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I/we understand that information held in my/our records relating to me/us, my/our children and other household members will be considered in support of a fostering application/continued approval to foster.

I/we understand that explicit consent of all parties referred to is needed, including young people aged 16 and over.

I/we understand that my/our name, address and DOB are added to a database to enable ESCC to record this application/safeguarding check.

I/we consent to ESCC asking the Local Authority in which I/we live (as below) to complete a check of their records and to share that information with ESCC for consideration in support of a fostering application/continued approval to foster

Declaration

Have you ever admitted to committing or attempting to commit any offence against a child although not convicted in court?

Yes

Have you ever had a court order made against you or a child in your care?

Yes

Have you ever had any child removed from your care, prevented from being received into your care or been subject to supervision in your care of/contact with any child?

Yes

Have you ever had an application to be a Foster Carer or Adopter declined or approval as a Foster Carer terminated?

Yes

Have you ever had registration as a childminder or registration of premises for purpose of providing care refused or cancelled?

Yes

Have you (or your child/ren) been on the Child Protection Register or subject of Child Protection/Safeguarding Plan?

Yes

Have you ever applied to foster or adopt with ESCC, any other local authority or any other service?

Yes

About you

What is your relationship to the applicant?

I am...

the fostering applicant

an adult child of a foster carer

a member of a fostering household

a support to a foster carer

Surname

Date of birth

First name

Have you been known by a previous name(s)?

Yes

Previous name(s)

All previous names you have been known by

Is this a joint application?

Yes

Current address

Address

Building and street line 1 of 2

Building and street line 2 of 2

Town or city

County

Postcode

Dates at current address

How long you have lived at this address

Previous addresses

Previous address(es) Optional

If this is an initial check, please provide all previous addresses from the past ten years.

If this is an update check please provide addresses for the past three years.

Address Optional

Dates at this address Optional

MM/YYYY to MM/YYYY

Add another address? Optional

Yes

Address Optional

Dates at this address Optional

Add another address? Optional

Yes

Address Optional

Dates at this address Optional

Add another address? Optional

Yes

Address Optional

Dates at this address Optional

About - second applicant

Surname Optional

Date of birth Optional

First name Optional

Have you been known by a previous name(s)? Optional

Yes

Previous name(s)

All previous names you have been known by

Address - second applicant

Address Optional

Building and street line 1 of 2

Building and street line 2 of 2

Town or city

County

Postcode

Dates at current address Optional

How long you have lived at this address

Previous addresses - second applicant

Previous address(es) Optional

If this is an initial check, please provide all previous addresses from the past ten years.

If this is an update check please provide addresses for the past three years.

Address Optional

Dates at this address Optional

Add another address? Optional

Yes

Address Optional

Dates at this address Optional

Add another address? Optional

Yes

Address Optional

Dates at this address Optional

Add another address? Optional

Yes

Address Optional

Dates at this address Optional

I agree

Declaration
I/we declare that all of the information given on this form is correct.

Full name

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