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Circle of Friends Application – Family Support 2

Circle of Friends Application - Family Support 2

  • MM slash DD slash YYYY

  • Employment

  • Relationships

  • MM slash DD slash YYYY

  • Children of Applicants who are living in the home

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY

  • Additional Information - Children living in the home

  • Volunteer Experience and Community Support

  • Home Information

    Note: California law prohibits smoking in a vehicle when a child is present, although Safe Refuge highly recommends that NO ONE EVER smoke in the presence of a child.

  • Transportation

  • Applicant(s) Vehicles

  • Make, Model, # of passengers
  • Make, Model, # of passengers

  • Background Disclosure & Consent

    All adults (over the age of 18) will be required to complete a LiveScan fingerprint clearance. If any box below is checked yes, please indicate the nature and circumstances of the original incident(s) in the space provided below. Include the date, place and the name off the individual that the incident applies to.
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