Foster Adoption Intake Form

FOSTER ADOPTION INTAKE FORM

Please take time to complete this intake form before we meet. Please be as specific as you can. We will call you promptly to schedule your consultation.

Your answers in this short questionnaire will give us the information we need to: 1) fully advise you during your consultation, and 2) use this information to prepare your legal pleadings.

The information you provide is confidential. If you do not retain us, the intake form will be destroyed. Be aware that completing this questionnaire alone does not create an attorney-client relationship. We reserve the right to decline representation after your initial consultation.

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Name *

Email *

Are you foster parents? *

• Yes
• No

Are you relatives? *

• Yes
• No

Adopting Parent 1 Name *

Please tell us your Full Legal Name that matches your driver's license or government issued ID as the court requires it.

Date of Birth *

Email: *

Phone Number *

Address *

Number, Street, City, State, Zip Code

Adopting Parent 2 Name *

Please tell us your Full Legal Name that matches your driver's license or government issued ID as the court requires it.

Date of Birth *

Email *

Phone Number

Address *

Where is the County Case? *

Please include Case Number, Department and Judge.

What is the current status of the case? *

Who is your agency? *

Is there a home study? *

Include Date Homestudy Completed/​ Updated

County Social Worker *

Please include name, email and phone number, and describe the worker's position in your case, if you know.

County Counsel *

Please include name, email and phone number.

Information about Child 1 *

Please include DOB, description of child, date of detention, and date placed in your care.

Information about Child 2

Please include DOB, description of child, date of detention, and date placed in your care.

Information about Child 3

Please include DOB, description of child, date of detention, and date placed in your care.

Child's Attorney *

Please include name, email and phone number.

Information about birth parents *

Please include full legal name, number and emails, and brief descriptions of background.

How did you hear about the Law and Mediation Offices of Kelly Chang? *

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