Online Inquiry
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<ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Basic Contact Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content">Thank you for taking the time to complete this form. Please answer questions completely and honestly.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_First_A"><i class="fa fa-font"></i><label class="er_fld_label required">First Name (Parent A)</label><input name="CST_1" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Last_A"><i class="fa fa-font"></i><label class="er_fld_label required">Last Name (Parent A)</label><input name="CST_2" type="text" class="er_fld_required"></li><li class="er_fld_type_dropdown" draggable="false" style="width: 25%;" map_to="FH_Gender_A"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Sex (Parent A)</label><select name="CST_30" class="er_fld_required"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Male">Male</option><option value="Female">Female</option></select></li><li class="er_fld_type_date" draggable="false" style="width: 25%;" map_to="FH_DOB_A"> <i class="fa fa-calendar"></i><label class="er_fld_label required">Date of Birth (Parent A)</label><input class="cst_datepicker er_fld_required" name="CST_48" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_EMail"><i class="fa fa-font"></i><label class="er_fld_label required">Email Address (Parent A)</label><input name="CST_3" type="text" class="er_fld_required"></li><li class="er_fld_type_number" draggable="false" style="width: 33.3333%;" map_to="FH_Phone_Mobile"><i class="fa fa-hashtag"></i><label class="er_fld_label required">Phone Number (Parent A)</label><input name="CST_4" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Occupation_A"> <i class="fa fa-font"></i><label class="er_fld_label required">Occupation (Parent A)</label><input name="CST_41" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_First_B"><i class="fa fa-font"></i><label class="er_fld_label">Partner/Spouse First Name (Parent B)</label><input name="CST_5" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Name_Last_B"><i class="fa fa-font"></i><label class="er_fld_label">Partner/Spouse Last Name (Parent B)</label><input name="CST_6" type="text"></li><li class="er_fld_type_dropdown" draggable="false" style="width: 25%;" map_to="FH_Gender_B"><i class="fa fa-caret-down"></i><label class="er_fld_label">Sex (Parent B)</label><select name="CST_31"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Male">Male</option><option value="Female">Female</option></select></li><li class="er_fld_type_date" draggable="false" style="width: 25%;" map_to="FH_DOB_B"> <i class="fa fa-calendar"></i><label class="er_fld_label">Date of Birth (Parent B)</label><input class="cst_datepicker" name="CST_49" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_EMail_2"> <i class="fa fa-font"></i><label class="er_fld_label">Email Address (Parent B)</label><input name="CST_33" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Phone_Mobile_B"> <i class="fa fa-font"></i><label class="er_fld_label">Phone Number (Parent B)</label><input name="CST_34" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Occupation_B"> <i class="fa fa-font"></i><label class="er_fld_label">Occupation (Parent B)</label><input name="CST_42" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="FH_MaritalStatus"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Relationship Status</label><select name="CST_7" class="er_fld_required"><option value="Single " selected="">Single </option><option value="Dating/Engaged">Dating/Engaged</option><option value="Married">Married</option><option value=""></option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="FH_Years_Married"><i class="fa fa-caret-down"></i><label class="er_fld_label">If married, for how long? </label><select name="CST_8"><option value="N/A" selected="">N/A</option><option value="Less than 1 year">Less than 1 year</option><option value="Between 1 and 2 years ">Between 1 and 2 years </option><option value="2 years or more ">2 years or more </option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Household Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Address_Street_1"><i class="fa fa-font"></i><label class="er_fld_label required">Street Address</label><input name="CST_9" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Address_Street_2"> <i class="fa fa-font"></i><label class="er_fld_label">Apartment # (if applicable) </label><input name="CST_10" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 20%;" map_to="FH_Address_City"><i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_11" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 20%;" map_to="FH_Address_State"><i class="fa fa-font"></i><label class="er_fld_label required">State</label><input name="CST_12" type="text" class="er_fld_required" value=""></li><li class="er_fld_type_number" draggable="false" style="width: 20%;" map_to="FH_Address_Zip"><i class="fa fa-hashtag"></i><label class="er_fld_label required">Zip Code </label><input name="CST_13" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 20%;" map_to="FH_Address_County"> <i class="fa fa-font"></i><label class="er_fld_label required">County</label><input name="CST_14" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="Location"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Which TBHC Office are you closest to? </label><select name="CST_16" class="er_fld_required"><option value=""></option><option value="Bedford">Bedford</option><option value="Waxahachie">Waxahachie</option><option value="Permian Basin">Permian Basin</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;"> <i class="fa fa-font"></i><label class="er_fld_label required">List the names and ages of each person who lives in your home.