Birth Mother Introduction Information

Birth Mother Introduction Form

The information requested in the following pages is necessary to help in finding the best adoptive family for you. Please take your time in completing this and feel free to reach out at any time to our staff if you have any questions.
Name*

First NameLast Name
Email*
example@example.com
Birth Date*
Place of Birth*
Phone Number*
Please enter a valid phone number.
Best way to contact you?*

EmailPhone CallText
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Whom do you live with? Are they supportive of adoption?
Are you married?
Your race or ethnicity?
Highest Level of Education completed or years attended

Hobbies or Interests

Adoptive Family Preferences

The information provided below will give us a basic idea of the qualities in the adoptive family you are looking for. You and your birth parent advocate will talk more about this when you meet and develop a plan that will meet your wishes, or a discussion on having no involvement in placement.
On a scale of 1 to 10, how committed are you to completing the adoption*
From looking into your options (1) to completely sure (10)
Do you want to be involved in selecting the adoptive family?*
If no, please skip the following questions
Marital Status of the adoptive family?
Married, Single, Same Sex couples, no preference
Preferred Race of the adoptive family?
What level of contact are you looking for with the adoptive family during your pregnancy?
After the birth, do you want contact with the adoptive family?
Do you have any other preferences or 'ideals' for the adoptive family?

Were you adopted?
If yes, what information do you know?
Have you ever placed a child for adoption before?
Have you ever been convicted of a crime?
Please note this does not interfere with acceptance into the Placing Parents Program
Have you ever been reported for child abuse or neglect?
Please note this does not interfere with acceptance into the Placing Parents Program

American Indian Information

The American Indian Tribal law applies to federally recognized Indian Tribes and only applies if enrollment or the possibility of enrollment exists. Whether or not someone is enrolled is usually shown by the person having a Certificate of Degree of Indian Blood (CDIB) card issued by the Bureau of Indian Affairs.
Are you a member of a Native American or Alaskan Native Tribe?*
If yes, please list Tribe(s)
Are you eligible for membership to a Tribe?
Are any of your direct relatives a member of a Tribe?

Current Pregnancy Information
Is this your first pregnancy?
If no, how many previous pregnancies?
Have there been complications during this pregnancy?
Do you have health insurance or are in need of health coverage?
Do you frequently use drugs or alcohol?
Please be open and honest with your usage of any drugs or alcohol used during your pregnancy and the frequency of use. This information is very important. We have many wonderful families open to adopting your baby, regardless of your substance usage.

Birth Father Information

Your birth parent advocate will discuss with you in further detail about your information regarding the birth father. If he wants to be involved in your adoption plan, or if the birth parent advocate can send him forms to complete.
Do you know who the birth father is?*
Name

First NameLast Name
Has the identified birth father acknowledged that he is the biological father?
Is he supportive of adoption?
Has he given or provided you any support during your pregnancy?
Is the pregnancy a product of incest or rape?

Adoption through A Giving Tree Adoptions
In selecting an adoptive family for your child,you may request that your child be placed with an adoptive family of your same religious and/or ethnic background, i.e. racial.

A Giving Tree Adoptions will do everything in our power, within reasonable request, honor your wishes. All adoptive families must complete a special training program that develops their understanding of how to best meet children’s needs. This includes information about child development, explaining adoption to children, and baby care.

A Giving Tree Adoptions checks on the applicants and members of their household to determine if they have criminal records that would make them unsuitable to raise children. A Giving Tree Adoptions receives references regarding all applicants to determine if their friends, employers and relatives consider them to be suitable to be adoptive parents.

A social worker from A Giving Tree Adoptions meets with the applicants and goes to their home to determine if they can provide a safe, loving and good family life for a child. Applicants must obtain a statement from a physician confirming they have no physical and/or mental health problems that would interfere with raising a child.
In the unlikely event that the family you select for your child is unable, for unforeseen reasons, to receive placement of the child, A Giving Tree Adoptions will use its sole discretion in selecting a family. If a specific family has been selected for your child, you may request that you be provided with certain information. This will be non-identifying and why it is believed this family will meet your child’s needs.

Open v. Closed Adoption
As a birth parent, we know you want the best for your child. To do this, you may wish to view profiles of potential adoptive families. If you desire you may interview potential adoptive families by phone, in person or via skype. You may choose to receive letters, visits or calls for the ongoing 18 years at your discretion. Letters can be placed in your file and retrieved when you please. This would be an open adoption.
If you are not completely comfortable choosing a family, you may opt to have staff do that for you. You have the choice to keep your adoption file closed having no further contact with the child. This is a closed adoption.
We believe that each person involved in the adoption process is equally important and continually strives to ensure all parties' needs are advocated for.

In addition to the support from our birth parent advocate, we will provide counseling resources and financial aid for you as needed. Our birth parent advocate is available to you for support and friendship. They are able to drive you to appointments as needed, or to grocery or general shopping.

We want to thank you for considering adoption. This is a deeply selfless loving act.
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Birth Mother Introduction Form

Adoptive Family Preferences

American Indian Information

Current Pregnancy Information

Birth Father Information

Adoption through A Giving Tree Adoptions