Adoption Application form 2022

Adoption Application Form
Thank you for taking the time to apply and learn more about adoption!

Please fill out this form and we will contact you to talk about next steps.
Contact information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal CodeCountry
Home Phone*
Please enter a valid phone number.
Cell Phone
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com
What is your preferred language?
What are your preferred communication methods? (check all that apply)

Home PhoneCell PhoneTextEmailOther
What type of care are you interested in providing?*
What prompted you to inquire with us today? (Check all that apply)

I have always wanted to adoptAnother adoptive parent referred meI want to help my communityI know a child in needI read an articleOnline researchfamilyconnexions.caFacebookPoster/FlyerOther
Additional Information
Please provide us any additional information that you would like to share about your interest in adoption.
Consent
Our database that we use to capture information about care-giving families is shared across the province with other Children's Aid Societies. We require your consent to capture your information in our system. The Child Protection Information Network (CPIN) is a province-wide, single information system for all children's aid societies (CAS) in Ontario. When an individual applies to become a foster or adoptive parent, their identifying information is entered into the system. To continue with the application, the individual will be asked to consent to the collection of their information in CPIN and to a search of the CPIN database. All approved resource parents involved with Simcoe Muskoka Family Connexions will be registered in CPIN. This enables information about adoptive/foster families to be readily available to inform adoption workers and assist in making better matches when placing children and youth.
Should be Empty:

Adoption Application Form

Contact information

Consent