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Please fill out the following form and I will match you with a child or children in need of a home. Please be specific!

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LN:

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Your name:
Age:
Occupation:
Interests:
Disabilities:

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Your SO's name:
Age:
Occupation:
Interests:
Disabilities:

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Child(ren) living with you (names, ages, interests, disabilities):

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Others living with you (names, relations):
Pet(s) (names, species):

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Location:
Do you travel often? If so, where to and how often:

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What is/are the household’s religion(s):
What language(s) do household members speak:

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The Adoptee(s):
How many children do you want to adopt (max. 3):
Ages (newborn-16):
Gender(s):
Preferred origin(s):
Preferred language(s):
Preferred religion(s):

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Will you accept:
-Disabilities (kinds and severity):
-Multiples (twins or triplets):
-Siblings and/or close relatives:
-Pregnant teen?:
-Teen mom, dad, or both:
--Teen mom, dad, or both WITH child:
-Gay/lesbian teens? If so, which or both:
-Children with a terminal illness:
-Children with pets? If so, what kind(s):

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Will you allow them to stay in contact with non-abusive parents/relatives/etc.:

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Other: