Registration of Interest in Foster Care
I have read the ‘Information Pack for Potential Foster Carers’ and
I would like to be contacted by a worker from CareSouth to arrange an Information Exchange Session
Your Name
Your Address
Home Phone
Work Phone
Mobile Phone
Email Address
Please complete for all members of your household
(include all people who regularly stay overnight)
Name of Householder
Date of Birth
Male / Female
Male
Female
Relationship to you
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
Male
Female
What language(s) do you speak at home?
Are you of Aboriginal background?
Yes
No
Are you of Torres Strait Islander background?
Yes
No
Have you previously applied to any other agencies to foster or have you previously been a foster carer?
Yes
No
Please provide details and the result of the application
What type of care are you interested in applying for?
Respite Care
Temporary Care
Long Term Care
I confirm to the best of my knowledge that the above information is correct.