Caregiver AFFIRM Registration Form

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Thank you for your interest in AFFIRM. Please use this form to register for an upcoming series. Registrations are collected on a rolling basis until a series is full. We will remove series dates from selection once they are full. Each individual participating in AFFIRM should complete a registration form for themselves.

If you are a new certification family and need assistance expediting registration for an upcoming AFFIRM series, please email info@hughlane.org. We will assist you in accessing the earliest possible series.

Email *

First Name *

Last Name *

Date of Birth *

YYYY

Phone Number

Agency *

Are you in process of becoming a certified foster family? *

Yes

I am already certified with my agency

I am a kinship family

I am a biological parent

I am a natural support of an LGBTQ+ child

What training date are you registering for? Please note that you must be available for all four sessions, which run from 6-8p unless otherwise noted. If you are a new certification family and need rapid access, please email us at larry@hughlane.org *

What is your race? *

What is your ethnicity? *

Do you identify as LGBTQ+ *

Yes

Prefer not to answer

Do you identify as Transgender? *

Yes

Prefer not to answer

Are you currently willing to provide placement for a lesbian, gay or bisexual youth? *

Yes

I would need more support

Are you currently willing to provide placement for a transgender, nonbinary or gender diverse youth? *

Yes

I would need more support

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