Parents Questionnaire To Receive Child's Profile


Home Study Approved Parents Questionnaire Form

Questionnaire form to fill out if you are requesting a particular child/children's profile sent to you.

Please complete this form to provide us with information concerning your family and your adoption needs.  This will also help us determine how we can best assist you. 

Please contact us after submission of the questionnaire or let us know the best time to reach you.  We will only send the child's profile upon your telephone call.  We will discuss with you the information about the child including the medical records, the procedure of the adoption and the cost.  Should you feel that this maybe the right child and program, we will then arrange shipment of his/her profile and any additional information that may be helpful in decision making.  We strongly advise that you review each option prior to requesting a particular child’s profile. 

Please note that our procedure is to share this information with other Agencies that may have children available who may be appropriate for your family .  Let us know if you prefer that we consult with you prior to forwarding the information. 

Info on the child you wish to receive profile of
Child's Name 
Child's ID 
Child's Birthday 
Where did you learn about this child? 
 

If you learned about this child through a Photo listing site, please mark which one:  

 

  AdoptableKids Adopting ChildrenToAdopt LuvDaKids Precious RainbowKids WelcomeGarden  
Prospective Parents Information Info 
Marital Status
Married  Divorced  Single Widowed
Family Last Name
Husband's First Name
Wife's First Name
Husband's Age Wife's Age
Husband's Citizenship Wife's Citizenship
Street Address
Suite/Apt. #
City
State/Province
Zip/Postal code
  
Country  
Home Phone  Area Code Number
Husband's Work Phone  Area Code Number
Wife's Work Phone  Area Code Number
Husband's Cell PhoneArea Code Number
Wife's Cell PhoneArea Code Number
*Contact Email:
Husband's E-mail
Wife's E-mail

# of Children Birth/Adopted Age/s of Boy/s Age/s of Girls

Home study
Completed   In-Progress   None
Social Worker's Name
Social Worker's Phone
Agency that Approved your Home study
Agency 's Phone
INS
Completed   In-Progress   Not Started

Date 1600 A filed Date INS approved

If INS approved, please indicate where your advance processing application is at: 

Retained at your local INS office  / what city

Forwarded to American Consulate or Embassy at:

Moscow, Russia   Bucharest, Romania   Kiev, Ukraine   

Warsaw, Poland   Baku, Azerbaijan   Guatemala   

Brazil   Costa Rica   China   Philippines  

Other  

Program(s) for which you would like more information on:

Domestic   China   Guatemala  
Romania   Russia   Bulgaria  
Azerbaijan   Kazakhstan   Belarus
Pilot Program(s) for which you be willing to participate in :

Poland   Costa Rica   Brazil

Costa Rica   China   Philippines  

  Other 

Who referred you to us?

May we share your information to other agencies? Yes   No

Please feel free to comment or make a suggestions 

 

 

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