Online Inquiry
Please attach a hard copy of this form below, or reenable the web form.
Click the 'Generate Form' link to pre-populate the form when you are ready.
<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 joining us today to explore your church's foster care ministry and to open your heart to hearing from the Lord about this ministry opportunity. Please take a minute to complete the form below.</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_date" draggable="false" style="width: 50%;"><i class="fa fa-calendar"></i><label class="er_fld_label required">Date of Encounter Training</label><input class="cst_datepicker er_fld_required" name="CST_34" type="text"></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">Location of Training</label><input name="CST_27" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_A" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Primary Parent First Name</label><input name="CST_3" 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_Name_Last_A"><i class="fa fa-font"></i><label class="er_fld_label required">Primary Parent Last Name</label><input name="CST_4" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_B" style="width: 100%;"><i class="fa fa-font"></i><label class="er_fld_label">Secondary Parent First Name</label><input name="CST_5" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="FH_Name_Last_B"><i class="fa fa-font"></i><label class="er_fld_label">Secondary Parent Last Name</label><input name="CST_6" 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">Primary Parent's Email</label><input name="CST_7" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="FH_EMail_2"><i class="fa fa-font"></i><label class="er_fld_label">Secondary Parent's Email</label><input name="CST_8" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Phone_Home"><i class="fa fa-font"></i><label class="er_fld_label required">Primary Phone</label><input name="CST_28" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 100%;" map_to="FH_Phone_Other"><i class="fa fa-font"></i><label class="er_fld_label">Secondary Phone</label><input name="CST_29" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown" draggable="false" map_to="FH_MaritalStatus" style="width: 50%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Marital Status</label><select name="CST_9" class="er_fld_required"><option value="Married">Married</option><option value="Single">Single</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Street_1" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Street Address Line 1</label><input name="CST_13" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Street_2" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label">Street Address Line 2</label><input name="CST_18" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_City" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_14" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_State" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">State</label><input name="CST_15" type="text" class="er_fld_required" value="Georgia"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Zip" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">Zip Code</label><input name="CST_16" 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_County"><i class="fa fa-font"></i><label class="er_fld_label required">County</label><input name="CST_37" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Church" style="width: 50%;"><i class="fa fa-font"></i><label class="er_fld_label required">What church do you attend?</label><input name="CST_22" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_radio" style="white-space: normal; width: 100%;" draggable="false"><i class="fa fa-circle-o"></i><label class="er_fld_label required">Are you currently fostering or caring for children that are not your own?</label> <label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_33" value="Yes">Yes</label> <label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_33" value="No">No</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_33" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_33_Other" type="text"></label> </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">Please list the ages of the children living in your home:</label><input name="CST_21" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Inquiry_Why_Parents"><i class="fa fa-font"></i><label class="er_fld_label required">What led you to consider foster care and/or adoption? </label><input name="CST_36" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_radio" style="white-space: normal; width: 50%;" draggable="false" map_to="FH_Inquiry_How_Referred"><i class="fa fa-circle-o"></i><label class="er_fld_label required">How did you learn about Encounter?</label> <label class="er_option"><input class="type_radio" type="radio" name="CST_23" value="A friend (who is not a foster parent)">A friend (who is not a foster parent)</label><label class="er_option"><input class="type_radio" type="radio" name="CST_23" value="A foster parent friend">A foster parent friend</label><label class="er_option"><input class="type_radio" type="radio" name="CST_23" value="Church service">Church service</label><label class="er_option"><input class="type_radio" type="radio" name="CST_23" value="Church communications">Church communications</label><label class="er_option"><input class="type_radio" type="radio" name="CST_23" value="Google search">Google search</label><label class="er_option"><input class="type_radio" type="radio" name="CST_23" value="Social Media Advertisement">Social Media Advertisement</label><label class="er_option"><input class="type_radio" type="radio" name="CST_23" value="Family Match Website">Family Match Website</label><label class="er_option er_option_other"><input class="type_radio er_option_other er_fld_required" type="radio" 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_checkbox" style="white-space: normal; width: 50%;" draggable="false"><i class="fa fa-check-square-o"></i><label class="er_fld_label required">I am interested in: </label> <label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="Becoming a foster parent">Becoming a foster parent</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="Becoming an adoptive parent">Becoming an adoptive parent</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="Providing overnight respite care for foster children in my local church">Providing overnight respite care for foster children in my local church</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="Providing overnight respite care for foster children in my community and surrounding areas ">Providing overnight respite care for foster children in my community and surrounding areas </label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="Volunteering for my church's foster care ministry">Volunteering for my church's foster care ministry</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="Transfering my current foster or adoption license to FaithBridge">Transfering my current foster or adoption license to FaithBridge</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="Connecting my church with FaithBridge">Connecting my church with FaithBridge</label><label class="er_option"><input class="type_checkbox er_fld_required" type="checkbox" name="CST_42" value="I am not interested in participating at this time">I am not interested in participating at this time</label><label class="er_option er_option_other"><input class="type_checkbox er_option_other er_fld_required" type="checkbox" name="CST_42" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_42_Other" type="text"></label></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">By attending this orientation today, this counts toward any training requirements that may pertain to your licensing process. By signing below, I acknowledge that I have participated in Encounter. </div></li></ul><ul class="er_fld_row"><li class="er_fld_type_signature" draggable="false" style="width: 50%;"><i class="fa fa-pencil"></i><label class="er_fld_label">Signature of Primary Parent</label><div class="cst_signaturepad"></div><input name="CST_25" type="text"><button class="type_button" disabled="">Clear Signature</button></li></ul><ul class="er_fld_row"><li class="er_fld_type_signature" draggable="false"><i class="fa fa-pencil"></i><label class="er_fld_label">Signature of Secondary Parent</label><div class="cst_signaturepad"></div><input name="CST_38" type="text"><button class="type_button" disabled="">Clear Signature</button></li></ul>
Submit