HANDS TO HOLD RESOURCE CENTER

Hands to Hold Resource Center Registration

PLEASE COMPLETE ALL FIELDS ACCORDINGLY

Registrant 1- First and Last Name

Gender

Age

Race

Occupation

Religion

Home Phone #

Work Phone #

Cell Phone #

email address

Registrant 2- First and Last Name

Gender

Age

Race

Occupation

Religion

Home Phone #

Work Phone #

Cell Phone #

email address

City of Residence

State of Residence

Estimated adoption Budget: Please DO NOT include estimated legal fees for finalization, home study fees and travel cost. If your budget is less than $23,000 it is unlikely that Hands to Hold Resource Center will have the ability to assist you with your journey. We suggest you remain Pro-Active in your search.:

Type of adoption plan preferred: Select ALL that apply:
Open - ongoing contact between families after placement
Semi-open - contact limited to pictures and letters possible email
Closed - no contact between parties after placement
None Chosen(Default)

Race of children your journey includes: Select all that apply

Full Caucasian Only
Any Caucasian Mix including African American
Any Caucasian Mix excluding African American
African American
Any African American mix
up to 1/4 African American with any other mix

Hispanic/Puerto Rican
Hispanic/Caucasian
Asian
Asian/Caucasian
Any race of non African American mix
Any Race

Gender of Child preferred:
Either
Boy
Girl

Open to a child of the opposite preferred gender if gender is selected or a gender unknown opportunity?
Yes
No
None Chosen(Default)

Open to a special needs or medically fragile child?
Yes
No
None Chosen(Default)

If YES,please describe any limitations (i.e:no feed tubes,no assisted breathing machines, no wheelchair bound children, open to downs children only, .)

Willing to consider Sibling groups of either full and/or half siblings:
Yes
No
None Chosen(Default)

If YES, please list the; maximum number of children within a group you will consider,

the age limits of the children youngest - oldest age child you will consider

and the gender of the siblings you are most open to consider.

Willing to consider a child or children whose birth mother smoked tobacco during pregnancy?
Yes
No
Case by Case
None Chosen(Default)

Willing to consider a child or children with drug exposure prior to birth?
Yes
No
Case by Case
None Chosen(Default)

Willing to consider a child or children with a positive drug screen at birth?
Yes
No
Case by Case
None Chosen(Default)

Willing to consider a child or children with alcohol exposure prior to birth?
Yes
No
Case by Case
None Chosen(Default)

Willing to consider a child or children whose birth parent(s) has depression?
Yes
No
Case by Case
None Chosen(Default))

Willing to a child or consider children whose birth parent(s) has bipolar and/or schizophrenia?
Yes
No
Case by Case
None Chosen(Default))

Willing to a child or consider children whose birth family/extended family has bipolar and/or schizophrenia?
Yes
No
Case by Case
None Chosen(Default))

Willing to consider a child or children whose birth family/extended family has depression?
Yes
No
Case by Case
None Chosen(Default)

Do you have a current domestic home study ?
Yes
No
In progress
None Chosen(Default)

Do you have a introduction document (i.e; Picture profile/album, Birthmother letter, Family Book, Profile)?
Yes
No
In progress
None Chosen(Default)

Do you have other children that live with you in the home or outside your home?
Yes
No
None Chosen(Default)

If YES, please list the

age of each child,

if they live in the home or outside the home

and if biological or adopted

Do you have an on-line profile or a website that could be shared and viewed by an adoption entity?
Yes
No
None Chosen(Default)

If YES, please provide web address so that we may present it to the agency, attorney and/or facilitator upon request:

You acknowledge that you have read and understand the disclaimer section for Hands to Hold Resource Center LLC:
Yes
No
None Chosen(Default)

You acknowledge that you have read, understand and accept the terms of agreement for Hands to Hold Resource Center LLC:
Yes
No
None Chosen(Default)

Any additional information you would like to provide Hands to Hold Resource Center:

Privacy Statement:

The information submitted on this registration is held in the strictest of confidence. It will only be released upon your approval. Your approval is required for each profile submission.

Hands to Hold Resource Center LLC is a privately owned and operated business, operating within the guidelines of the governing state. Hands to Hold Resource Center is an accredited business with the Better Business Bureau.

By clicking "Submit", you declare that the foregoing is true and correct. Hands to Hold will not be held responsible for incorrect information.

We look forward to being a part of your adoption journey!