Foster Carer Registration of Interest Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.I/We have read the Information Pack for potential carers, including “Matthew’s story” and (mark one) *I/we would like to be contacted by a worker from your agency to arrange an Information Sharing Session.I/we have already arranged with your agency to attend an Information Sharing SessionInformation Session DatePersonal DetailsPlease provide the following information. If you have a couple, details of both people must be providedCarer Name *PhoneEmail *Carer Name 2Phone 2Email 2Home Address *Household InformationNumber of Household membersInclude adults, young people and children regularly living in your home or residing on your property on a regular or frequent basis, including in a caravan, vehicle or any other structure.Member 1DOBGenderMaleFemaleRelationship to first personRelationship to second personMember 2DOB 2Gender 2MaleFemaleRelationship to first person 2Relationship to second person 2Member 3DOB 3Gender 3MaleFemaleRelationship to first person 3Relationship to second person 3Member 4DOB 4Gender 4MaleFemaleRelationship to first person 4Relationship to second person 4Member 5DOB 5Gender 5MaleFemaleRelationship to first person 5Relationship to second person 5Details of other membersWhat languages do you speak at home?Are you of Aboriginal background?YesNoAre you of Torres Strait Islander background?YesNoHave you or any member of your household applied to, or been authorised to be a carer with any other agencies?YesNoDetailsWhat type of care are you interested in applying for? (mark any you are interested in)Respite careEmergency care interimRestoration careLong-term fosteringFostering with a view to undertaking (until 18 years) or adoptionFostering with a view to open adoptionSubmit
