2. 
   Due to the COVID-19 pandemic, the majority of our training programs have shifted to virtual or online learning. The foster care preservice training program is a combination of live and self-paced virtual learning. To register for classes, or for more information, please complete and submit this form.
   
4. Yes! I would like to register for LCCS Foster Care and Adoption Pre-Service Training.

   I am registering for:

   -- Select One --Yes! Sign me up for virtual training.I am not ready to register, but please have someone call me.
6. Household Member #1
8. First Name*
9. Last Name*
11. Address 1*
13. Address 2
15. City*
16. State*
17. Zip *
19. Phone*
20. Other phone
21. Gender
    -- Select One --MaleFemaleOtherPrefer not to respond
23. Your email address (Will only be used for contact with you about your inquiry)*
25. Household Member #2
27. First Name
28. Last Name
30. Address1
32. Address2
34. City
35. State
36. Zip
38. Phone
39. Other phone
40. Gender
    -- Select One --MaleFemaleOtherPrefer not to respond
42. Your email address (Will only be used for contact with you about your inquiry)
44. I am interested in*

    1. Foster care
    2. Adoption
    3. Dual foster care and adoption
    4. Not sure
45. If you are interested in a specific child/children, please provide name(s).
47. Referral sources*

    1. Newspaper advertisement
    2. Newspaper story
    3. Radio advertisement
    4. Radio story
    5. Television advertisement
    6. Television news story
    7. Facebook/Twitter/Other social media
    8. Internet/Adopt US Kids website
    9. Internet/LCCS website
    10. Friend
    11. Family member

    1. Other foster/adoptive parent
    2. LCCS employee
    3. School
    4. Church, synagogue or mosque
    5. Community program/event
    6. Telephone book
    7. Other agency
    8. Inquired before
    9. Brochure or flyer
    10. Other
49. Any other questions, comments or information
Leave This Blank:


51. 1. Receive an email copy of this form.
52. Email address

    This field is not part of the form submission.

53. Submit

* indicates a required field