HOCKING COUNTY CHILDREN SERVICES 93 WEST HUNTER STREET LOGAN, OHIO 43138 ( 740)-385-4168
INITIAL INFORMATION FORM
PROSPECTIVE FOSTER/ADOPTIVE PARENTS
Today's Date
Your Information
Name(s) of Prospective Parent(s):
Address:
Work Phone:
Home Phone:
Best Time To Call:
Email:
Prospective Mother's DOB
:
Prospective Father's DOB
:
Marital status
:
Single
Married
Widow
Separate
Divorced
Co-parenting
Length of marriage
:
Children already in your home:
:
How Many?
Female/s
Male/s
Employment:
Prospective Mother
:
Hours Working per Week:
Prospective
Father
:
Hours Working per Week:
Location of Home
County:
Own or Rent?
Where is home located?
City
Apartment Complex
Rural
Mobile Home Park
Number of bedrooms
:
Preference of children
How Many?
male or female or both?
Age Range:
Reason for Preference