Name

Mailing Address

City

County Select a County Abbeville Aiken Allendale Anderson Bamberg Barnwell Beaufort Berkeley Calhoun Charleston Cherokee Chester Chesterfield Clarendon Colleton Darlington Dillon Dorchester Edgefield Fairfield Florence Georgetown Greenville Greenwood Hampton Horry Jasper Kershaw Lancaster Laurens Lee Lexington Marion Marlboro McCormick Newberry Oconee Orangeburg Pickens Richland Saluda Spartanburg Sumter Union Williamsburg York

Zip Code

Cell Phone Number

Home Phone Number

Work Phone Number

Email Address

Number of children in your care

Relationship to child/children:

How did you become involved with this child/children? (Select ALL that apply)

What time of day works best for you during the weekdays? (Select ALL that apply)

What day of the week works best for you? (Select ALL that apply)

Briefly describe why Kinship Care is important to you.

Please DO NOT use this form to report child or adult abuse or neglect.. Non-emergency reports of abuse or neglect can be made by calling the statewide, 24/7 abuse/neglect hotline at 1-888-CARE-4-US (1-888-227-3487) or by reporting online here. For emergencies, please contact 911 or your local law enforcement office.