Application for Resources – Fostering Sweet Dreams

Name of Placement- Worker or House name *

Type of Placement *

What agency has referred you to FSD, or which agency are you with? REFERRAL IS NOW REQUIRED FOR RESOURCES

If DHS Resource Home Please Attach 1st Page of Placement Paperwork

Maximum file size: 516MB

Email FSD will respond to *

County of Placement *

City of Placement *

Caseworker/ Person requesting resources name *

Caseworker/ Person requesting resources phone number *

Number of Children Impacted *

Child 1- Please fill out all information accurately

Name *

Sex- REQUIRED *

Male

Female

Age- REQUIRED *

If UNDER 2 years old please select

Child 2- Please fill out all information

Name *

Sex- REQUIRED *

Male

Female

Age- REQUIRED *

If UNDER 2 years old please select

Child 3- Please fill out all information

Name *

Sex- REQUIRED *

Male

Female

Age- REQUIRED *

If UNDER 2 years old please select

Child 4- Please fill out all information

Name *

Sex- REQUIRED *

Male

Female

Age- REQUIRED *

If UNDER 2 years old please select

Child 5- Please fill out all information

Name *

Sex- REQUIRED *

Male

Female

Age-REQUIRED *

If UNDER 2 years old please select

Child 6- Please fill out all information

Name *

Sex-REQUIRED *

Male

Female

Age- REQUIRED *

If UNDER 2 years old please select

Does the child/children currently have a bed?

Since they do not have a bed, what are they currently sleeping on?

Since yes was selected, why are resources being requested?

Resources

Make selections below, click add to add additional resources.

Please share any additional information that will help us better understand this situation and the needs *

Pick ups are Tuesday or Thursday (unless otherwise noted) 10 am - 1 pm. A pick up time must be confirmed and scheduled prior to items being available to pick up. All pick ups are at our location at 412 WIMBLEDON RD EDMOND, OK 73003.

*This application is not a guarantee that resources will be provided*

Waiver of Liability: By accepting resources from Fostering Sweet Dreams, you acknowledge that the items provided may be used and any item is provided in an AS IS CONDITION. Acceptance of any resource from Fostering Sweet Dreams hereby waives any claim for damages that may occur due to use of any item and hereby releases Fostering Sweet Dreams from any and all liability associated with acceptance and use of any item provided to you, your heirs, assigns or the end user by Fostering Sweet Dreams.

Signature- By signing this you are understanding we do not guarantee brand new resources for every request. *

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