2024 Transition to Adulthood Request -Foundation for Foster Children

Step 1 of 7

Application Date*

Submitter Name*

First Last

Submitter Phone Number*

Submitter Email*

Relation to the youth*

If other, please specify.*

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

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*

Current Need

What's the current need?

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Career*

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Housing*

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Parenting*

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Transportation*

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Cost of request*

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Activity Provider Name*

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Activity Provider Phone*

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Activity Provider Email*

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Activity Provider Website

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Activity Provider Address*

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

Please describe the current need and how this activity would benefit the youth. Please also include any relevant information needed to process this request.*

Please attach any documentation relevant to this request

Max. file size: 50 MB.

Is this time sensitive?*

Yes

If yes, when do you need us to process this by?*

Release of Information

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

Electronic Signature: Release of Information*

Please type first and last name

Electronic Signature: Release of Information

By checking this box you accept this electronic signature.

Photo/Testimony Release

Foundation for Foster Children Photo/Testimony Release: provides the Foundation for Foster Children (FFC) with permission to use photographs or testimonies provided in internal and external communications such as program newsletters and FFC marketing materials including, but not limited to, the website and print materials of FFC. Youth 18 and older must provide direct consent before services will be initiated. Consent must be provided by the caregiver, caregiver support, IL specialist, TSS, GAL or their respective supervisors before services will be initiated for youth 14-17.

Photo/Testimony Release: Consent*

I do give consent

I do not give consent

I do not have permission to provide consent

Photo/Testimony Release Statement*

By signing below, I hereby give the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein. I understand that FFC may use photographs and testimonies in internal and external communications including program newsletters and FFC marketing materials including, but not limited to, the website and print materials. I understand that compensation in any form for the use of this likeness is prohibited.

Photo/Testimony Release Statement*

By signing below, I hereby do not give the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein.

Photo/Testimony Release Statement*

By signing below, I hereby am unable to give/deny the Foundation for Foster Children (FFC) permission to use photographs or testimonies of the youth named herein.

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

Electronic Signature: Photo/Testimony Release*

Electronic Signature: Photo/Testimony Release

By checking this box you accept this electronic signature.

Waiver and Release of Liability Form

In return for being allowed to participate in the Foundation for Foster Children volunteer activities and all related activities, including any activities incidental to such participation (“Volunteer Activities”), the undersigned Volunteer or Parent/Legal Guardian of Volunteer if Volunteer is under age 18 (hereafter referred to using “I”, “me”, or “my”) releases and agrees not to sue the Foundation for Foster Children or its officers, directors, employees, sub-contractors, sponsors, agents and affiliates (“the Foundation”) from all present and future claims that may be made by me, my family, estate, heirs, or assigns for property damage, personal injury, or wrongful death arising as a result of my participation in the Volunteer Activities wherever, whenever, or however the same may occur.

I understand and agree that the Foundation is not responsible for any injury or property damage arising out of the Volunteer Activities, even if caused by their ordinary negligence or otherwise.

I understand that participation in the Volunteer Activities involves certain risks, including, but not limited to, serious injury and death. I am voluntarily participating in the Volunteer Activities with knowledge of the danger involved and I agree to accept all risks of participation. I also agree to indemnify and hold harmless the Foundation for all claims arising out of my participation in the Volunteer Activities.

I understand that this document is intended to be as broad and inclusive as permitted by the laws of the state in which the Volunteer Activities take place and agree that if any portion of this Agreement is invalid, the remainder will continue in full legal force and effect. I also acknowledge that the Foundation have not arranged and do not carry any insurance of any kind for my benefit or that of Volunteer (if Volunteer is under 18), my parents, guardians, trustees, heirs, executors, administrators, successors and assigns. I represent that, to my knowledge, I am in good health and suffer no physical impairment that would or should prevent my participation in Volunteer Activities.

I also understand that this document is a contract which grants certain rights to and eliminates the liability of the Foundation.

Electronic Signature*

Please type first and last name

TTA SERVICE REQUEST