Your Information

Name (Required)

Relationship to Child (Required)

Email (Required)

Cell Phone

Home Phone

Work Phone

Address Where the Gifts Should be Mailed (Required)

City (Required)

State (Required)

Zip (Required)

Caseworker Information

Caseworker Name (Required)

Caseworker Phone Number (Required)

Foster Child's Information

Child First Name Only (Required)

Child Date of Birth (Required)

Age of Child on his/her Birthday (Required)

Is this child likely to receive little or nothing for their birthday? (Required)
YesNo

How long has this child been in foster care? (Required)

Birthday Information

What would the child like for their birthday? Please be specific. Items must be valued at $25 or less. If clothing, please specify size. (Required)

Describe the child's personality, talents and interests. Give specific examples and detail (Required):

Release Form

Do you agree to pick up the gifts in Kirkwood, MO or Bethalto, IL within 7 days of being notified? (Required)
YesNo

By completing and signing this application, I hereby request to enroll the foster child in my physical custody in the Foster & Adoptive Care Coalition’s Birthday Buddy program. 1. I understand there is no guarantee that my foster child will be matched with a Birthday Buddy. I understand that I will be contacted if the child is matched; 2. I understand that the Birthday Buddy program is completely dependent on the generosity and responsibility of others. I understand that even if my foster child is matched with a Birthday Buddy, circumstances beyond the Coalition’s control may prevent my foster child from receiving presents through the Birthday Buddy program. 3. If my foster child is matched with a Birthday Buddy, I agree to pick up the donated birthday presents in a timely fashion. I understand that I must pick up these birthday presents at one of the Birthday Buddy Coordinators’ homes in Kirkwood, Missouri or Bethalto, Illinois. 4. I promise to inform the Coalition if the foster child is removed from my physical custody before their birthday. 5. I promise that we will write a thank you note to the Birthday Buddy within 14 days of receiving the birthday present. I will send the thank you note to the Birthday Buddy Coordinator, to be forwarded to the Birthday Buddy. 6. I attest that the information in this Birthday Buddy application is true to the best of my knowledge and belief.

By typing your full name below, you electronically acknowledge reading and understanding the above information. You state that all of the information you provided is true.

First Name (required)

Last Name (required)

Phone Number - Please Include Dashes (required)

Email (required)

Address (required)

State (required)

Zip (required)

1st Birthday Buddy Choice (required)

2nd Birthday Buddy Choice(required)

Are you hosting an event to collect the gifts? If yes, please describe the event below:

Your Name (required)

Your Email (required)

Your Phone Number (required)

Mailing Address (required)

City (required)

State (required)

Zip (required)

Are you licensed? (required)

If yes, who is your licensing agency?

Are you inquiring about a specific child?

How many bedrooms in your home/apartment?

How many full or part-time household members?

Do you have plans to move in the next year?

Are you interested in fostering, adopting or both? (required)

What ages of children are you interested in caring for?

How did you hear about the Coalition?

If you're experiencing issues with this form, please call the Coalition at 314-367-8373 to inquire about becoming a foster or adoptive parent.

Your Name (required)

Phone Number (required)

Email (required)

Address (required)

State (required)

Zip (required)

Are you 21 years or older? (required)
YesNo

Child's Information

Child First & Last Name (required)

Child Date of Birth (required)

Child Placement (required)
RelativeFosterGroup CareIndependent

Caregiver's Information

Caregiver Name (required)

Caregiver Email (required)

Caregiver Address (required)

Caregiver City (required)

Caregiver State (required)

Caregiver Zip (required)

Caregiver Phone (required)

Case Manager's(CM) / Adoption Worker's(AW) Information

CM/AW Name (required)

CM/AW Agency (required)

CM/AW Phone (required)

CM/AW Email

Wish Information

Wish Description (required)

Why is Wish Important to Child? (required)

Wish Cost (required)

Date(s) of Activity (if applicable - i.e. summer camp dates)

Wish Website (if applicable)

Vendor Information (where the wish will take place or be purchased from)

Vendor Name (required)

Vendor Address

Who will provide transportation for this class/activity?

Who should the Coalition contact to facilitate this wish once it has been granted?

Release

By completing and submitting this application, I hereby request to enroll the foster child in my physical custody (or a child whose case I am managing) in the Foster & Adoptive Care Coalition’s Little Wishes program.
1. I understand there is no guarantee that my foster child’s wish will be granted by a donor. I understand that I will be contacted when my child’s wish has been granted.
2. I understand that the Little Wishes program is completely dependent on the generosity of others. I understand that even if my foster child’s wish is granted, circumstances beyond the Coalition’s control may prevent my foster child from receiving the wish through the program.
3. I promise to inform the Coalition if the foster child is removed from my physical custody before the wish has been granted.
4. I promise that if my child receives a wish that is tangible that he/she will take this gift with them if placement changes.
5. I promise that we will write a thank you note to the donor within 14 days of receiving the little wish. I will send the thank you note to the Little Wishes Coordinator, to be forwarded to the donor.
6. I attest that the information in this Little Wish referral form is true to the best of my knowledge and belief.

Your Name (required)

Phone Number (required)

Email (required)

Occasion You're Interested in Sharing:

Your Name (required)

Phone Number (required)

Email (required)

Event You're Organizing:

Select Opportunity (required)
—Please choose an option—Clothing Drive OrganizerCourt Appointed Special AdvocateJunior BoardLittle Wishes ElfMentorHope in a Handbag Day of VolunteerOffice SupportRefresh VolunteerReFresh Volunteer GroupSchool Supply Drive OrganizerTutor

Your Name (required)

Phone Number (required)

Your Email (required)

Address Line 1 (required)

Address Line 2 (required)

City (required)

State (required)

Zip (required)

How did you hear about the Coalition?