Privacy Declaration

Waiting Child Access & Privacy Declaration

Full Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState

Zip Code

E-mail

example@example.com

Phone Number

Format: (000) 000-0000.

Are you or your spouse (if applicable) a US Citizen?

Do you have a completed, pending, or expired home study?

If you are inquiring about a specific child, please identify or share the child's name:

Do you have an age preference for the child you wish to adopt?

Check all that apply.

Is there a specific country or countries you are interested in adopting a child from?

Check all that apply.

Check to indicate that you or your spouse are a US citizen(s) *If not, we are unable to assist you.

Signature

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