LN:
Your name:
Age:
Interests:
Disabilities:
Your SO's name:
Age:
Interests:
Disabilities:
Child(ren) living with you (name, age, interests, disabilities): Others living with you (name, age, relations):
Pet(s) living with you:
Location:
Language(s) spoken:
Religion:
Other:
The Adoptee(s)
How many children do you wish to adopt?
Age(s) (0-17):
Gender(s):
Preferred country/heritage of origin:
Preferred language(s):
Preferred religion:
Will you accept:
Siblings?
Multiples (twins, triplets, etc.)?
Children with disabilities? If so, what sort and severity?
Children who need constant medical attention?
Children who are terminally ill?
Pregnant teens?
Teen parents? If so, which one, or both? If both, will you allow a couple to stay together?
Will you allow them to stay in contact with non-abusive parents/relatives/friends/etc?
Other: