Full Legal Name (required)
Birth Name
Previous Names
Preferred Name
Pronouns
Birth Date (Required) (yyyy-mm-dd)
Place of Birth
Gender
FemaleMaleOtherGender Fluid
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
Full Legal Name
Birth Date (yyyy-mm-dd)
Racial Origin
May we contact you at work?
Address Line 1
Address Line 2
City
Province
OntarioQuébecBritish ColumbiaAlbertaNova ScotiaManitobaSaskatchewanNew BrunswickPrince Edward IslandNewfoundland and LabradorNorthwest TerritoriesYukonNunavut
Postal Code
Home Phone
Can a message be left?
Email Address (Required)
Name
Birthdate (yyyy-mm-dd)
Lives With
Racial/Ethnic Origin
FNIM*
*FNIM=First Nations Inuit Metis
Birthdate
Relation to Applicant(s)
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)
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
Age of Child (or age range)
Gender of Child
MaleFemaleAnyBoth
Race/Ethnic Origin of Child
Are you considering adopting or Fostering siblings?
YesNoUnsure
Have you previously applied to adopt or foster
either as an individual, a couple or in a previous relationship?
Have you previously started or completed an adoption
or fostering education program?
Have you previously started or completed a homestudy assessment?
Have you previously been involved with a Children's Aid Society
or any protection authority outside of Ontario?
If "Yes", please provide specifics:
I/We the undersigned, submit this application with the following acknowledgements:
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.
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.
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.
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
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
