LAKE COUNTY DEPARTMENT OF JOB AND FAMILY SERVICES

CHILDREN SERVICES DIVISION

Please complete and submit this form if you would like more information regarding our foster care and/or adoption programs.  You may also call (440) 350-4218 or (440) 918-4218 to learn more information.  By submitting this form, you will receive a packet of information and a follow-up phone call from a member of our Substitute Care Unite.

If you reside beyond a 30 mile radius from Painesville, the information packet will give you the names and contact information for both public and private agencies in your area.

Inquiring about (select all that apply):  Foster care     Adoption

Parent #1 First Name: 
Parent #1 Last Name: 
Parent #1 Date of Birth: 

Parent #2 First Name: 
Parent #2 Last Name: 
Parent #2 Date of Birth: 

Other Names (maiden, etc.): 

Street Address: 

City: 

State: 

Zip Code: 

Home Phone: 

Work Phone (Parent #1): 

Work Phone (Parent #2): 

E-Mail Address: 

Optional Information:  Where did you hear about LCDJFS's Foster Care and Adoption Program?  Please select all that apply: