Client Application
Client's First Name *
Your answer
Client's Middle Name *
Your answer
Client's Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Address *
Your answer
Phone number *
Your answer
Email
Your answer
Client's Birthdate *
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Does Parent/Guardian Work? *
Workplace Phone Number
Your answer
Place of Work
Your answer
Can Parent/Guardian Be Called At Work? *
Client's School *
Your answer
Client's Grade *
Your answer
Client's Teacher *
Your answer
Family Status: Please circle as many as apply *
Required
Spouse/Significant Other's Name
Your answer
Non-Custodial Parent's Name
Your answer
Please list names and ages of other children living in the home. *
Your answer
Parent/Guardian's highest level of education: *
Parent/Guardians College/Vocational Major
Your answer
Are you currently attending College?
Are you affiliated with a church? *
If yes, name of church.
Your answer
How would you describe your child's personality? Check all appropriate responses. *
Required
How do you think a Kinship volunteer could help your child? *
Your answer
Does your child have any special problems (health problems, allergies, learning disabilities, behavior disorders) a volunteer should be aware of? *
Your answer
What are some of your child's special interests or favorite activities? *
Your answer
Is the child's non-custodial parent living in the area?
Does he or she visit the child?
If yes, how often?
Your answer
Would this parent have any objections to your child's participation in Kinship?
Your answer
Do you anticipate any major life changes within the next year? (such as moving, divorce, new baby, etc.) *
Your answer
Date *
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