CHILD INQUIRY FORM

Connecting the Hearts of Foster Children with their Forever Families

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Child(ren) for Whom You are Inquiring:
Marital Status: Married Single Widowed Other
Your Full Legal Name:
Other Adults Living in Your Home (18 & older): Relationship:
  Relationship:
  Relationship:

Children Living in Your Home:

  Age: Gender: Male Female
   Age: Gender: Male Female
   Age: Gender: Male Female
   Age: Gender: Male Female
State of Residence:
County of Residence:
Best Daytime Phone Number:
Email Address:  
Licensing Status: Licensed to FosterCertified to Adopt In the process of getting licensed/certifiedJust beginning the process of getting licensed/certified (continue to the special notes section)
Licensing/Certification Worker's Name (if applicable):

Licensing/Certification Worker's Email address:

Licensing/Certification Worker's Phone number:

Licensing/Certification Worker's Agency:

Do you have an electronic copy of your home study?
 

 Yes No

Special Notes:

 
  Please Initial in the Box that "I have read and understand the following Legal Disclaimer":

The Arizona Heart Gallery (AHG), LLC, promotes the need for adoptive parents and foster parents in our communities.  While we occasionally undertake additional acts at the request of individuals to facilitate foster and adoptive relationships, AHG cannot guarantee or warrant that these acts will have any effectiveness whatsoever and takes no responsibility for the accuracy of the information AHG passes on to others while undertaking such actions.  By requesting AHG to undertake such actions, you understand that AHG does not make decisions regarding the matching of foster children with prospective families and is not responsible for the outcome of foster or adoption matching; any action you ask AHG to undertake on your behalf regarding a potential or existing foster or adoptive relationship is undertaken at your own risk and discretion. 

ONE LAST THING:
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