Please fill out the form below to get more information about how you can become a Foster parent to a child in need, or to provide Respite-Care services to a local family.
Your Name
Address Line 1
Address Line 2
City
State
ZIP
Phone number where we can reach you, including area code.
Your email address
Are you interested in:
  • Foster Care
  • Respite Care
  • Not Sure - Tell Me More!
Please describe any experience you have had with foster or respite care:
Please describe any experience you have had working with special needs children.
How did you FIRST hear about us?
  • Internet search
  • From another foster/respite parent
  • From a co-worker or friend
  • From THIS website
  • From the Family Focus newsletter
  • From an email newsletter
  • At an event hosted by NVFS
  • Announced at an event hosted by another organization
  • On the radio/TV or in a newspaper ad
  • I saw a flyer at a business or church
What is your marital status?
  • Married
  • Single
  • Divorced/Separated living apart
  • Widowed
  • Cohabitating
Please list the names and ages of all children and/or dependents living in your home. First names are fine.
Please list the names and ages of children or dependents living outside your home.