Relative Adoption Intake Form

RELATIVE 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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Adoptive Parent #1 Full Legal Name *

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

Adoptive Parent #2 Full Legal Name *

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

Email *

Address *

Full street address and zip code.

Phone number *

Are you working with a licensed adoption or foster family agency? *

Are you currently home-studied? *

When was your home study last updated/completed? *

IS THERE ANYTHING IN THE ADOPTIVE PARENT'S LIFE WHICH COULD POSE A PROBLEM IN THE REQUIRED INVESTIGATION (CRIMINAL HISTORY, ETC.)? IF YES, DESCRIBE: *

Child #1 Legal Name *

Child #1 DOB or Due Date *

Child #2 Legal Name

Child #2 DOB or Due Date

Birth Mother Legal Name *

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

Description of Birth Mother *

Description of Father *

Please be as detailed about the father as possible. Is his identity known? Is his name on the child's birth certificate? Is there a paternity case? Did he act like the child is his own and raise the child as his own?

IS EITHER BIRTH PARENT, OR THE CHILD, POTENTIALLY ELIGIBLE FOR MEMBERSHIP IN A NATIVE AMERICAN OR ESKIMO TRIBE (OR HAVE ANY SUCH HERITAGE)? *

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

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