Schedule to the Rules. rule 4. Forms. Republic of Uganda Form 1. Application to Foster A Child. Foster Care Placements. The Children Act. Name of applicant _____________________________________________ Married/single _________________________ Age __________________ Address _____________________________________________________ ___________________________ Tel. No. _________________________ Number of children _____________________ Age(s) ________________ Employment of applicant _______________________________________ Employment of husband _______________________________________ Employment of wife __________________________________________ Other sources of income (e.g. farm) ______________________________ ____________________________________________________________ Have you ever fostered a child/children before? (If so, give particulars) ____________________________________________________________ ____________________________________________________________ ____________________________________________________________ Reasons to foster _____________________________________________ ____________________________________________________________ Are you willing to undertake short-term fostering? ___________________ Names of two referees and their addresses (one shall be your local LC 1 chairperson or village chief) 1. __________________________________________________________ 2.__________________________________________________________ ____________________________________________________________ ____________________________________________________________ Age range _____________________ Sex of child you wish to foster _____ Applicant’s signature __________________________________________ Date _______________________________________________________ _____ rule 9.