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Post Adoption or Counseling Inquiry Form

Please complete the following to the best of your ability in order for us to appropriately respond to your inquiry

Your full name: *

I am interested in (check all that apply): *

Background information

Making contact with biological relatives

Updating my information at The Cradle

Counseling

Other

If "Other" please specify:

Was your adoption through The Cradle?:

Yes

No

Unsure

Your role in the adoption circle:

Adopted Person

Adoptive Parent

Birth Parent

Other

If "Other" please specify:

Your gender:

Male

Female

Your email address: *

Your street address:

Your city, state and zip:

Phone number (best number on which to reach you):

Adopted person's name at time of adoption or birth:

Adopted person's date of birth:

Adoptive parents' full names (if known):

Birth mother's name at time of adoption (if known):

Birth mother's date of birth (if known):

Would you like to receive mailings from The Cradle? (check all that apply):

Email

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Comments:

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