Isle of Wight Council

	Initial Enquiry Form for Fostering and Adoption
	ALL FIELDS MARKED WITH A * ARE REQUIRED ENTRIES

If you wish, this form may be completed on-line, printed and sent to: The Fostering and Adoption Services Team County Hall Newport Isle of Wight PO30 1UD Date:

Applicant/s

		Male	Female
*	Surname
	Forename/s
	Maiden surname
	Any former surname
	Date of birth (dd/mm/yyyy)
	Home telephone number (include area code)
	Mobile telephone number
	Email address
	Preferred method of contact	Home Telephone Mobile Telephone Email	Home Telephone Mobile Telephone Email

*	Building/house name/number
*	Street address
*	Town name
*	Postcode

Children in your family

	Full names	Date of birth (dd/mm/yyyy)	Living at home? (Y/N)
			Yes No
			Yes No
			Yes No
			Yes No
			Yes No
			Yes No

Please indicate your area of interest

	Fostering
	Long Stay	Yes No Not sure
	Short stay	Yes No Not sure
	Short-term breaks	Yes No Not sure

	Family Link (children with disabilities)	Yes No Not sure
	Adoption	Yes No Not sure
	Combined Accommodation Scheme (16)	Yes No Not sure
	Day care	Yes No Not sure

	Age of children you would consider
	Under 5	Yes No Not sure
	5-10 years	Yes No Not sure
	10-13 years	Yes No Not sure
	13 years	Yes No Not sure
	Could you take more than one child?	Yes No

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy . Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013