October 25, 2025 Match Event Family Registration Form

October 25, 2025 Match Event Family Registration Form
You're Invited!
Match Event – Harrisburg Area
Date: Saturday, October 25, 2025
Time: 9:00 AM – 3:30 PM
Location: Central Pennsylvania – Harrisburg Area

Join us for a special Match Event featuring a variety of indoor and outdoor activities in a beautiful, park-like setting. It’s a wonderful opportunity to connect with youth in a relaxed and engaging environment. Please dress comfortably and wear appropriate footwear for outdoor activities and changing weather conditions.

Eligibility: This event is open to fully licensed or homestudied families only.

We look forward to welcoming you in October! To attend, please complete the registration form in full. You will receive a confirmation once your registration has been accepted. The event address and directions will be provided at that time.
Adult 1*

First NameLast Name
Adult 2

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Email*
example@example.com
Does either Adult have a chronic condition, disability, dietary restrictions or food allergies?*
Please explain any accommodations person requires.
Any questions or comments?
Agency You Are Working With*
Worker Name*

First NameLast Name
Worker Phone Number*
Please enter a valid phone number.
Worker Email*
example@example.com
Agency Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Meet the Families Booklet
The answers to the following questions will be used to make our Meet the Families Booklet. This booklet will serve as a reference for the case workers and youth to remember the families when inquiring at the end of the event.

Please upload one photo of all approved in the home study. Only show youth you have the legal right to share. If you have youth in your family who are still in foster care, they may be unable to have their photos shared. Thank you!
Family Members in the home*
Enter First Name only
Occupations*
Do You Have Pets?*
If so, what kind and what are their names?
Favorite Family Activities*

50 word limit0/50
I/We Want To Adopt Because*

50 word limit0/50
Family Photo For Booklet*

Cancelof
Release and Authorization to Photograph/Videotape

The undersigned does hereby consent to photographing and/or videorecording during the Match Event. It is understood that the images may be used in print publications, online publications, presentations, websites, and social media. The undersigned does hereby release the Adoption Center from all claims whatsoever arising out of, related to or based on the use of said materials.
Adult 1

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Adult 2

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Demographic Information

The demographic information you provide Adoption Center is very important. Adoption Center respects an individual’s right to keep certain personal information private. Any information provided will be used solely for the important purposes of improving our service offerings and fundraising. We will not sell, trade, or transfer an individual’s personal demographic information to any third party or entity. If you have any questions or concerns regarding the information you provide in this survey, please contact us at mediarecruitment@adopt.org. Thank you.
Adult 1: what is your gender identity?
Adult 2: what is your gender identity?

	Adult 1	Adult 2
Do you consider yourself part of the LGBTQ+ community?

Adult 1: what is your ethnicity or racial background?

African American or BlackAsian/Pacific IslanderHispanic/LatinoCaucasian/ WhiteNative AmericanOther
Adult 2: what is your ethnicity or racial background?

African American or BlackAsian/Pacific IslanderHispanic/LatinoCaucasian/ WhiteNative AmericanOther
Should be Empty:

October 25, 2025 Match Event Family Registration Form

Meet the Families Booklet

Demographic Information