Hosting Application  (This program only applies to families in the states of Pennsylvania, New Jersey and Delaware.)

Name:


Address:



State:   PA NJ DE



Phone:
     

Email:

How many children would you like to host?

How many weeks would you like to host?
1    2   3    4    5    6

What is your preference as to the age and sex of child/children? (Keep in mind the children range in age from 5-11)
Male, from ages to
Female, from ages to

Do you have any children of your own? Yes    No

Would you give permission for a background check on child abuse, etc? Yes    No

** This is the first step in the hosting process. You will be notified as to the next step which includes an interview, and an information/orientation night.

Note: Completion of this application does not guarantee participation in the hosting program.