FAMILY FORM
Last Name: Dirks
Mother's name:
Shelby Rebecca
Father's name:
Joshua Ryan
Children's name & Ages:
Ellery Michelle (16)
Charna Rose (14)
James Alexander (7)
Charles Michael Thomas (5)
Norah Ophelia Georgia (5)
Kaia Adrienne (4)
Rylan Joshua (2)
Jeremy Ryan (2)
Taryn Alexandra (newborn)
Pets: Outside pets only
ADOPTIVE FORM
How many children would you like to adopt? as many as you will give me
Siblings? sure
Twins? sure
Triplets? sure
What gender? either
Would you be willing to handle disabilities? Which kind? ADD or ADHD only
Are your current children easy going and loving? Very
Where do you want your child to be from? Anywhere is fine
What age? any