An Energetic 12-year-old girl

A smart, kind and energetic 12 year old girl is looking for caregivers in Contra Costa County. She's does well in school and is a big fan of Justin Bieber. She has a medical condition that restricts her to a wheelchair and does require some help from her caregivers. Prior medical training is not required. She can teach you everything you need to know.

If you may be interested, let us know by completing the form below.

Registration

Name*
First Last
Mobile Phone*
Email*
Street Address*
Street Address City State ZIP Code
Which County do you live in?*
Gender
What is your age?
What is your marital status?
What is your current employment status?
Employment is not a requirement for approval.
Do you have a co-applicant?
(ie. Spouse, partner, etc.)
Co-applicant Name (if applicable)
First Last
Co-applicant's Age (if applicable)
What is your co-applicant’s current employment status? (If applicable)
Employment is not a requirement for approval.
Do you have children living at home?
If yes, how many children do you have living at home?
Do you have an extra bedroom to accommodate a young person?
It is acceptable for a teenager to share a room with another teen of the same-gender.
Would you consider taking siblings?
In the last five years, have you lived in any state other than your current state of residence?
Have you ever been a certified foster parent (or resource parent)?
If yes, what is the name, city, and state of the agency you were last certified?
Do you have any questions we can answer for you?
What language do you prefer to communicate?

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