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Personal Details Applicant 1

Full Legal Name (required)

Birth Name

Previous Names

Birth Date (Required) (yyyy-mm-dd)

Place of Birth

Gender

Ethnic Origin

Racial Origin (required)

Citizenship

Religion

Education

Language(s) Spoken

Occupation

Employer

Native Band Name/No.

Cell Phone

Work Phone

May we contact you at work? (required)
YesNo

Personal Details Applicant 2

Full Legal Name

Birth Name

Previous Names

Birth Date (yyyy-mm-dd)

Place of Birth

Gender

Ethnic Origin

Racial Origin

Citizenship

Religion

Education

Language(s) Spoken

Occupation

Employer

Native Band Name/No.

Cell Phone

Work Phone

May we contact you at work?
YesNo

Address Line 1

Address Line 2

City

Province

Postal Code

Home Phone

Can a message be left?
YesNo

Email Address (Required)

Children and other members of household:

Children in Household:

Name Gender Birthdate (yyyy-mm-dd) Lives With Racial/Ethnic Origin FNIM*

*FNIM=First Nations Inuit Metis

Other adults living in applicant(s) home

Name Gender Birthdate Relation to Applicant(s)

Marriage or Domestic Partnership

Current Marriage Date (yyyy-mm-dd)

Current Domestic Partnership Date (yyyy-mm-dd)

Applicant 1 Past Marriage or Domestic Partnership         Applicant 2 Past Marriage or Domestic Partnership        
Date Begun (yyyy-mm-dd)     Date Ended (yyyy-mm-dd)    
Date Begun (yyyy/mm/dd)     Date Ended (yyyy-mm-dd)    

Present Application

Tell us what you are interested in (please check all that apply)

Adopt at Children's Aid Society
Adopt at Children's Aid Society but also interested in fostering
Adopt Privately
Foster Parent Adopting Foster Child
Fostering and Adopting
Fostering
Wanting to Foster or Adopt a Specific Child

Type of child you are considering parenting (the following section is required)

Age of Child (or age range)
Gender of Child MaleFemaleAnyBoth
Race/Ethnic Origin of Child
Are you considering adopting or Fostering siblings? YesNoUnsure

Previous Applications/Child Welfare Involvement (the following section is Required)

Have you previously applied to adopt or foster
either as an individual, a couple or in a previous relationship?		 YesNo
   
Have you previously started or completed an adoption
or fostering education program?		 YesNo
   
Have you previously started or completed
a homestudy assessment?		 YesNo
   
Have you previously been involved with a Children's Aid Society
or any protection authority outside of Ontario?		 YesNo
If "Yes", please provide specifics:

Additional Comments

Any additional information or comments:

Acknowledgements

I/We the undersigned, submit this application with the following acknowledgements:

  1. I/We acknowledge that the process of adoption by Ontario residents is governed by the Child and Family Services Act (CFSA), and the Intercounty Adoption Act (IAA). We acknowledge that the process of fostering is governed by the Child & Family Services Act and Foster Care Licensing Regulations.
  2. I/We acknowledge that our worker's role is to ensure the best interests of any child who may be placed with me/us when assessing the suitability and eligibility of applicant(s). The worker's recommendation does not guarantee approval by the Children's Aid Society in public adoption, the Ministry of Children and Youth Services in Private and International Adoption of Canada Immigration in International adoption, nor the eventual placement of a child in my/our family. We further acknowledge that the worker's recommendation does not guarantee approval to provide foster care.
  3. I/We give full permission to our worker to communicate and exchange information about me/us, in written or verbal form, with other children's aid societies, child protection authority outside of Ontario, private and international adoption agencies, physicians, mental health professionals, referees, other adoption licensees and practitioners, government agencies/departments, and other sources, as necessary, in order to further my/our application. We also give permission for our worker to search required electronic databases to complete the assessment.
  4. I/We understand that any false statement or omitted information in this application may jeopardize my/our application.
Applicant 1 Acknowledgement (Required) Applicant 2 Acknowledgement

Please take a moment to tell us about where you heard about fostering/ adoption.

Radio Ad; Specify
Television Ad; Specify
Television Program; Specify
Newspaper Ad;Which ad and in which newspaper
Newspaper Article; What was the article about and which newspaper?
Agency Website
Agency Pamphlet or Handout: Specify
Social Media (Facebook, Twitter Instagram etc); Specify
Word of Mouth; Specify
Personal Involvement; Specify
Community Event; Specify

Other; Specify