West Covina Lic #197805881
Riverside Lic #330600001 
ALPHA TREATMENT CENTERS
FOSTER FAMILY AGENCY
Where Adoption begins with Foster Care

Thank you for your interest in becoming a Foster Parent or considering Adoption through Alpha Treatment Centers.
Please fill out the form below and we will contact you with information regarding foster care and/or adoption. Before submitting this form please review the information provided on our requirements page.

I am interested in:

Primary caretaker is the person providing most of the childcare in the home
Primary Caretaker Name:

Secondary caretaker is typically an adult related to the primary caretaker (spouse, partner, relative living in the home)
who will be involved in the care and supervision of those residing in the home.
Secondary Caretaker Name:

Contact Ph#:email:


In what city do you reside?  Zip Code


How many adults/adult children live in your home? How many children? (under 18)

How many bedrooms in your home?    How many seat belts in your car?

Does your property have a body of water located on it?



YesNo
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