FOSTER CARE INTEREST FORM

First Name (required)

Last Name (required)

Street Address

City

State

ZIP

Telephone Number

Your Email (required)

DOB

Profession

Place of Employment/School

Languages Spoken other than English

Previous Volunteer/Work experience that relates to the work of Hope Rising

Special Skills (media, technology, administration, marketing, fundraising, event planning, care giving, horse experience) br/>

Availability

Please share your heart regarding the desire to become a foster parent or respite care giver with Hope Rising

If wanting to be considered for direct care or mentoring, please let us know if you have ever experienced any form of abuse.

Emergency Contact Info

Do you have any medical history that we should be aware of (allergies, medications, etc.)

Disclaimer and Signature

I understand that as a care giver, I am willing to submit to a background check, fingerprinting and drug testing in order to be considered. I hereby waive, release and hold harmless from any liability or claims for damages for personal injury, including death, as well as from claims for property damage which arise in connection with any aforementioned activity against Hope Rising/The Meadows Ranch and all affiliated staff members. I hereby consent to treatment of any minor child under my care or myself for any and all medical procedures deemed necessary as a result of accident or injury.

I grant to Hope Rising/The Meadows Ranch, its representatives and employees the right to take photographs of me and my property in connection with Hope Rising/The Meadows Ranch events. I authorize Hope Rising/The Meadows Ranch, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Hope Rising/The Meadows Ranch may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

Electronic Signature

Check Box – I understand that by checking this box, I am providing my electronic signature to the above agreement