New Foundations, Inc.
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  Inquiry Form
 

New Foundations, Inc. services southeastern Pennsylvania.

First Name:

 

Last Name:

 

Street Address:

 

County:

 

City:

 

State:

 

Zip:

 

Home Phone:

 

Work Phone:

 

Work Phone2:

 

Cell Phone:

 

Cell Phone 2:

 

Email Address:

 

Best Time To Contact You:    

 

Where did you hear about us: 

 

Please specify a name of where you did hear about us:

ex. Philadelphia Inquirer

Family Member 1 Name: 

 

Age:

 

Gender:

 

Health:

 

Family Member 2 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 3 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 4 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 5 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 6 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 7 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 8 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 9 Name:

 

Age:

 

Gender:

 

Health:

 

Family Member 10 Name:

 

Age:

 

Gender:

 

Health:

 

How many bedrooms in your home:

 

What is the total number of beds:

 

Where in your home are the bedrooms:

Example: 1st floor, 2nd floor, 3rd floor

Additional information:

Home Member 1 Name:

 

Occupation:

 

How many hours a week do you work:

 

What is your income:

Home Member 2 Name:

 

Occupation:

 

How many hours a week do you work:

 

What is your income:

Home Member 3 Name:

 

Occupation:

 

How many hours a week do you work:

 

What is your income:

Home Member 4 Name:

 

Occupation: 

 

How many hours a week do you work: 

 

What is your income:      

Home Member 5 Name:

 

Occupation:

 

How many hours a week do you work:

 

What is your income:

What type of transportation do you use:

 

Alternate Caregiver1:  

Age:
(Must be over 21)

Relationship to:

 


Alternate Caregiver2:

Age:
(Must be over 21)

Relationship to:

 

What race of child are you looking for:

Example: Any, African American, Biracial, Caucasian, Hispanic, Other

(You may use multiple race defineres. Just seperate with a comma)

What gender of child are you looking for:

 

Age From:

(Please specify years or months)

Age To:

(Please specify years or months)

Do you have Fostercare Experience:

 

Have you ever committed a crime:

 



Comments if you have Fostercare Experience:

Comments if you have committed a crime:

Any Questions or Comments:

 

   
   
 

Philadelphia Program Office
7210 Rising Sun Avenue Suite A
Administrative Office Philadelphia, PA 19111
(215) 203-8733
(215) 745-0329 (Fax)
Toll Free: 1-877-NFI-4KID

  Swarthmore Program Office
630 Fairview Road, Suite 202
Swarthmore, PA 19081
(610)-876-4474
(610) 328-4631 (Fax)