*Only 1 reference can be a relative & that relative must not live with you. All references must be 18 years of age or older.*
I have read and understood the above statements. I certify that the information given on this form is true and correct and I
recognize that any misrepresentation of facts will result in my being unable to foster from PVHS. I understand that
submission of this application does not guarantee that I will be able to foster and that approval or denial of this application is
at the sole discretion of PVHS.