Sleep Safe - Child ReferralPlease complete this form to request a bed for a child in foster care. Child's Name * First Name Last Name Age * Gender * DHS Case # or Wayne County Court # Caseworker's Name * Agency * Phone * (###) ### #### Email * Comments * Living Status * living with parent or guardian reunification with parent moving into a family placement exiting homelessness transitioning out of foster care exiting divorce exiting abusive home other Current Sleeping Arrangement * Please select the child's current sleeping arrangement for request of a new bed. no bed whatsoever lost bed to bed bugs broken bed sharing bed blow-up mattress toddler bed or crib mattress on floor other Thank you!
