Adoption Orientation Registration
Child care is not provided during the training session, please make alternate arrangements if needed.
Orientation you plan to attend:
Tue Apr 13 - 10:00-11:30am
Tue Apr 13 - 6:30-8:00pm
Tue May 11 - 10:00-11:30am
Tue May 11 - 6:30-8:00pm
Tue Jun 8 - 10:00-11:30am
Tue Jun 8 - 6:30-8:00pm
Tue Jul 13 - 10:00-11:30am
Tue Jul 13 - 6:30-8:00pm
Tue Aug 10 - 10:00-11:30am
Tue Aug 10 - 6:30-8:00pm
Tue Sep 14 - 10:00-11:30am
Tue Sep 14 - 6:30-8:00pm
Tue Oct 12 - 10:00-11:30am
Tue Oct 12 - 6:30-8:00pm
Tue Nov 9 - 10:00-11:30am
Tue Nov 9 - 6:30-8:00pm
Tue Dec 14 - 10:00-11:30am
Tue Dec 14 - No pm Orientation
Select
Please provide the following information:
First
Last
Address
E-Mail
City
County
State
Zip
Home Phone
Alt Phone
What is the age range of the child(ren) you are interested in adopting?
We would like to have the following information on the type of child you would consider:
Either birth parents involved in (prior to or during pregnancy):
Select
Yes
No
Would Consider
Tobacco
Select
Yes
No
Would Consider
Alcohol
Select
Yes
No
Would Consider
Marijuana
Select
Yes
No
Would Consider
Cocaine/Crack
Would be willing to take a child whose background includes:
Select
Yes
No
Would Consider
Oppositional Defiant Disorder
Select
Yes
No
Would Consider
Emotional Illness
Select
Yes
No
Would Consider
Learning Disabilities
Select
Yes
No
Would Consider
Allergies/Asthma
Select
Yes
No
Would Consider
ADHD/ADD
Select
Yes
No
Would Consider
Bed Wetting
Select
Yes
No
Would Consider
Physical Illness
Select
Yes
No
Would Consider
Reactive Attachment Disorder
Would you adopt a child who has been:
Select
Yes
No
Would Consider
Physically Abused/Neglected
Select
Yes
No
Would Consider
Emotionally Abused/Neglected
Select
Yes
No
Would Consider
Sexually Abused
Select
Yes
No
Would Consider
Drug Exposed
Would you consider:
Select
Yes
No
Would Consider
A Child Who Requires Therapy
Select
Yes
No
Would Consider
Siblings
Would you consider the following racial backgrounds:
Select
Yes
No
Would Consider
Caucasian
Select
Yes
No
Would Consider
Bi-Racial (African-American/Caucasian)
Select
Yes
No
Would Consider
African-American
Select
Yes
No
Would Consider
Other Bi-Racial
Select
Yes
No
Would Consider
Hispanic
Select
Yes
No
Do you require adoption support subsidy (financial assistance) to adopt?
Select
Yes
No
Do you require continued Medicaid coverage to adopt?
Please list any other factors or conditions that you would or would not like to consider:
Adoption Orientation Registration