Complete and submit this form to register for foster care and adoption preservice training.
Unless otherwise noted, all classes take place at the Northwest Ohio Regional Training Center, 705 Adams Street, Toledo.

Yes! I would like to register for LCCS Foster Care and Adoption Pre-Service Training.

I am registering for:

Tuesdays & Thursdays, starting Sept. 7 & 9, 2010 through Oct. 19, 6 - 9 p.m. Saturdays, 9 a.m. - 4 p.m., Oct. 2 - Nov. 20, 2010 I am not ready to register for a class, but please send me information about foster care & adoption.

First name*

Last name*

Address 1*

Address 2

City*

State*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip *

Home telephone*

Daytime phone

Cell phone

Your email address
(Will only be used for contact with you about your inquiry)*

Gender*

Male

Female

Federal law requires that we collect information about the race or culture of people who inquire about foster parenting or adoption. This information is not used in any way to determine your eligibility as a foster or adoptive parent, and you are not required to answer. If you choose to give this information, which of the following describes your race or culture (select one):

Ethnicity*

Caucasian African-American Native American

Asian or Pacific Islander Prefer not to answer

Culture*

Hispanic or Latino

Non-Hispanic or Latino

Tell us about your interests.

I am interested in*

Foster care Adoption

Dual foster care and adoption Not sure

If you are interested in a specific child/children, please provide name(s).

Referral sources*

Newspaper advertisement Newspaper story Radio advertisement Radio story Television advertisement Television news story Home for Keeps segment Internet/OAPL website Internet/LCCS website Friend Family member

Other foster/adoptive parent LCCS employee School Church, synagogue or mosque Community program/event Telephone book Other agency Inquired before Brochure or flyer Other

Any other questions, comments or information