Application Form – Acorn House Fostering

Applicant 1

Applicant 2

Family Name – Applicant 1 *

Family Name – Applicant 2 *

Forename(s) – Applicant 1 *

Forenames(s) – Applicant 2 *

Previous names – Applicant 1

Previous names – Applicant 2

Other “known by” names – Applicant 1

Other “known by” names – Applicant 2

Sexual orientation/how you identify? – Applicant 1 *

Sexual orientation/how you identify? – Applicant 2 *

Date of birth -Applicant 1

Date of birth – Applicant 2

Ethnicity -Applicant 1 *

Ethnicity – Applicant 2 *

Religion or faith group – Applicant 1 *

Religion or faith group – Applicant 2 *

Practising or non-practising – Applicant 1 *

Practising or non-practising – Applicant 2 *

Primary language in the – Applicant 1 *

Primary language in the home – Applicant 2 *

Other language(s) spoken in the home – Applicant 1 *

Other language(s) spoken in the home – Applicant 2 *

Would you consider yourself to have a disability or a long-term health condition? – Applicant 1 *

Would you consider yourself to have a disability or a long-term health condition? – Applicant 2 *

Email – Applicant 1

Email – Applicant 2

Mobile number – Applicant 1 *

Mobile – Applicant 2 *

Place of birth – Applicant 1 *

Place of birth – Applicant 2 *

NI Number – Applicant 1 *

NI Number – Applicant 2 *

Do you have the right to work in the UK? – Applicant 1 *

Do you have the right to work in the UK? – Applicant 2 *

Have you had any involvement with the local authority /children’s social care? – Applicant 1 *

Have you had any involvement with the local authority /children’s social care? – Applicant 2 *

Married/single/cohabiting What date did you start to live together? Date of marriage – Applicant 1 *

Married/single/cohabiting What date did you start to live together? Date of marriage. – Applicant 2 *

Please complete all questions below for both Applicant 1 and 2

Full Address (including postcode) *

Length of time at this address *

Do you own or rent the property? Have you sought the landlord’s permission to foster? *

Name of home local authority *

If you have been living at the above address for less than seven years, please provide your previous address details. *

Have any of the applicants ever had any involvement with CMS (CHILD MAINTENANCE SERVICE) previously known as CSA (CHILD SUPPORT AGENCY)? If so, please supply the child’s birth name, the child's date of birth, both parents' names and both parents' date of birth. (copy) *

Have either applicant ever been convicted of a criminal offence or been told that you are unable to work with children or vulnerable adults? *

Do you use social media platforms, such as Facebook, Instagram etc? If so, please could you let us know which ones. *

Do you own any pets/animals? – We will need to carry out a risk assessment on any pets/animals. *

Please provide details of any under the age of 18 living in the household – please include name, gender, date of birth and relationship to the applicant. *

Please provide details of any schools / colleges, higher education for the above children – please include name of child, name of the school, and contact details. *

Please provide details of any children (UNDER 18) from a current or previous partnership living elsewhere – please include name, gender, date of birth and relationship to the applicant. *

Please provide details of any other adults living in the household – We will need to carry out DBS checks and Local authority checks on all household members over the age of 18 the applicant. *

Please provide details of any adult children living elsewhere – please include name, gender, date of birth and relationship to applicant. *

Please provide details of any ex-partner – including any children in that relationship – please include name, date and length of relationship, last known address, contact number, social media platform they use. *

Please provide details of your education/occupation – please include your occupation, full contact details and start date of employment *

Are you or have you ever been made bankrupt or have you been awarded a CCJ – If yes, please provide full details. *

Have you previously applied to become a foster carer, adopter or child-minder? *

Yes
No

If yes, give details of the date, name and address of the agency/service, type of application and outcome.

Has either applicant had any family court proceedings or in any proceedings about children and/or family? If yes, give details including the date, name of court, type of order made and the names of the children concerned. *

DETAILS OF YOUR ACCOMMODATION – Briefly describe the home including proposed sleeping arrangements. *

MEDICAL HISTORY – Do you, your partner, or any of the people named in your application suffer or have ever suffered from a serious illness, mental or physical of a kind, which might affect the safety or welfare of a child? *

DOCTORS – Please give the name, address and telephone number of your family doctor, who will also be asked to complete a medical form with details of your medical history. *

REFERENCES – Please give details of six people who will act as a referee. – please include name, address, telephone number and email address for each reference (only one family member per applicant) *

If the length of employment has been less than 5 years, please provide your previous employment on a separate piece of paper. If either applicant has ever worked with children or vulnerable adults in the past please provide full details. *

EMPLOYMENT REFERENCES – Please provide contact details for your employer. If you are self-employed, please supply to details of your accountant – please include name, address, telephone number, email, length of employment and occupation. *

Applicant(s) Consent *

I / we consent to Acorn House Fostering Services making written and/or verbal checks with the organisations and individuals indicated below. I consent for checks to be made on my children with these organisations and individuals as appropriate. I have consulted with and sought the views of my children according to age and understanding and they have no objection to these checks being undertaken. Criminal record check Medical check Local authority for current address Local authority for previous addresses Police service/state embassy for another country where lived. Current employer (including voluntary positions) previous employers (including voluntary positions) where the work involved children or vulnerable adults. Previous fostering services or adoption agencies Schools and colleges currently attended by my/our children. Health visitors currently allocated to my/our children NSPCC Personal referees (as listed in my/our application form). Children, including adult children and former partners.

Applicant(s) Declaration *

I/we undertake to be truthful and honest in providing full and accurate information for this assessment, both verbally and in writing. I/we understand that Acorn House Fostering may seek verification of any information that I/we have supplied or will supply and that if any of this information is found to be false or misleading, this may result in the fostering service deciding not to proceed with my/our application. I/we understand that the Acorn House Fostering will be taking up a series of checks and references and will be seeking our consent to do this. I/we understand that if we are not willing to consent to these checks and references being undertaken, Acorn House Fostering may decide not to progress with my/our application. Acorn House Fostering has given me/us their privacy notice that explains how my/our personal data will be kept and shared.

your include of

GDPR Agreement *

I/we consent to having this website store my submitted information so they can respond to my enquiry.