Foster Care/Adoption Inquiry Form

Please take a moment to complete the following information, and we will send you additional information about becoming a foster/adopt parent through Clermont County Children?s Services.

Items with a "*" next to them are required fields.

Inquiring about:
AdoptionFoster Care

Parent #1 First Name: *
Parent #1 Last Name: *
Parent #1 Date of Birth:
Ethnicity/Race:

Parent #2 First Name:
Parent #2 Last Name:
Parent #2 Date of Birth:
Ethnicity/Race:

Other Names
(maiden, etc.):

Street Address: *
City: *
State: *
Zip: *

Home Phone:
Work Phone (Parent#1):
Work Phone (Parent#2):
Email Address:

OPTIONAL INFORMATION

Where did you hear about Clermont County?s Foster Care & Adoption Program?

Radio AdNews StoryBillboard
Radio ProgramOther Foster ParentCommunity Event
TV AdOther Adoptive ParentInternet
TV ProgramPosterOther
Newspaper Ad

If other, please specify:

Comments: (Max: 200 characters)

If you have additional questions, please feel free to call the number below or send e-mail to Clermont County Children?s Services staff.

Clermont County Children?s Services
Telephone: 513-732-7173
Fax: 513-732-7833

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