Foster/Adoptive/Kinship Family Form

Name *

First Name

Last Name

Phone

(###)

###

####

I am a foster parent interested in these services:

Please check all that apply. (We serve children and families from York and surrounding South Carolina counties.)

Receiving emails via the Defend Newsletter

Attending Connection and/or Respite Events

Applying for the Mental Health Scholarship

I want to visit the York County Foster Closet

We need supplies from the Back 2 School program

Placement Type *

Foster

Adoption

Kinship

Other

Ages of Children

Please check all that apply.

Infant

12-24 months

2-3

4-5

6-7

8-9

10-11

12-13

14-15

16-18

Schedule Appointment

(Weekdays)

9am

10am

11am

12pm

After Hours Appt. (we’ll contact you to schedule)