1. Registration Number (will be assigned)
2. I am
3. I am searching for
4. My First Name & Last Name (current)
5. Email Address
6. Re-enter Email Address
12. If you have a Facebook account, please provide your Facebook email address which can be found at your Timeline
I understand that if I do not provide a snail mail address or telephone number, my search info will NOT be posted in the Registry.
7. Mailing Address
8. Home Phone Number
9. Alternate Phone Number
10. Best time to Contact if needed
11. Name of Relative or Close Friend to contact if we can not reach you
12. Their Relationship to you
13. Relatives/Friends Complete Address
13 a. Relatives/Friends Phone Number
13 b. Relatives/Friends Email Address
Selected info below will be posted in the Adoption Database Registry
14. Adoptees Date of Birth
If unsure of date, please insert range or explain here
15. Adoptees Gender
16. Adoptees Race
17. Adoptees First Name at Birth
18. Adoptees Middle Name at Birth
19. Adoptees Last Name at Birth
20. Adoptees City of Birth
21. Adoptees State of Birth
22. Adoptees County or Providence of Birth
23. Adoptees Country of Birth
24. Birth Mothers First Name
25. Birth Mothers Middle Name
26. Birth Mothers Maiden Name
27. Birth Mothers Last Name at Birth
28a. Birth Mothers Age at time of Birth
28b. Birth Mothers DOB, if known
29. Her regular City & State of Residence at time of Birth
30. Birth Mothers Occupation
31. Birth Fathers First Name
32. Birth Fathers Middle Name
33. Birth Fathers Last Name
34a. Birth Fathers Age at time of Birth
34b. Birth Fathers DOB, if known
35. His regular City & State of Residence at time of Birth
36. Birth Fathers Occupation
37. Birth Mothers & Birth Fathers Marital Status
(Married, Unmarried, Divorced - Please explain)
38. Hospital of Birth
40. Name of Adoption Agency
41. If private adoption, name of attorney or firm
42. County or Providence Adoption took place
43. City Adoption took place
44. State Adoption took place
45. Adoptees Age when Relinquished to Adoptive Parents
46. Adoptees First Name after Adoption
47. Adoptees Middle Name after Adoption
48. Adoptees Last Name after Adoption
49a. Adoptive Mothers First & Last Name
49b. Adoptive Mothers Maiden Name
50. Adoptive Fathers First & Last Name
51. Date Adoption Finalized
52. Did Adoptee have older/younger siblings when relinquished for adoption
(Give Details -DOB or ages, sex)
53. Amended Birth Certificate Number
54. Original Birth Certificate Number (if known)
55. The Adoption Database Registry is open for public viewing and is easily pulled up in various search engines. If someone inquires on your registration, do you give the Registry Administrator your permission to provide your email address to the inquirer so they may contact you directly?
56. Have you applied for your NON ID information from the adoption agency or state vital records?
57. Have you registered with the ISRR (International Soundex Reunion Registry)? If not, download the registration form at http://www.isrr.net/registration.shtml and mail it in.
58. I hereby agree that I take full responsibility for posting my search information, and furthermore shall not hold the Adoption Database, nor any of its associates liable in any way .
59. You are invited to join our free Adoption Database Search & Support Group to exchange search ideas with other Triad Members and to receive assistance from many Search Angels within our Group.
60. If you replied "yes" to #59, please select one of the mail options as to how you would like to receive email from other Group members. We currently have over 4,800 members so our Group is very active. If you don't check your mail box each day, we advise you to select Digest delivery version or you may set up a Google.com account to read the messages at the Group Site.
61. How were you referred to Adoption Database?
62. OPTIONAL: Adoption Database has teamed with ABC Producers of Extreme Makeover who are piloting the reality show "Find My Family" about search and reunion, featuring families reuniting after years of separation due to an adoption. There is no cost involved for their assistance, except your agreement to film and air your search and reunion on their upcoming series if all parties are in agreement to do so.
I am interested in the ABC Search & Reunion TV series "Find My Family" and would like the Producers to contact me
63. Additional Comments (capable of lengthy comments)
Please allow a few moments for registration form to transmit.
*Note: If you are adoptee searching for another sibling(s) who has been adopted, please complete this registration form with YOUR information. You may complete another registration for the sibling, if you know their information at no additional charge. You can provide any explanations in Comment area.