Appointment Booking Form

Thank you for scheduling an appointment with us. Your appointment will be approved after completing this form and uploading all necessary documentation. After your appointment is approved, you will also be required to complete a "Toiletries Request Form" for any diapers or toiletry items.

Which volunteer shopping assistant is your appointment with?

Date / Time of appointment

First Name of Foster Parent

Last Name of Foster Parent

Foster Parent Phone/Mobile

The purpose of this form is to be filled out by a Foster Family, Kinship Placement, At-Risk Family, and/or a DCS or affiliate caseworker. If you are a foster parent you MUST list your caseworker's name and phone number. If you are a caseworker filling out this form to shop for a client you MUST list the foster family information in the required fields.

I am a:

Caseworker First Name

Caseworker Last Name

Caseworker Phone/Mobile

What county do you live in?

Your Current Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Legal Paperwork & ID

Beginning immediately you are required to provide the following:

A copy of your foster care license, placement papers showing child(rens) name, or court ordered guardianship paperwork showing child(rens) name
A copy of your drivers license or state id

Failure to comply with this request will result in your appointment being cancelled and may impact further services with our organization.

Form 906 or Accepted Legal Paperwork

Choose File(s)

Valid Driver's License or State ID

Choose File(s)

Is this your first visit? Foster Families are allowed two visits per 12 month period. If you receive a new placement, additional appointments can be made for the new child/children in care.

Yes

Date of Last Visit

Any other comments or needs?

Cancellation Policy

You can cancel online up to 24 hours prior to the appointment.