San Luis Valley 2021 Support Group "Restart" Registration

2021-SanLuisValley-Support-Group-Restart

General Family Information
Are you fostering as a single individual or as a couple?*
- Single
- Couple
Foster Parent 1 Name*
First Last
Foster Parent 1 Phone*
Foster Parent 1 Email*
Foster Parent 1 Allergies/Dietary Restrictions*

This is not necessarily support group related, just helpful to have on hand for events/encouragement gifts/etc!
Foster Parent 1 Nametag*
We know that it's been a while since you've needed your nametag - let us know if you need a replacement nametag, if you never got one (licensed during covid), or if you still have yours and don't need a new one! We will use the name you entered above for the nametag.
- Yes, I need a nametag!
- No, I have mine!
Foster Parent 2 Name*
First Last
Foster Parent 2 Phone*
Foster Parent 2 Email*
Foster Parent 2 Allergies/Dietary Restrictions*

This is not necessarily support group related, just helpful to have on hand for events/encouragement gifts/etc!
Foster Parent 2 Nametag*
We know that it's been a while since you've needed your nametag - let us know if you need a replacement nametag, if you never got one (licensed during covid), or if you still have yours and don't need a new one! We will use the name you entered above for the nametag.
- Yes, I need a nametag!
- No, I have mine!
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Do you need a Hope & Home nametag?*
We know that it's been a while since you've needed your nametag - let us know if you need a replacement nametag, if you never got one (licensed during covid), or if you still have yours and don't need a new one!
- Yes, I/we need a nametag(s)!
- No, I/we still have ours!
Name(s) to appear on nametag (first and last please):
Childcare Information
Hope & Home provides free childcare services to families attending classes and Support Groups at Hope & Home (and we LOVE being able to do so!). We know that in foster care your childcare needs can change quickly. Please keep us informed of those changes! We strive to ensure that each and every child has a great, growth-oriented experience at Hope & Home. Please read our 2021 Childcare Policy
Childcare Policy*
By checking the box below, I affirm that I have read, understand, and agree to comply with Hope & Home's Support Group Childcare Policy.
- Yes, I agree
- No, I don't agree
Signed Childcare Policy
If you are tech savvy, please upload your signed childcare policy. **Note: if you are a couple, both individuals need to sign this policy or upload two documents. Digital signatures are okay! If you can't upload your signed policy right now, we will ask you to sign one prior to utilizing childcare in 2021 as we must have a policy on file for each family!
Drop files here or

Max. file size: 50 MB.
How many placements are you generally open for and what age ranges?*
Examples: 2 openings, ages 7-18 OR 1-3 openings, ages 1-3, 12-16 OR Closed license. | Knowing this number helps us arrange groups to be able to accommodate potential placements in childcare numbers.
How many children are you registering today?*
We understand that this number may change, but please register the children who will be in your home as of June 1. (If you are uncertain whether or not a placement will still be with you on June 1, please go ahead and register them. It is easier to remove someone than add them.) Thank you!
Child 1 Name*
First Last
Child 1 Age*
Child 1 Date of Birth*
MM slash DD slash YYYY
Child 1 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 1 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 1 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 2 Name*
First Last
Child 2 Age*
Child 2 Date of Birth*
MM slash DD slash YYYY
Child 2 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 2 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 2 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 3 Name*
First Last
Child 3 Age*
Child 3 Date of Birth*
MM slash DD slash YYYY
Child 3 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 3 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 3 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 4 Name*
First Last
Child 4 Age*
Child 4 Date of Birth*
MM slash DD slash YYYY
Child 4 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 4 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 4 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 5 Name*
First Last
Child 5 Age*
Child 5 Date of Birth*
MM slash DD slash YYYY
Child 5 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 5 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 5 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 6 Name*
First Last
Child 6 Age*
Child 6 Date of Birth*
MM slash DD slash YYYY
Child 6 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 6 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 6 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 7 Name*
First Last
Child 7 Age*
Child 7 Date of Birth*
MM slash DD slash YYYY
Child 7 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 7 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 7 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 8 Name*
First Last
Child 8 Age*
Child 8 Date of Birth*
MM slash DD slash YYYY
Child 8 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 8 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 8 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 9 Name*
First Last
Child 9 Age*
Child 9 Date of Birth*
MM slash DD slash YYYY
Child 9 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 9 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 9 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 10 Name*
First Last
Child 10 Age*
Child 10 Date of Birth*
MM slash DD slash YYYY
Child 10 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 10 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 10 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 11 Name*
First Last
Child 11 Age*
Child 11 Date of Birth*
MM slash DD slash YYYY
Child 11 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 11 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 11 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Child 12 Name*
First Last
Child 12 Age*
Child 12 Date of Birth*
MM slash DD slash YYYY
Child 12 Status*
We do not put this status anywhere that is visible to your child or others. It is only used to better inform how we care for your child.
Child 12 Allergies*
Please list ALL allergies your child has. Only list actual allergies here, preferences can be described in the "Additional Information" section below.
Child 12 Additional Information*
Please tell us anything else we should know here! This information is valuable to us as we use it in order to provide the best possible care for your child. Information given can range from "Autistic, non-verbal." to "Sensory issues - heavy work helps." to "Significant history of sexual abuse. Watch closely in play spaces with other children." to "Loves playing dress up" to "Doesn't like pepperoni, prefers cheese."
Support Group Registration
Neighborhood Support Groups are designed to act as your homeroom - a space where you can get to know other foster parents, welcome new foster parents, share in the joys and struggles, happiness and sadness of foster parenting.
Please register for one:*
- 2nd Monday - 6pm - Living Waters Bible Fellowship (2910 Clark Street, Alamosa, CO 81101)
- 4th Thursday - 8:30pm - Direct Reach Virtual Support Group (ZOOM)
Other Comments*
Is there any other information we should know when placing you into a Support Group?

San Luis Valley 2021 Support Group "Restart" Registration

2021-SanLuisValley-Support-Group-Restart

General Family Information

Childcare Information

Support Group Registration

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