Family and Children's Services

Adoptee Disclosure Request

Name of Person Requesting Information(Required)

First Last

Address(Required)

Street Address Address Line 2 City Postal Code

Home Phone(Required)

Work Phone

Can a message be left?(Required)

Yes

Email Address(Required)

Present Name of Adopted Person

First Last

Date of Birth

Place of Birth

Adoptive Name

Birth Name

Name of Adoptive Parents(Required)

Note: This information is required to identify your adoption record. Adoptive parents will not be contacted.

Placing Agency

Date of Adoption

Specific Request or Concerns

Alternate Contact Name(Required)

First Last

Alternate Contact Address(Required)

Street Address Address Line 2 City Province Postal Code

Alternate Phone Number(Required)

Birth Relative Disclosure Request

Name of Person Requesting Information(Required)

First Last

Relationship to Adopted Person(Required)

Birth Mother

Birth Father

Birth Sibling

Birth Grandparent

Other

Address(Required)

Street Address Address Line 2 City Postal Code

Home Phone(Required)

Work Phone

Can a message be left?(Required)

Yes

Email Address(Required)

Birth Name of Adopted Person(Required)

First Last

Date of Birth(Required)

Place of Birth(Required)

Name of Birth Parent at Time of Adoption Placement(Required)

Note: This information is required to identify your adoption record. Adoptive parents will not be contacted.

Placing Agency

Date of Adoption Placement

Specific Request or Concerns

Alternate Contact Name(Required)

First Last

Alternate Contact Address(Required)

Street Address Address Line 2 City Province Postal Code

Alternate Phone Number(Required)

Family and Children's Services

Call us anytime, day or night: 1-800-265-8300 or 519-824-2410
Help support our Children First Fund

Test Forms

Adoptee Disclosure Request

Birth Relative Disclosure Request

Volunteer Application