</label><input name="CST_36" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content">Ex: Sally Doe (12), Bobby Doe (10), Johnny Doe (5)</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;" map_to="FH_NumBedrooms"><i class="fa fa-caret-down"></i><label class="er_fld_label required">How many bedrooms are in your home? </label><select name="CST_15" class="er_fld_required"><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5+">5+</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Foster/Adopt Interest</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 100%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_info">TBHC is looking for foster families who can meet the greatest needs of children in care. Children who have moderate to high behavioral and emotional needs have the most difficult time finding placement. We have a variety of programs to fill in these gaps. We are in need of families willing to say yes to these types of kids and prevent them from being lost in the system.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox er_fld_selected" style="white-space: normal; width: 50%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Interested In:</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Foster Care">Foster Care</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Teen Pregnancy Care (Foster Care)">Teen Pregnancy Care (Foster Care)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Dual License (Fostering with ability to Adopt)">Dual License (Fostering with ability to Adopt)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Treatment Family Foster Care (transitional program for higher needs)">Treatment Family Foster Care (transitional program for higher needs)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Temporary Emergency Placement (14-30 day placements)">Temporary Emergency Placement (14-30 day placements)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Kinship (Fostering or Adopting a child you personally know)">Kinship (Fostering or Adopting a child you personally know)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Matched/Straight Adoption (From Foster Care)">Matched/Straight Adoption (From Foster Care)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Private Infant Adoption">Private Infant Adoption</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_23" value="Donating/Volunteering with TBHC">Donating/Volunteering with TBHC</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_23" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_23_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 33.3333%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Number of children you're open to</label><select name="CST_39" class="er_fld_required"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Unsure, I'd like to know more before deciding">Unsure, I'd like to know more before deciding</option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option></select></li><li class="er_fld_type_radio" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-circle-o"></i><label class="er_fld_label required">Would you be interested in fostering a pregnant/parenting teen</label> <label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_40" value="Yes">Yes</label><label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_40" value="No">No</label><label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_40" value="Unsure but I'd like to know more">Unsure but I'd like to know more</label><label class="er_option er_option_other er_option_other_off"><input class="type_radio er_option_other er_fld_required" type="radio" name="CST_40" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_40_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 25%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Age Range: please check all that apply</label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_43" value="Infant">Infant</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_43" value="Toddlers/Pre-School Range">Toddlers/Pre-School Range</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_43" value="Elementary Age">Elementary Age</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_43" value="Middle School Age">Middle School Age</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_43" value="High School Age">High School Age</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_43" value="I don't have a preference">I don't have a preference</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_43" value="Unsure, I'd like to learn more before deciding">Unsure, I'd like to learn more before deciding</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_43" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_43_Other" type="text"></label></li><li class="er_fld_type_checkbox" style="white-space: normal; width: 25%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Openness with Race: please check all that apply</label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="African-American">African-American</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="Asian-American (less than 1% of kids in care)">Asian-American (less than 1% of kids in care)</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="Caucasian">Caucasian</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="Hispanic">Hispanic</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="Multiracial">Multiracial</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="Native American (less than 1% of kids in care)">Native American (less than 1% of kids in care)</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="All of the above">All of the above</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_44" value="Unsure, I'd like to know more before deciding">Unsure, I'd like to know more before deciding</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_44" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_44_Other" type="text"></label></li><li class="er_fld_type_radio" style="white-space: normal; width: 25%;" draggable="false"><i