Stepparent Adoption Intake Form

STEPPARENT 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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INFORMATION ABOUT THE STEPPARENT (THE ADOPTING PARENT) Full Legal Name (First-Middle-Last) *

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

ADOPTING PARENT'S EMAIL *

ADOPTING PARENT'S PHONE *

HOME ADDRESS *

(STREET, CITY, STATE, ZIP)

DATE AND STATE OF MARRIAGE *

DATE STEPPARENT BEGAN SHARING PHYSICAL CUSTODY OF CHILD *

INFORMATION ABOUT THE EXISTING PARENT (STEPPARENT'S SPOUSE) FULL LEGAL NAME (FIRST-MIDDLE-LAST) OF STEPPARENT'S SPOUSE *

PHONE NUMBER OF SPOUSE *

EMAIL OF SPOUSE *

FULL MAIDEN NAME (FIRST-MIDDLE-LAST) *

INFORMATION ABOUT THE CHILD BEING ADOPTED: FULL LEGAL NAME (FIRST-MIDDLE-LAST) OF CHILD/CHILDREN TO BE ADOPTED *

DATE AND CITY/STATE OF CHILD'S BIRTH *

AFTER THE ADOPTION IS FINALIZED, WHAT DO YOU WANT THE CHILD'S NAME TO BE (FIRST-MIDDLE-LAST)? *

INFORMATION ABOUT THE ABSENT PARENT: FULL NAME OF THE ABSENT PARENT *

ADDRESS, PHONE, EMAIL FOR THE ABSENT PARENT. HE/SHE IS NOT CONTACTED UNTIL YOU GIVE PERMISSION.

(YOU CAN PROVIDE THIS INFORMATION LATER IF YOU PREFER.)

HAVE YOU DISCUSSED ADOPTION WITH THE ABSENT PARENT? DO YOU THINK HE/SHE WILL CONSENT? *

PLEASE DESCRIBE THE AMOUNT OF CONTACT THE ABSENT PARENT HAS HAD WITH THE CHILD, AND ALSO THE AMOUNT OF SUPPORT PROVIDED. *

PLEASE LIMIT REPLY TO 4 SENTENCES.

DESCRIBE ANY COURT ACTIONS WITH THE ABSENT PARENT REGARDING CUSTODY, SUPPORT, VISITATION / PATERNITY. *

PLEASE LIMIT REPLY TO 4 SENTENCES.

IS THE ABSENT PARENT ON THE BIRTH CERTIFICATE OR PREVIOUSLY MARRIED TO THE OTHER PARENT? *

DID THE ABSENT PARENT EVER HAVE THE CHILD IN HIS HOME AND HOLD THE CHILD OUT AS HIS OWN NATURAL CHILD? *

IS THE CHILD A WARD OF THE COURT OR A COURT-ORDERED GUARDIANSHIP? *

ARE THE STEPPARENT, EXISTING PARENT AND CHILD ALL US CITIZENS? IF NOT, EXPLAIN: *

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

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

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

NAME OF PERSON COMPLETING THIS QUESTIONNAIRE *

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