No
- Not Currently
Are all medications locked away or out of reach?*
- Yes
- No
- Not Currently
Do you have adequate first-aid supplies?*
- Yes
- No
- Not Currently
Are safety drills conducted monthly?*
- Yes
- No
- Not Currently
Do you have access to adequate care for foster children during the summer?*
- Yes
- No
i.e. taken to day care, transported to a summer camp, or remain in the home if approved by treatment team (approval based on each child's needs)
Can you commit to completing the necessary paperwork?*
- Yes
- No
Can you commit to a meeting with the program manager once a month?*
- Yes
- No
Can you attend a service team meeting once a quarter for each child in your home?*
- Yes
- No
Can you transport the child when necessary to appointments, school, service team meetings, family visits, or therapy sessions?*
- Yes
- No
Will you be able to respect the cultural, ethnic, and religious differences of the child?*
- Yes
- No
Will you collaborate with teachers, biological parents, and service team members as needed?*
- Yes
- No
Can you commit to 24 hours yearly of additional training?*
- Yes
- No
Can you say that money will not be the major factor in the decision to become a Therapeutic Foster Care Parent?*
- Yes
- No
Will you accept a child that may have severe behavioral or emotional problems?*
- Yes
- No
Can you commit to having a list of rules and consequences that everyone must follow regardless if the child is biological or fostered?*
- Yes
- No
Email
This field is for validation purposes and should be left unchanged.

Name of Child	Age

Age(s)	Gender(s)	Ethnicity(s)

Age	Gender

About Perspective Parents & Home

Strengths & Needs Checklist