Caregiver AFFIRM Registration Form
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 sarah@hughlane.org.   We will assist you in accessing the earliest possible series.
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Email *
First Name *
Last Name *
Date of Birth *
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/
DD
/
YYYY
Phone Number
Agency *
Are you in process of becoming a certified foster family? *
What training date are you registering for?  Please note that you must be available for all three sessions, which run from 6-8 p.m. unless otherwise noted.  If you are a new certification family and need rapid access, please email us at sarah@hughlane.org *
What is your race? *
What is your ethnicity? *
Do you identify as LGBTQ+ *
Do you identify as Transgender? *
Are you currently willing to provide placement for a lesbian, gay or bisexual youth? *
Are you currently willing to provide placement for a transgender, nonbinary or gender diverse youth? *
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