Children's House International Pre-Application/Waiting Child Release FormPlease confirm you qualify for these two conditions to continue:You are: Married - age 23 or older Single - age 25 or olderIs at least one parent a U.S. citizen? Yes NoThanks, now we just need a little informationParent 1(Required) First Last Parent 1 Birth Date(Required) MM slash DD slash YYYY Parent 1 Email(Required) Parent 1 Phone(Required)Parent 2(Required) First Last Parent 2 Birth Date MM slash DD slash YYYY Parent 2 Email(Required) Parent 2 PhoneYears Married(Required)Please choose an optionSingleDivorced123456789101112131415161718192021222324252627282930+Street Address(Required)City(Required)State(Required)AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificZIP Code(Required)Total Yearly Income# of Children in Home Currently:012345678910+Ages of ChildrenHas either applicant been arrested?(Required) No YesDoes either applicant have a current and/or past medical or mental health diagnosis?(Required) No YesProgram of Interest(Required) Unsure ALL Brazil Bulgaria Colombia Colombia Hosting Ecuador Georgia Honduras Hungary India India Relative Adoption Moldova Mexico Portugal Romania Family Journeys Home Study Only (FLA, UT, WA, LA, TX, ID) Domestic Adoption ConsultingAre you open to adopting a child age 6+?(Required) Yes No Open to DiscussionWhen are you wanting to begin your adoption?(Required) Immediately 6 mo 12 mo just looking for informationAny comments or concerns?Consent I agree to receive SMS Text Messages from Children's House International related to my inquiry
