Adoption Preferences Adoption Preferences EmailThis field is for validation purposes and should be left unchanged.Today's Date MM slash DD slash YYYY Adoptive Parent 1 First Last Adoptive Parent 2 First Last Gender PreferencesCaucasian Yes No Caucasian Percentage 25% 50% 75% 100% Indicate the maximum % that you prefer.African American Yes No African Percentage 25% 50% 75% 100% Indicate the maximum % that you prefer.Hispanic Yes No Hispanic Percentage 25% 50% 75% 100% Indicate the maximum % that you prefer.Asian Yes No Asian Percentage 25% 50% 75% 100% Indicate the maximum % that you prefer.Other Racial/Ethnic Preference Yes No Other Racial/Ethnic Percentage 25% 50% 75% 100% Indicate the maximum % that you prefer.Other Ethnic PreferencePositive ToxicologyPositive Toxicology (“Pos Tox”) birth mother at some point during pregnancy or at birth.We deal with cases in which the Birth Mother has used an illegal substance/drug at some point during the pregnancy. Would you be interested in having your profile shown in such a scenario?Show profile? Yes No Additional CommentsWe receive referrals from hospitals in which the newborn child and/or mother have tested positive at birth. The hospital contacts us because the Birth Mother has chosen adoption as an option to the child possibly going into the Dependency/Foster Care system. The hospital is mandated to report the matter to Child Protective Services (CPS). Because we need to react immediately to put together an adoption plan to avoid the child going into CPS custody, would you be willing to have us show your Profile to the Birth Mother to be considered to adopt such a child, knowing you will have access to prenatal records and the ability to discuss the health of the child with the hospital staff?Show profile after birth? Yes No Additional CommentsSpecial NeedsAre you open to special needs? Yes No If yes, what kinds of special needs are you open to?Newborn or an older-than-newborn childDo you wish to only adopt a newborn child at this time? Yes No Would you consider an older child? Yes No Additional CommentsSiblingsWould you consider adopting siblings? Yes No Please note, newborn twins are very rare!Additional CommentsFinancial ParametersWhat are the financial parameters you would place on this adoption (i.e. is there a ceiling on the total expenses for this adoption to be realistic for you)? Note: the range, depending on what type of adoption you choose is "$0" (child from foster care or through a full-service licensed Foster Family and Adoption Agency) to about $30,000. The two biggest variables are Birth Mother Living Expenses and the Birth Father. We will discuss this further when we consult,What is the greatest amount you would be comfortable spending?Financial CommentsAny other specific requests or conditions you want us to know about?Adoptive Parent 1Adoptive Parent 2
