Fostering

Online Application Form

Please answer the questions below so that we can gain an understanding of your circumstances.

(All information that we receive will be treated in the strictest confidence and will not be disclosed to third parties).

We look forward to hearing from you soon

Please make sure you fill in the fields marked with *

Title:*

First Name:*

Last Name:*

Date of Birth: (i.e. 01/01/1970)*

How long have you been in your current relationship?:
(must contain 2 digits, i.e. 01)

Years *

Months *

Please fill in your address details:

House Number/Name:*

Street Name:*

City/Town:*

County:*

Postal Code:* No space

Telephone No:

Email:

What is your religion?*

What is your ethnic group?*

Do you have children?*

If you don't live alone, please fill in the table below to indicate who else lives in your property.

Household 1:

Full Name:

Gender:

Date of Birth: (i.e. 01/01/1970)

Relationship to you:

Household 2:

Full Name 2:

Gender:

Date of Birth: (i.e. 01/01/1970)

Relationship to you:

How many bedrooms do you have?*

Do you have a spare room?*

Do you work?*

Please give details:

If you have a partner that lives in your property, do they work?

Please give details:

Contact

Barking and Dagenham Placement Service

512a Heathway

Dagenham

RM10 7SJ

Team Manager: Pranitha Rampersad

Private Fostering Social Worker: Vijdan Sever

Team Administrator: Chris Kiddell

Tel: 020 8227 5802 during office hours, 8.30am - 4.30pm.

Tel: 020 8227 5949 outside office hours (answerphone).

Fax: 020 8227 5998

Email: fostering@lbbd.gov.uk|

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Civic Centre

Rainham Road North, Dagenham, RM10 7BN

Telephone: 020 8215 3000

Fax: 020 8227 5184

Textphone: 020 8227 5755

Email: enquiries@lbbd.gov.uk|

Out of hours emergencies|

Telephone: 020 8594 8356

Fax: 020 8227 3470

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