Mother-Child Care Application

(Click here for a description of the Mother-Child Care program.)

Instructions :

• Fill in all blanks where applicable.
• Contact an elder or minister of a CHURCH OF CHRIST for a recommendation for placement.
• The mother and children ages 14 and above should have a psychological evaluation completed which must include the following (or equivalent):
  • A standard test of intelligence (i.e., WISC or Stanford-Binet)
  • A test of academic achievement (i.e., WRAT or California Achievement Test)
  • A personality description (i.e., Rorschach, T.A.T)
  • A personality inventory (California Test of Personality/Bell Adjustment Inventory)
• Mail all of the above information plus any other data that might help in an evaluation to:
  • Medina Children’s Home
    Attn: Mother Child Care - Admissions
    21300 State Highway 16 N.
    Medina, Texas 78055
  • Or fax to 830-589-7570

After review of the application you will be contacted with further instructions.

If placement is approved the following will be needed:

• A physical and dental examination of the mother and the equivalent of a UIL (University Interscholastic League) physical and a dental examination of each school age child
• A negative tuberculosis test for the mother and each child
• Divorce papers or any other legal documentation that proves legal custody of each child.
• A certified copy of birth certificates for each child.
• A copy of the mother and children’s Social Security cards.
• School records for all school age children.
• Immunization records for all children.
• Cash or check for $250.00 for a security deposit.

Click here to apply online for Mother-Child Care using secure submission.

Click here for a printable Mother-Child Care application form.

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