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Adoption Application

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					This is an adoption application for parents planning on adopting a child. This is a
standard form that is sent to adoption agencies and contains information regarding the
parents' background, education, finances, as well as other information the agencies
deem necessary to the adoption process. This application is useful for parents who are
considering adopting a child.
Child desired: Sex _________, Age _________.

                                             Applicants for Child

Names:

   Husband ______________________ (Last name first)                    Date of Birth:

   Wife ________________________(Maiden name first)                    Date of Birth

Address _________, City _________, County _________, State ____Zip Code ______ Phone Number _________

Last Previous Address _________                                        Date of Moving

Nationality of Husband _________; of Wife _________.

Marriage Information

Name of Church _________, City _________, State _________.

Date of Marriage _________. Please submit marriage certificate with this application. If either party has been
previously married, give details _________.

                                         Religious and Educational Status

Husband:

   Baptism:

   Confirmation:

   First Communion:

   Schools attended:

Wife:

   Baptism:

   Confirmation:

   First Communion:

   Schools attended:




                                                       2 of 5
                                                   Church and School

Name of church you attend

Address

Name of Pastor

Distance from home of nearest parochial school

                                Children or Other Members of Family Living at Home

Name                Relationship              Birth date                Religion

Name                Relationship              Birth date                Religion

Is any member of your family a mental or physical invalid?

                                              Description of Applicants

Husband: Height           Weight              Color of Eyes                  Color of Hair            Complexion

Wife: Height          Weight              Color of Eyes                  Color of Hair            Complexion

Child: Height          Weight              Color of Eyes                 Color of Hair             Complexion

Child: Height          Weight              Color of Eyes                 Color of Hair             Complexion

Please send us photographs.

   Under Family list mother, father, brothers, sisters. If any are deceased, give date and cause of death.

Husband's Family:

Name                Address             Age                  Religion              Practicing?           Number of
Children

Name                Address             Age                  Religion              Practicing?           Number of
Children

Name                Address             Age                  Religion              Practicing?           Number of
Children

Wife's Family:

Name                Address             Age                  Religion              Practicing?           Number of
Children




                                                           3 of 5
Name               Address              Age               Religion             Practicing?   Number of
Children

Name               Address              Age               Religion             Practicing?   Number of
Children

   Note any instances of legal adoption of brothers, sisters, or nephews and nieces.

                                                  Home of Applicant

Private Dwelling?
Apartment?
Number of Rooms
If owned, what is the value?
Purchase price?
Present mortgage?
Amount of monthly rent or mortgage payments?
What business, if any, is conducted in the building in which the applicants reside?


                                                Finances of Family

Husband:

Occupation _________, Name of Firm _________, Address _________, Phone _________, How Long _________,
Income _________.

Previous Employment: _________, Dates _________._________, Dates _________.

Military record? Dates _________, Rank or Rating _________, Type of Discharge: _________.

Wife:

   Occupation _________, Name of Firm _________, Address _________, Phone _________, Dates _________,
Income _________.

Previous Employment: _________, Dates _________._________, Dates _________.




      
				
DOCUMENT INFO
Description: This is an adoption application for parents planning on adopting a child. This is a standard form that is sent to adoption agencies and contains information regarding the parents' background, education, finances, as well as other information the agencies deem necessary to the adoption process. This application is useful for parents who are considering adopting a child.