Family Enrollment

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Registration Information

Foster/adoptive parents traditionally register with Share My Smile upon attending one of two events: the Holiday Dinner Celebration or the Family Festival. However, parents can register at any time. If you are a foster/adoptive parent in the *thirty counties we serve in Iowa and would like to receive services, please complete and submit the form below. If additional information is needed, you will be contacted by a representative.

*We serve the following Iowa Counties: Adair, Audubon, Carroll, Cass, Crawford, Fremont, Guthrie, Harrison, Mills, Monona, Montgomery, Page, Pottawattamie, and Shelby. We serve Douglas County (NE) and other Iowa Counties on a case by case basis. Please contact us for questions. 

*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
*REQUIRED
List all foster children, including kinship and guardianship, 18 and under. Include name, sex, and birthday (name, F/M, mm/dd/yyyy). Complete all requested information on each child or services could be delayed to obtain information.
List all adopted children 18 and under. Include name, sex, and birthday (name, F/M, mm/dd/yyyy). Complete all requested information on each child or services could be delayed to obtain information.
List all biological children 18 and under. Include name, sex, and birthday (name, F/M, mm/dd/yyyy). Complete all requested information on each child or services could be delayed to obtain information.
List any comments, questions, or concerns you may have at this time or anything you feel is important for Share My Smile to know on an immediate basis. Thank you.

Please note that due to the nature of foster care, it is our current policy that the parent is responsible for keeping Share My Smile informed of the status of the foster children in the home in order to receive program benefits for these children. Thank you.

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