Test Forms - 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

No

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

No

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)

Volunteer Application

Volunteer Applicant Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City Postal Code

Email Address(Required)

Home Phone(Required)

Alternate Phone

Emergency Contact Name(Required)

First Last

Phone(Required)

Relationship to Volunteer

Education

Special Skills, Qualifations or Interests

Employment Status

Full Time

Part Time

Student

Not Seeking Employment

Seeking Employment

Homemaker

Retired

Have you had any previous contact with this Agency?(Required)

Yes

No

Why are you interested in volunteering at F&CS?(Required)

List the benefits you are expecting to gain from Volunteer work:

Are you curently volunteering? If so, please state where:

Related Work / Volunteer Experience

Organization Name 1

Type of Work 1

Dates 1

Organization Name 2

Type of Work 2

Dates 2

Organization Name 3

Type of Work 3

Dates 3

How did you hear about volunteering at F&CS?

Newspaper

Radio

Another Agency

Website

Word of Mouth

Volunteer Centre

Other

Please specify?

Interest Area

What time commitment can you provide?

Less than 6 months

6 to 12 months

One-year or more

Short-term special events

Other

What positions interest you?

Mentor

Parent-Aide

Driver

Tutor/Homework Help

Youth Mentor

Childcare

Special Events/Fundraising

Administration/Reception

Other

Check all that interest you.

What other volunteer position interests you?

What age group would you like to work with?

Do you have a gender preference you'd prefer to work with?

Comments

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