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:
ProspectiveFather:
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