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2021 - 2022 Participant Registration Form

Personal Information
Home Phone     Cell Number     Email Address
Applicant
Yes     No
Release Statement

This statistical information will be used to keep accurate records of the services provided by the community college Foster and Kinship Care Education Program. This information will assist the college in keeping accurate records of the classes that you take. It will also help the college to keep you informed of upcoming classes and events within the FKCE program at your local community college. Your name, address, phone number and partial social security number will remain confidential. Statistical data may be reported to funding agencies. No unauthorized person will have access to your information.

I am aware that I am consenting for Long Beach City Community College District's Foster Care Program to share via electronic means and/or mail, my FKCE workshop attendance transcript and certificates, that maintain record of all my community college FKCE workshop trainings, to the Department of Children and Family Services, Probation Office, and/or the Foster Family Agency that I maintain a foster care contract.