Care4All Children Services

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Inquiry Form.

Name *
Name
Over 25 Years Old *
Date Of Birth
Date Of Birth
US Citizen *
phone number
Address
Address
Do you have a valid drivers license? *
Checkbox 1 *
Do you have Auto Insurance (at least liability)?
Are you currently employed? *
Have you lived in any other state than Georgia in the past ten years? *
Are you and /or spouse currently recieving any Government Assistance? *
Does anyone in your home have a Criminal Background / Record? *
Do you have any pets? *
Medical Health History
Have you or anyone living in your home ever been diagnosed of Hypertention, Diabetes, Ashtma, Heart Conditions, High Blood Pressure, High Cholesterol, Seizures or other? *
Where did you hear about Care4all Children Services?
Spouse Information:
Spouse Information:
Is spouse employed?
Does spouse have a valid drivers license?
Auto Insurance
U.S. Citizen:
Has spouse lived in any other state other than Georgia in the past ten years?
Criminal Background / Record
Spouse's Physical Health:
Are there children currently residing in the home:
Are there any other Adults residing in the home?
If yes, Who?
If yes, Who?
Have you or your spouse ever been foster parents before?
Has The Department of Child and Family Services (DFCS) or Child Protective Services (CPS) EVER been to your home for any reason?
Do you or (spouse) have a history of drug and/or alcohol abuse?
Mental Health History:
Have you or anyone in your home ever been diagnosed with ANY type of mental health illnesses, such as Depression, Anxiety Disorder, Bipolar, Schizophrenia, Mood Disorder etc.?
Are you / they currently recieving treatment?
Do you or anyone living in your home have a history of being suicidal or homicidal?
If yes, did you / they seek help?
A Complete Physical including a TB Test and RPR for all individuals 18 and older A Complete Physical including TB test for children 16 and older annually. A Complete Physical and shot record for babies and children annually. 53 hours or Pre-service training, including CPR / First Aid Certification, IMPACT, Medication Administration, Handle With Care, Understanding Trauma, etc. 24 Hours of on-going training annually A detail Home Study of your home as required by the State of Georgia Age Qualification: Must be 25 years of age if single, 21 if married Can be Single, Married, Divorced, Separated or Widowed / er May be with or without children of your own May be employed or not employed, but have A Source of Income May be a Homeowner or Renter Must have a Landline telephone Must have a minimum of 5 approved references minimum of each applicant All adults living in the home (18 & over) must undergo background checks, including fingerprinting and drug screening. Determination of results for application approval is on a case by case basis. Both parents must complete the training.