Placement Request

The Baptist Children’s Village is here to take the good news of Jesus Christ to at-risk Mississippi children and families. You have a Savior. In HIM there is HOPE.

You may request placement of a child or children into our residential program or request help for a family through our Dorcas In-Home Family Support Program by filling out the form fields below. Fields marked with an * are required. Someone from our social services office will follow up with you.

Person or Agency Making Request *

Name *

Address *

City *

State *

Zip Code *

Mississippi County from which the child(ren) are being referred *

Email Address

Phone Number *

Program Application *

Child #1 Full name, Age, and Date of Birth *

Child #2 Full name, Age, and Date of Birth

Child #3 Full name, Age, and Date of Birth

Child #4 Full name, Age, and Date of Birth

Child #5 Full name, Age, and Date of Birth

Comments

Leave this field blank

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

!Designate a Portion of What You Owe the State of Mississippi to The BCV

Placement Request

Partnerships