Filling out the form below allows us to provide your family with the best possible service.

If you need assistance completing this form, call us at (541) 779-5242.
Or email us at info@familynurturingcenter.org

Self-Referral Form

  • Please list all children living in the household (0-18 years of age)

  • Need help with this form?

  • Don't hesitate to get in touch! info@familynurturingcenter.org or (541) 779-5242
  • Confidentiality: We appreciate your letting us get to know you and your family, and we will maintain your privacy. Relevant family information is thoughtfully and respectfully shared between programs and appropriate staff members here at the Family Nurturing Center. This sharing of information allows us to provide your family with the best possible service. What we talk about is private, but there is an important exception. All of the people who work for the Family Nurturing Center are mandated reporters of child abuse. This means that we are required by law to let DHS or a law enforcement agency know if we have any reasonable cause to believe a child is unsafe or has been harmed. If we are ever required to make a report, we will support your family through the process in whatever way possible, and will continue to provide services to you and your family. We know that parenting is hard work, and we will partner with you to keep your family safe. The staff at the Family Nurturing Center will do all that we can to support parents and families. Please talk to your child’s teacher/care coordinator if you have questions.