2021 Birthday Celebration - Cake Request - Foundation for Foster ChildrenFoundation for Foster Children

Application Date*

Submitter Name*

First Last

Submitter Phone Number*

Submitter Email*

Relation to Child*

If other, please specify.*

Child's Information

Child's Name*

First Last

Child's Phone Number*

If under 18 you can provide caregiver,primary contact, mentor, etc phone number

Child's Email*

If under 18 you can provide caregiver, primary contact, mentor, etc email address

Date of Birth*

Age*

Does the youth have children?*

Yes
No

Gender*

Female
Male

Ethnicity*

African-American
Asian-American
Caucasian
Hispanic-Latino
Multi-Ethnic

Parental Rights Terminated*

Yes
No
Not Sure

Placement*

Foster Home
Group Home
Relative (Not Bio Parent)
Non-Relative Parent
Other

Group Home Name*

Address where child resides:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Residing County*

Orange
Seminole
Osceola

Grade*

School Currently Attending*

Is the youth case closed?*

Yes
No
N/A

Is this case OTI or ICPC?*

OTI
ICPC
Neither

Child Welfare Team

Is the youth case managed by an state agency/case manager or by a community organization?

Child Welfare Agency/Case Manager
Community Organization

Case Manager information

Case Management Agency*

Case Manager Name*

First Last

Case Manager Phone*

Case Manager Email*

Case Management County*

Community Organization

Please specify the community organization name*

Contact Name*

First Last

Phone*

Email*

Primary Contact Information

Caregiver, mentor, family member, etc.

Primary Contact Name*

First Last

Primary Contact Phone*

Primary Contact Email*

Celebration Club

The Foundation for Foster Children has partnered with our friends at Four Rivers to provide beautiful birthday cakes to celebrate our foster youth on their birthday. We ask for at least one week notice.

What birthday is the child/youth celebrating?*

Type of Cake*

Vanilla
Chocolate
Red Velvet
Cookie N' Cream

Type of Icing*

Vanilla
Chocolate

Preferred Pick-Up Date*

Please provide the name that you would like to be on the cake for the youth.

Does the child have any food allergies?*

If yes, please explain what type of food allergy that the youth has.*

Number of people celebrating*

Please provide an idea of how the child would like the cake decorated with a theme or favorite character, and we will try our best to accommodate.*

Do you have an example or picture of what you would like this cake to look like? Awesome! Please attach here

Max. file size: 50 MB.

Media/Photo Consent Form and Testimonies

This consent and release form grants permission to Foundation for Foster Children for the use of testimonies, photograph(s) or electronic media images. Images will be stored in a secure location and only authorized staff will have access to them. They will be kept as long as they are relevant and after that time archived. Media/Photo/Testimonies consent forms and release will expire may 1st of 2024, unless:

*Child turns 18, new consent form will be required

*Change in placement for children under 18, new consent form will be required with current legal guardian signature.

*Legal guardian/child/young adult choices to withdraw their consent for any reasons.

Photo and Testimony Consent*

I am willing to share my story and/or feedback and I give consent to use my photo.
I do not have permission to provide consent

Please provide the name, phone and email address of the individual with permission to provide/deny photo consent.*

Media/Photo Consent Form and Testimonies*

By signing below, I hereby give the Foundation for Foster Children (FFC) permission to use my photograph and use an approved story in FFC marketing materials including, but not limited to, the website and print materials of FFC. I understand that I will not receive compensation for the use of this likeness in any form.

Electronic Signature*

Consent for Release of Information*

I approve the release of the confidential information provided in this referral to FFC and its funding agencies, including but not limited to, Orange County Commission for Children.