Stepparent Adoption Intake Questionnaire

Stepparent Adoption Intake Questionnaire
Please complete this intake so we can prepare the adoption petition and the Virginia VS-21 Report of Adoption.
Stepparent petitioner and contact
Stepparent first name
Stepparent middle name
Stepparent last name
Stepparent suffix
Stepparent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Stepparent birth or maiden last name
Stepparent pronouns
Stepparent custom pronouns
Stepparent relationship to child
Stepparent phone number
Please enter a valid phone number.Format: (000) 000-0000.
Stepparent email address
example@example.com
Stepparent street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Stepparent city
Stepparent state
Stepparent ZIP code
Date stepparent began living in the same household as the child

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Date stepparent first met the child

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Child's current legal parent joining the petition
Joining parent first name
Joining parent middle name
Joining parent last name
Joining parent suffix
Joining parent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Joining parent birth or maiden last name
Joining parent pronouns
Joining parent custom pronouns
Joining parent relationship to child
Does the joining parent use the same current address as the stepparent?
Joining parent street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Joining parent city
Joining parent state
Joining parent ZIP code
Child to be adopted
Adoptee current first name
Adoptee current middle name
Adoptee current last name
Adoptee current suffix
Adoptee date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Adoptee state of birth
Adoptee country of birth
Adoptee birth certificate number
Adoptee pronouns
Adoptee custom pronouns
Has the adoptee ever used a different legal name?
Adoptee prior legal name at birth or earliest prior name
Will the adoptee's legal name change after adoption?
Adoptee new first name
Adoptee new middle name
Adoptee new last name
Adoptee new suffix
Other or noncustodial parent
Other parent first name
Other parent middle name
Other parent last name
Other parent suffix
Other parent date of birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Other parent sex on birth record
Other parent pronouns
Other parent custom pronouns
Is the other parent deceased?
Other parent street address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Other parent city
Other parent state
Other parent ZIP code
Other parent's consent or legal basis
Marriage and household
Were the child's legal parents previously married to each other?
Stepparent and joining parent's marriage date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Marriage city
Marriage state
Should be Empty:

Stepparent Adoption Intake Questionnaire

Stepparent petitioner and contact

Child's current legal parent joining the petition

Child to be adopted

Other or noncustodial parent

Marriage and household