Foster Carer – Register of Interest | South Coast Medical Service Aboriginal Corporation

I/ we have read the Information Pack for potential Carers, including “Matthew’s Story” and:*
- 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 Session
- I/ we have not read the Information Pack
I am interested in applying for:*
- Emergency care
- Respite care
- Interim/restoration care
- Long term fostering
- Fostering with a view to guardianship
- Unsure
Your contact details
Name of person 1*
First Last
Name of person 2
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 1*
Phone 2
Email 1*
Email 2
Your home
Please complete the list below for all members of your household. (Click on the + on the right to add a new line for another household member).*
Name DOB Male or female Relationship to person 1 Relationship to person 2
What language(s) do you speak at home?
Person 1 is:*
- of Aboriginal background
- of Torres Strait Islander background
- of both Aboriginal & Torres Strait Islander background
- None of the above
Person 2 is:*
- of Aboriginal background
- of Torres Strait Islander background
- of both Aboriginal & Torres Strait Islander background
- None of the above
Have you or any members of your household applied to, or been authorised to be a Carer with any other agencies?
- Yes
- No