class="fa fa-circle-o"></i><label class="er_fld_label required">Gender</label> <label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_45" value="Boy">Boy</label><label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_45" value="Girl">Girl</label><label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_45" value="Both or either">Both or either</label><label class="er_option er_option_other er_option_other_off"><input class="type_radio er_option_other er_fld_required" type="radio" name="CST_45" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_45_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_section" draggable="false" style="width: 50%;"><i class="fa fa-header"></i><label>Background Information</label><hr></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false" map_to="FH_ReferralSource"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">How did you find out about TBHC? </label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Google (TBHC Website)">Google (TBHC Website)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Facebook">Facebook</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Instagram">Instagram</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="I went to a Foster Care & Adoption Event ">I went to a Foster Care & Adoption Event </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="I'm connected with a TBHC Foster/Adopt family ">I'm connected with a TBHC Foster/Adopt family </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Family Member or Friend ">Family Member or Friend </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="My Church">My Church</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="I've attended a Joint Information Meeting (JIM)">I've attended a Joint Information Meeting (JIM)</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="CPS/DFPS/OCOK ">CPS/DFPS/OCOK </label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_19" value="Hope Local or Brave Event">Hope Local or Brave Event</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_19" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_19_Other" type="text"></label></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_ReferredByName"> <i class="fa fa-font"></i><label class="er_fld_label required">Please name the person, event, or church who referred you if applicable</label><input name="CST_21" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 100%;"> <i class="fa fa-paragraph"></i><label class="er_fld_label required">Do you have any experience with foster care or adoption?</label><textarea name="CST_46" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_medium" draggable="false" style="width: 50%;" map_to="FH_Inquiry_Why_Parents"><i class="fa fa-paragraph"></i><label class="er_fld_label required">Why do you desire to foster and/or adopt? (please provide detailed response) </label><textarea name="CST_24" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 50%;" draggable="false" map_to="none"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">Do you attend a church in your area? </label> <label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="No">No</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="No, but I have recently moved/changed churches and am looking for a new church">No, but I have recently moved/changed churches and am looking for a new church</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Yes, and they have a foster care & adoption ministry">Yes, and they have a foster care & adoption ministry</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_17" value="Yes, but they don't have a foster care & adoption ministry">Yes, but they don't have a foster care & adoption ministry</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_17" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_17_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Church"> <i class="fa fa-font"></i><label class="er_fld_label">What is the name of your Church? (if applicable)</label><input name="CST_18" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" style="width: 50%;"><i class="fa fa-caret-down"></i><label class="er_fld_label">Does your church have a foster care and adoption ministry?</label><select name="CST_47"><option value="- Not Specified -" selected="">- Not Specified -</option><option value="Yes">Yes</option><option value="No">No</option><option value="Unsure">Unsure</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;" map_to="FH_Inquiry_Comments"> <i class="fa fa-paragraph"></i><label class="er_fld_label required">Are there any circumstances that TBHC should be aware of prior to starting the licensing process?</label><textarea name="CST_25" style="width:100%;" class="er_fld_required"></textarea></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">For example: recent major life changes, potential background check ineligibility, financial concerns, grief and loss from infertility, etc... Please know that we appreciate your honesty as we know that often times these changes or circumstances can be deeply personal. Thank you for sharing with us.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;"> <i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_warn">Our family recruiter will promptly reach out to your family with additional information Due to our emails consistently ending up in junk/spam folders, we have been reaching out by call and/or text message to ensure you have received a follow up. If your family would prefer not be reached by call or text, please let us know by using the text box below. We're looking forward to meeting your family very soon!</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 100%;"><i class="fa fa-paragraph"></i><label class="er_fld_label required">Questions or Concerns?</label><textarea name="CST_26" style="width:100%;" class="er_fld_required"></textarea></li></ul>
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