Providing safe and healthy homes for children of families in crisis.

Intake Form

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  • Guardian/Caller Information

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  • Bio Parent Information

  • Goals - *Aim for the goal(s) to be TIED TO THE CRISIS. Guide caller to think about how they can use their own talents and capabilities and what is available to them to bring their family out of crisis and towards stability. Check for goals possibly set with Case Manager from Partnering Agency.

  • Children to Be Hosted

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Other Information to Communicate

  • • If children are placed with SRFC host family, there is an expectation that you will be in contact with your children DAILY (each night) through host family.

    • For any child over 12, SRFC staff needs to speak with them to assess their willingness to participate in the program so that parent can get the help needed.

    • SRFC is a faith-based organization. We encourage our host families to include the children they are hosting in all their daily activities; this could include church on Sundays. Are you OK with that?

    Reminder - Please bring your ID, medical IDs for each child, car seats (if they have them) any medications MUST be in prescription bottles, anything else you think your child(ren)will need during the host.