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Inquiring about: Adoption Foster Care
Parent #1First Name:
Parent #1Last Name:
Date of Birth:
Parent #2 First Name:
Parent #2 Last Name:
Date of Birth:
Other Names (maiden, etc.):
Street Address:
City:
State: Zip Code:
Home Phone:
Work Phone (Parent#1):
Work Phone (Parent#2):
OPTIONAL INFORMATION
Where did you hear about CSB's Foster Care & Adoption Program?
Radio Ad Radio Program
TV Ad TV Program
Newspaper Ad News Story
Other Foster Parent Other Adoptive Parent
Poster Billboard
Internet Other:
Ethnicity / Race (optional):
COMMENTS


If you have additional questions, please feel free to call the number below or send e-mail to the SCCS staff.
Summit County Children Services
Telephone: 330.379.1990
Fax: 330.379.1924
Email: inquiry@summitkids.org


Summit County Children's Services 2006
Child Hotline (330)434-KIDS(5437)
Summit County Children Services Website Policies