NAME

NAME AT TIME OF BIRTH

ADOPTEE BIRTHPARENT OTHER

EMAIL ADDRESS

CODE WORD TO PREVENT UNAUTHORAIZED CHANGES

WEBSITE URL

ANY OTHER IDENTIFYING INFORMATION YOU WOULD LIKE TO INCLUDE

ABOUT THE ADOPTEE

DATE OF BIRTH

BIRTH CERTIFICATE #

NAME OF HOSPITALPHYSICIAN

CITY OF BIRTHCOUNTY

STATE(no abbreviations)

COUNTRYATTORNEY

AGENCY

ANY OTHER INFORMATION THAT WOULD BE HELPFUL (it's a good idea to keep something back to help you know if you have found the right person)

Birthfamily And Adoptees Registry

Index To Pages

last update 10/01/00