A Family For Every Child

A Family For Every Child
Phone: 541-343-2856
Toll-Free: 877-343-2856
info@afamilyforeverychild.org

A Family For Every Child

Tax I.D. 20-4151057

Christy Obie-Barrett,
Executive Director

Address:880 Beltline Road
Springfield, OR 97477

Fax: 541-343-2866

Foster/Adoption Inquiry Form

Please fill out this form with whatever information you would like to share at this point. Inquire about foster kids available for adoption on this form. We will get back to you immediately!

Inquiries and submissions are provided free by A Family For Every Child, a non-profit organization.

If you have already registered and would like to just ask a question please email to inquiry@afamilyforeverychild.org

If you have already registered and want to inquire about additional children use the form, here!

* indicates required fields.

If you don't have an answer for a particular question, please leave the field blank.

1. Basic Information

Parent 1 Information:

*First Name:
*Last Name:
Stay At Home Parent?
Occupation:
Employer:

Parent 2 Info: (if applicable)

First Name:
Last Name:
Stay At Home Parent?
Occupation:
Employer:

Parent(s) Contact Information:

*Street:
*City:
*County:
*State:
*Zip:
*Email:
*Phone:
Mobile:
Fax:

2. Adoption Worker & Home Study Info

Adoption Agency Name:
Adoption Worker First Name:
Adoption Worker Last Name:
Adoption Worker Street:
Adoption Worker City:
Adoption Worker State:
Adoption Worker Zip:
Adoption Worker Phone:
Adoption Worker Email:
Will Agency Do Post-Placement Supervision?
Is The Adoption Agency Certified?
Are You Foster Care Certified?
If so, Foster Care Certifier:

Which stage of the homestudy process are you in?

Haven't Started:
Gathering Info:
Training:
Study underway:
Very close to complete:
Completed:

If Home Study Completed, Date: (yyyy-mm-dd)

3. Your Interests

Note: More information helps us find you better matches!

What are you interested In?

Adoption?
Foster-To-Adopt?
Are You Willing To Accept Boy(s)?
Are You Willing To Accept Girl(s)?
Are You Open To Adopting Siblings?
How Many Siblings Will You Consider?

What ages are you interested in?

Birth-5:
6-10:
11-14:
15-18:

Are you willing to maintain contact with...

Foster Parents:
Bio Family:

What race(s) are you interested in?

White:
Hispanic:
African American/Black:
Asian/Pacific Island:
American Indian:
Alaskan Native:
Other:

What issues are you unwilling to accept?

Physical:
Emotional:
Learning:
Substance Abuse:
HIV Positive:
Behavioral:
Medical:
Development:

What disability levels are you willing to accept?

Behavioral Disability?
none:
mild:
moderate:
severe:

Developmental Disability?
none:
mild:
moderate:
severe:

Emotional Disability?
none:
mild:
moderate:
severe:

Learning Disability?
none:
mild:
moderate:
severe:

Medical Disability?
none:
mild:
moderate:
severe:

What challenges/risk-factors are you willing to consider?

Past Parenting Experience:

Specific Children:

If additional, more sensitive, information is available on a child you select, the child's bulletin will be sent to your email. If no bulletin is available we are able to post all the child's information on the web.
Child's Name & Bulletin 1:
Child's Name & Bulletin 2:
Child's Name & Bulletin 3:

4. Additional Info About Family

Please copy the numbers
of the security code in the figure to the right.

Foster/Adoption Inquiry Form

1. Basic Information

Parent 1 Information:

Parent 2 Info: (if applicable)

Parent(s) Contact Information:

2. Adoption Worker & Home Study Info

Which stage of the homestudy process are you in?

3. Your Interests

What are you interested In?

What ages are you interested in?

Are you willing to maintain contact with...

What race(s) are you interested in?

What issues are you unwilling to accept?

What disability levels are you willing to accept?

What challenges/risk-factors are you willing to consider?

Past Parenting Experience:

Specific Children:

4. Additional Info About Family

*How many parents are in the home?

What are the parents ethnicities? (check as many as apply)

What are the ages of the children in your home? (check as many as apply)

What are the ethnicities of the children in your home? (check as many as apply)

What training has the family taken?

Please provide a short family bio:

How did you hear about us?

How would you like to be contacted?