Online Inquiry

Click the 'Generate Form' link to pre-populate the form when you are ready.

<ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;">
<i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">Name</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_A" style="width: 50%;">
<i class="fa fa-font"></i><label class="er_fld_label required">First</label><input name="CST_1" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 50%;" map_to="FH_Name_Last_A">
<i class="fa fa-font"></i><label class="er_fld_label required">Last</label><input name="CST_2" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false">
<i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_bold">Adult #2 Name (optional)</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Name_First_B" style="width: 33.3333%;">
<i class="fa fa-font"></i><label class="er_fld_label">First</label><input name="CST_3" type="text"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Name_Last_B">
<i class="fa fa-font"></i><label class="er_fld_label">Last</label><input name="CST_4" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_content" draggable="false" style="width: 50%;">
<i class="fa fa-info-circle"></i><label>Guidelines\Help Text</label><div class="cst_content er_fld_fontstyle_normal">Home Address</div></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Address_Street_1" style="width: 33.3333%;">
<i class="fa fa-font"></i><label class="er_fld_label required">Address Line 1</label><input name="CST_5" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_Address_Street_2">
<i class="fa fa-font"></i><label class="er_fld_label">Address Line 2</label><input name="CST_14" type="text"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_City">
<i class="fa fa-font"></i><label class="er_fld_label required">City</label><input name="CST_6" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_Zip">
<i class="fa fa-font"></i><label class="er_fld_label required">Zip Code</label><input name="CST_15" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 25%;" map_to="FH_Address_County">
<i class="fa fa-font"></i><label class="er_fld_label required">County</label><input name="CST_7" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_text" draggable="false" map_to="FH_Phone_Home" style="width: 33.3333%;">
<i class="fa fa-font"></i><label class="er_fld_label required">Phone</label><input name="CST_8" type="text" class="er_fld_required"></li><li class="er_fld_type_text" draggable="false" style="width: 33.3333%;" map_to="FH_EMail">
<i class="fa fa-font"></i><label class="er_fld_label required">Email</label><input name="CST_9" type="text" class="er_fld_required"></li></ul><ul class="er_fld_row"><li class="er_fld_type_radio" style="white-space: normal; width: 33.3333%;" draggable="false" map_to="FH_Inquiry_Comments"><i class="fa fa-circle-o"></i><label class="er_fld_label">What is your preferred method of contact?</label>

<label class="er_option"><input class="type_radio" type="radio" name="CST_16" value="Email">Email</label><label class="er_option"><input class="type_radio" type="radio" name="CST_16" value="Phone">Phone</label><label class="er_option"><input class="type_radio" type="radio" name="CST_16" value="Text">Text</label><label class="er_option"><input class="type_radio" type="radio" name="CST_16" value="Mail">Mail</label><label class="er_option er_option_other er_option_other_off"><input class="type_radio er_option_other" type="radio" name="CST_16" value="Other:">Other:<input class="cst_Other" name="CST_16_Other" type="text"></label></li><li class="er_fld_type_dropdown" draggable="false" style="width: 33.3333%;" map_to="Location"><i class="fa fa-caret-down"></i><label class="er_fld_label required">Which of our office locations is closest to your home?</label><select name="CST_18" class="er_fld_required"><option value=""></option><option value="BAY CITY">BAY CITY</option><option value="GAYLORD">GAYLORD</option><option value="GRAND RAPIDS">GRAND RAPIDS</option><option value="LANSING">LANSING</option><option value="OAK PARK">OAK PARK</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_dropdown er_fld_selected" draggable="false" map_to="FH_ReferralSource" style="width: 50%;"><i class="fa fa-caret-down"></i><label class="er_fld_label required">How did you hear about us?</label><select name="CST_10" class="er_fld_required"><option value="Spotify">Spotify</option><option value="Facebook">Facebook</option><option value="Billboard">Billboard</option><option value="Web Search">Web Search</option><option value="Children's Protective Services">Children's Protective Services</option><option value="Church/Pastor">Church/Pastor</option><option value="Display Table at Event">Display Table at Event</option><option value="Foster Care Navigator">Foster Care Navigator</option><option value="Legacy Adoption Services">Legacy Adoption Services</option><option value="TV Ad">TV Ad</option><option value="Social Media">Social Media</option><option value="Wellspring Employee">Wellspring Employee</option><option value="Wellspring Foster Parent">Wellspring Foster Parent</option><option value="Other">Other</option><option value="- Please Select -" selected="">- Please Select -</option></select></li></ul><ul class="er_fld_row"><li class="er_fld_type_text er_fld_showif" draggable="false" style="width: 100%;" map_to="FH_ReferredByName" er_fld_condfld="CST_10" er_fld_condvals="er_fld_showif_values=Other">
<i class="fa fa-font"></i><label class="er_fld_label">If other, please explain:</label><input name="CST_21" type="text" class=""></li></ul><ul class="er_fld_row"><li class="er_fld_type_checkbox" style="white-space: normal; width: 33.3333%;" draggable="false" map_to="FH_Interest"><i class="fa fa-check-square-o"></i><label class="er_fld_label">Interested In:</label>

<label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Foster Care">Foster Care</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Relative Only">Relative Only</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Foster to Adopt">Foster to Adopt</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Independent Living">Independent Living</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Medically Fragile">Medically Fragile</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Infants">Infants</label><label class="er_option"><input class="type_checkbox" type="checkbox" name="CST_11" value="Teens">Teens</label><label class="er_option er_option_other er_option_other_off"><input class="type_checkbox er_option_other" type="checkbox" name="CST_11" value="Other:">Other:<input class="cst_Other" name="CST_11_Other" type="text"></label></li><li class="er_fld_type_radio" style="white-space: normal; width: 33.3333%;" draggable="false"><i class="fa fa-circle-o"></i><label class="er_fld_label required">How long have you been considering becoming a foster parent?</label>

<label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_20" value="Less than 6 months">Less than 6 months</label><label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_20" value="6 months - 1 year">6 months - 1 year</label><label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_20" value="1-2 years">1-2 years</label><label class="er_option"><input class="type_radio er_fld_required" type="radio" name="CST_20" value="More than 2 years">More than 2 years</label><label class="er_option er_option_other er_option_other_off"><input class="type_radio er_option_other er_fld_required" type="radio" name="CST_20" value="Other:">Other:<input class="cst_Other er_fld_required" name="CST_20_Other" type="text"></label></li></ul><ul class="er_fld_row"><li class="er_fld_type_paragraph er_fld_type_paragraph_small" draggable="false" style="width: 50%;" map_to="FH_Inquiry_Why_Parents">
<i class="fa fa-paragraph"></i><label class="er_fld_label required">Why do you want to be a foster parent?</label><textarea name="CST_12" style="width:100%;" class="er_fld_required"></textarea></li></ul>