Today's Date:
August 29, 2008
Husband's First Name:
Husband's Last Name:
Wife's First Name:
Wife's Last Name:
Wife's Maiden Name:
Street Address:
City:
State:
Zip:
E-mail:
Home Phone:
Husband's Office Phone:
Husband's Cell Phone:
Wife's Office Phone:
Wife's Cell Phone:
Best Time to Reach You:
How did you hear of Angel Adoption :
To help us determine your adoption time frame please tell us when you will be ready to adopt?
Type of Child You Wish To AdoptAngel Adoption, Inc. only deals with newborn babies.
If requested by the birthmother, would you consider meeting her?
Do you particularly wish to meet her?
Would you refuse to meet her under any circumstances?
Would you be open to drug exposure?
Would you be open to drug addicted?
If your state allows, if the situation arises, how much court approved birthmother support would you be willing to pay (estimated amount)? This helps us in knowing which profiles we can send to a birthmother in need of expenses.
Are there any specific birthparent traits or characteristics that would be difficult for you to accept in the background of a child? If yes please specify:
If you had your choice of an ideal adoption situation, would you be most interested in:
Husband's Occupation:
Name and Address of Present Employer:
Husband Military Service:
Date of Military Discharge:
Wife's Occupation:
Name and Address of Present Employer:
Wife's Military Service:
Date of Military Discharge:
Husband's Date of Birth:
Husband's Religion:
Do You Practice Your Faith?
Husband's Race:
Husband's Ethnic Origin:
Husband's Eye Color:
Husband's Hair Color:
Husband's Height:
Husband's Hobbies, Talents and Interests:
Husband's Community Service/Activities:
Wife's Date of Birth:
Wife's Religion:
Do You Practice Your Faith?
Wife's Race:
Wife's Ethnic Origin:
Wife's Eye Color:
Wife's Hair Color:
Wife's Height:
Wife's Hobbies, Talents and Interests:
Wife's Community Service/Activities:
Date & Place of this Marriage:
Is this the first marriage for Wife?
Is this the first marriage for Husband?
Highest Level Attained:
Name & Location of School:
Year Graduated:
Degrees Acquired:
Highest Level Attained:
Name & Location of School:
Year Graduated:
Degrees Acquired:
FINANCIAL SUMMARY (Remains Confidential)
Husband's Average Annual Income:
Wife's Average Annual Income:
Husband's Life Insurance:
Wife's Life Insurance:
Husband's Savings:
Wife's Savings:
Type of Dwelling:
Do you Own or Rent:
If you rent, what is your monthly payment?
If you own, what is your market value?
Equity Amount?
Mortgage Payment?
Please list the children in your family and indicate if the child is adopted
Name of Child (1):
Age:
Birthdate:
Adopted of Biological:
Name of Child (2):
Age:
Birthdate:
Adopted of Biological:
Name of Child (3):
Age:
Birthdate:
Adopted of Biological:
Name of Child (4):
Age:
Birthdate:
Adopted of Biological:
Names and Ages of Children
Do Any of These Children Live With You? If so, which ones?
HUSBAND'S FAMILY BACKGROUND
Name and Age of Parents:
Number of Siblings:
Number of Nieces/Nephews:
Briefly describe your relationship with your extended family, including the amount of contact you have with them:
Please indicate how your extended family feels about your plans to adopt a child:
Name and Age of Parents:
Number of Siblings:
Number of Nieces/Nephews:
Briefly describe your relationship with your extended family, including the amount of contact you have with them:
Please indicate how your extended family feels about your plans to adopt a child:
ADDITIONAL PERSONAL HISTORY
Have you or your spouse ever: (Check all that apply and fill out comments box below)
Declared Bankruptcy? If you check any of the boxes above, please explain:
Do you consume alcohol?
Do you smoke?
Please briefly describe why you are unable to have children:
What medical procedures and counseling have you undergone regarding infertility?
How do you feel about the help you have received?
Please describe briefly your reasons for wanting to adopt?
GENERAL LIFESTYLE INFORMATION
Please describe your home and neighborhood:
What is a typical weekday and weekend like in your home?
What do you enjoy doing together & individually:
Describe any experience you have had with children:
What are your thoughts on disciplining children?
What are your plans for child care for the baby?
Please briefly describe how you think your life will change after the adoption?
HOME STUDY & ATTORNEYS* If you do not have a home study we can provide a contact for you.
Do you have a completed home study?
If Yes, completed by:
Phone Number:
Do you have an attorney?
Attorney Name:
Phone Number:
Are you signed up with any other adoption consultants, organizations, or agencies?
If Yes please list their names and phone numbers:
By clicking "Submit", you declare under penalty of perjury that the foregoing is true and correct.
Please note: We will contact you within one to two weeks of receipt of your complete application. Contact will be made by email or phone. If you do not hear from us, please email us at angeladpt@aol.com
. Your application will not be processed or considered complete until we have received your photograph. To avoid delays, please send your photograph to the address below along with your name and contact information.
Angel Adoption, Inc. 5 Jandus Road,
If you have any questions, please email us angeladpt@aol.com
Thank you for your interest in Angel Adoption, Inc.
Pregnant? We are here to help: Angel Adoption, Inc. 
