Fostering in County Durham - Registration of Interest

Thank you for your interest in fostering. Please complete this form then click on the Send Details button. Please note that any information that you provide is subject to the Data Protection Act.

Fields marked with this symbol * must be completed.

If you would like any further information about fostering please contact us by e-mail at fostering@durham.gov.uk, or via telephone at one of these offices.

About You

* Title(s):	- Please Select - Miss Mr Mrs Ms
* First Name:
* Surname:
* Address:
* Postcode:
E-Mail address (if available):
Telephone no. (day) including STD code:
Telephone no. (evening) including STD code:
* Date of birth, e.g. 01/02/1973:
* Gender:	- Please Select - Female Male
Your Partner (if applicable)
Title:	- Please Select - Miss Mr Mrs Ms
First Name:
Surname:
Date of birth, e.g. 01/02/1973:
Gender:	- Please Select - Female Male

Who are the other members of your household (adults and children)?

First name	Surname	Gender	Date of birth (dd/mm/yyyy)	Relationship to you (e.g. parent, son, lodger)
		- Select - Female Male
		- Select - Female Male
		- Select - Female Male
		- Select - Female Male
		- Select - Female Male

What bedroom space can you offer a child? * Their own room A shared room

How would you describe your ethnic background?

Background:	- Please Select - Any other ethnic group Bangladeshi Black/African Black/Carribean Black/other Chinese Indian Mixed race African Mixed race Asian Mixed race Carribean Pakistani White British White Irish White other background
What is your religion, if any:
Do you practice your religion:	Yes No
Language(s) spoken at home:

Your interest in fostering

What ages and sexes of children are you interested in fostering? (Please tick as many boxes as applicable)?

Are you interested in particular types of fostering? (Please tick as many boxes as applicable)

Please tick here if you would like us to send you information on adoption

Your details will be checked on our database when we receive this form.

I understand that personal data which I have supplied on this form will be held and processed by Durham County Council for the purpose of administering the "fostering - registration of interest" service. This service records details of individuals who are interested in fostering, and this information may be shared with people from other organisations involved in arranging or providing such services.

By completing this form I consent to Durham County Council processing sensitive personal data, such as health related information or details about my/our personal circumstances, where this is required.

Durham County Council Council is the Data Controller for the purposes of the Data Protection Act.

Do you agree to the above conditions: Yes No