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* Thank you so much for you willingness to assist us with covering a child's supervision needs in a hospital setting. In addition, to hospital coverage availability, there will  be a few questions regarding your availability as an emergency placement.  To begin, please share your contact information.

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* If applicable, in which FSD District office did you receive your current foster care license?

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* Separate from hospital coverage, are you interested in receiving a phone call when we need an emergency placement?

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* Please select a hospital you feel comfortable visiting to cover a child's supervision needs

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* If you indicated you are able to spend time covering a child's supervision need at UVM Medical Center. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Northwestern Medical Center. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Central VT Medical Center. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Rutland Regional Medical Center. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Gifford Medical Center. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at North County Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Mount Ascutney Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Copley Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Northeastern Vermont Regional Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Springfield Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Porter Medical Center Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Grace Cottage Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Brattleboro Memorial Hospital. Please select from the options below which times would work for you:

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* If you indicated you are able to spend time covering a child's supervision need at Southwestern Vermont Medical Center. Please select from the options below which times would work for you:

Your name and contact information along with the details of which hospitals you can consider visiting to support children will be shared with the Emergency Services Team and the FSD District Office you are connected to.   Thank You for your willingness to support children in care in this manner.

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