2025 Foster Summer Program Flyer

Registration for 2025 Foster Summer Program for Youth and Young Adults

Foster Parent Information

Foster Parent(s) Name(s)

Foster Parent(s) Primary Email

Address

City

Region/State/Province

Postal / Zip code

Home Phone (Landline)

Parent 1's Phone (Cell)

Parent 1's Phone (Work)

Is anyone other than the foster parents authorized by DCS to pick up your foster child(ren)?

Parent 2's Phone (Cell)

Parent 2's Phone (Work)

If yes, please list name and phone numbers of all authorized alternative pick-ups

NEVER SEND ANY UNAUTHORIZED PERSON TO PICK UP YOUR FOSTER CHILDREN. TAKE HEART, INC. MAY NOT RELEASE FOSTER CHILDREN TO UNAUTHORIZED INDIVIDUALS.

DCS Information

Your DCS Caseworker’s Name and Phone Number

Names of Youth's Biological Parents

Are you working with an agency, other than or in addition to DCS, regarding the placement of the above-named child(ren)? (Y/N)

If so, please list agency, name of case manager/staff, and contact phone and email

Current Situation Regarding Biological Parent Contact and Other Pertinent Information

NECESSARY DOCUMENTS

I understand that I must provide Take Heart Inc. with a copy of parent/youth Driver's License/State Issued ID for above youth to be eligible for this program

I understand that I must provide Take Heart Inc. with a copy of relevant DCS paperwork for above youth to be eligible for this program

I understand that I must provide Take Heart Inc. with a copy of Court Orders (relating to contact, etc.) for above youth to be eligible for this program

Thanks for registering!

Take Heart, Inc. (including any of its affiliates) is an equal opportunity nonprofit. It does not discriminate against any person on the basis of race, creed, religion, color, national origin, marital status, gender, sexual orientation, or (dis)ability.

Registration for 2025 Foster Summer Program for Youth and Young Adults

Youth/YA Information

Foster Parent Information

NEVER SEND ANY UNAUTHORIZED PERSON TO PICK UP YOUR FOSTER CHILDREN. TAKE HEART, INC. MAY NOT RELEASE FOSTER CHILDREN TO UNAUTHORIZED INDIVIDUALS.

DCS Information

NECESSARY DOCUMENTS

Take Heart, Inc. (including any of its affiliates) is an equal opportunity nonprofit. It does not discriminate against any person on the basis of race, creed, religion, color, national origin, marital status, gender, sexual orientation, or (dis)ability.

If registering multiple youths/young adults, please fill out one form per individual

Address

Phone

Email

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