Client Information "*" indicates required fields X/TwitterThis field is for validation purposes and should be left unchanged.Client 1 Full Legal Name* First Middle Last Suffix Please tell us your Full Legal Name that matches your driver's license or government issued ID as the court requires it.Please verify that this is your full legal name that matches your driver's license or government issued ID:* Yes No If the name you entered above does not match your driver's license or government issued ID please change it above so that it is matching. Alias or Maiden Name First Middle Last Suffix If you have changed your legal name, please tell us your full legal maiden name that matches your birth certificate as the court requires it.Client 2 Full Legal Name First Middle Last Suffix Please tell us your Full Legal Name that matches your driver's license or government issued ID as the court requires it.Please verify that this is your full legal name that matches your driver's license or government issued ID: Yes No If the name you entered above does not match your driver's license or government issued ID please change it above so that it is matching. Address* Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code UntitledPhone*FaxAre you working with a licensed adoption or foster family agency? Yes No Are you currently home-studied? Yes No UntitledWhen was your home study last updated/completed?Client 1 Personal InformationBirthdate* MM slash DD slash YYYY Birthplace City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State OccupationReligionSpoken Languages (Other the English)HobbiesFacebook and/or Instagram handlesFollow us on Instagram! https://www.instagram.com/familybuilding/ Follow us on TikTok! https://www.tiktok.com/@familybuildinglaw?_r=1&_t=ZT-93qJQsL50VZAre you currently married? Yes No Have you been married before? Yes No Do you have other children? Yes No Criminal HistoryHave you ever been arrested? Yes No Have you ever been convicted of a crime? Yes No Has there been any child abuse registry reports or complaints made against you? Yes No Been in bankruptcy? Yes No Been in mental hospital? Yes No Had psychotherapy? Yes No Received other than an honorable discharge from military service? Yes No Been turned down by an adoption agency? Yes No Placed a child for adoption? Yes No Employment InformationCompany NameCompany WebsiteCompany Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxEducational InformationEducational History High School College Other Client 2 Personal InformationBirthdate MM slash DD slash YYYY Birthplace City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State OccupationReligionSpoken Languages (if other that English)HobbiesFacebook and/or Instagram handlesHave you been married before? Yes No Are you currently married? Yes No Do you have other children? Yes No Client 2 Criminal HistoryHave you ever been arrested? Yes No Have you ever been convicted of a crime? Yes No Has there been any child abuse registry reports or complaints made against you? Yes No Been in bankruptcy? Yes No Been in mental hospital? Yes No Had psychotherapy? Yes No Received other than an honorable discharge from military service? Yes No Been turned down by an adoption agency? Yes No Placed a child for adoption? Yes No Client 2 Employment InformationCompany NameCompany WebsiteCompany Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code PhoneFaxClient 2 Educational InformationEducational History High School College Other Emergency ContactSomeone who will always know where you are/how to reach you.Name First Last Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code RelationPhoneHow did you hear about our office?*Describe the reason you are seeking legal counsel:Do you have a consultation set up with our office? Yes No Would you like to schedule a consultation? Yes No I/We understand the importance of fully and accurately completing the above information as this information may be material in the matter for which we have consulted the law office. Therefore, we state that the foregoing is true and correct. Should any of the foregoing information change I/we will immediately advise the law office of such change.Client 1's Signature*Client 2's Signature*
