Shelter-Inquiry

House of Hope Shelter Program Application

Shelter Client Request Form

Contact Info

First Name*

Middle Name *

Last Name*

Email*

Phone

Ext

Work
Mobile
Home

Address Line 1

Address Line 2

City

State/Province

Postal Code

Country *

Options

Public Message of Support

Additional Information for Your Order

What additional information would you like us to know?

If yes, please give us age and gender of the children expected to come into the program below.

To the best of my knowledge, all the information provided on this form is correct. I understand that Tender Hearts Ministries carefully screens employees and volunteers that interact with children through S.L.E.D. and D.S.S., and I agree to the screening process. I also understand that if I choose to have direct interaction with clients I will be required to abide by the standards, policies, and procedures set forth by Tender Hearts Ministries and the department in which I work.

Please List Criminal History

Additional Information for Your Shelter Request(s)

1 X Shelter Request

First Name

Last Name

Your Date of Birth

Phone Number

Are you seeking shelter as an Individual or a Mother with Child/ren?

If yes, please give us age and gender of the children expected to come into the program below.

By clicking I agree to the terms.