Adoption Intake | Louisville Law Services

Adoptive Parent Information

Please type N/A if you don't know the answer to a question.

Please use full Legal / Government names.

First Name*

Middle Name*

Last Name*

Maiden Name (Name on current birth certificate)*

Gender*

Race*

Birthday*

State of Birth*

Social Security Number*

Street*

City*

Zip*

State*

Length of time at current residence (please specify days, months, or years)*

Lenght of time in current state*

Relationship to other party*

Phone*

Email*

Emergency Contact

Your emergency contact may be contacted by our office in the event there is a time sensitive issue and we have not heard from you.
Emergency contact is not a party to this case.

First Name*

Last Name*

Relationship to Adoptive Parent*

Street*

City*

ZIP*

State*

Phone*

Email*

Adoptive Parent Employment Information

Employment Status*

Yes

Retired

Disabled

Job Position*

Employer Name*

Biological Parent Information

Please use full Legal / Government names.

First Name*

Middle Name*

Last Name*

Maiden Name (Name on current birth certificate)*

Gender*

Race*

Birthday*

State of Birth*

Relationship to Adoptive Parent*

Street*

City*

Zip*

State*

Length of time at current residence (please specify days, months, or years)*

Social Security Number*

Phone*

Email*

Biological Parent Employment Information

Employment Status*

Yes

Retired

Disabled

Job Position*

Employer Name*

Additional Parties

Please use this section to provide information for the known donor, or other biological parent(s).

Please use full Legal / Government names.

Number of Additional Parties*

Additional Party 1

First Name*

Middle Name*

Last Name*

Maiden Name (Name on current birth certificate)

Gender*

Race*

Birthday*

State of Birth*

Relationship to Adopted Parent*

Street*

City*

Zip*

State*

Phone*

Email*

Social Security Number*

Job Position*

Employer Name*

Additional Party 2

First Name*

Middle Name*

Last Name*

Maiden Name (Name on current birth certificate)*

Gender*

Race*

Birthday*

State of Birth*

Relationship to Adopted Parent*

Street*

City*

Zip*

State*

Phone*

Email*

Social Security Number*

Job Position*

Employer Name*

Additional Party 3

First Name*

Middle Name*

Last Name*

Maiden Name (Name on current birth certificate)*

Gender*

Race*

Birthday*

State of Birth*

Relationship to Adopted Parent*

Street*

City*

Zip*

State*

Phone*

Email*

Social Security Number*

Job Position*

Employer Name*

Additional Party 4

First Name*

Middle Name*

Last Name*

Maiden Name (Name on current birth certificate)*

Gender*

Race*

Birthday*

State of Birth*

Relationship to Adopted Parent*

Street*

City*

Zip*

State*

Phone*

Email*

Social Security Number*

Job Position*

Employer Name*

Marriage

Date of Marriage*

State of Marriage*

County of Marriage*

Length of Relationship*

Children/Adult Adoptee Information

Please use full Legal / Government names.

Number of children/adults being adopted*

New birth certificate would be needed if both parents are not listed on birth certificate or if one parent is listed with the wrong title.

Adoptee 1

Adoptee 1 First Name*

Adoptee 1 Middle Name*

Adoptee 1 Last Name*

Adoptee 1 Gender*

Adoptee 1 Birthday*

Adoptee 1 State of Birth*

Adoptee 1 Race*

Adoptee 1 City of Birth*

Adoptee 1 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 1 name changed on the birth certificate?*

Yes

Adoptee 1 New First Name

Adoptee 1 New Middle Name

Adoptee 1 New Last Name

Adoptee 2

Adoptee 2 First Name*

Adoptee 2 Middle Name*

Adoptee 2 Last Name*

Adoptee 2 Gender*

Adoptee 2 Birthday*

Adoptee 2 State of Birth*

Adoptee 2 Race*

Adoptee 2 City of Birth*

Adoptee 2 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 2 name changed on the birth certificate?*

Yes

Adoptee 2 New First Name

Adoptee 2 New Middle Name

Adoptee 2 New Last Name

Adoptee 3

Adoptee 3 First Name*

Adoptee 3 Middle Name*

Adoptee 3 Last Name*

Adoptee 3 Gender*

Adoptee 3 Birthday*

Adoptee 3 State of Birth*

Adoptee 3 Race*

Adoptee 3 City of Birth*

Adoptee 3 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 3 name changed on the birth certificate?*

Yes

Adoptee 3 New First Name

Adoptee 3 New Middle Name

Adoptee 3 New Last Name

Adoptee 4

Adoptee 4 First Name*

Adoptee 4 Middle Name*

Adoptee 4 Last Name*

Adoptee 4 Gender*

Adoptee 4 Birthday*

Adoptee 4 State of Birth*

Adoptee 4 Race*

Adoptee 4 City of Birth*

Adoptee 4 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 4 name changed on the birth certificate?*

Yes

Adoptee 4 New First Name

Adoptee 4 New Middle Name

Adoptee 4 New Last Name

Adoptee 5

Adoptee 5 First Name*

Adoptee 5 Middle Name*

Adoptee 5 Last Name*

Adoptee 5 Gender*

Adoptee 5 Birthday*

Adoptee 5 State of Birth*

Adoptee 5 Race*

Adoptee 5 City of Birth*

Adoptee 5 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 5 name changed on the birth certificate?*

Yes

Adoptee 5 New First Name

Adoptee 5 New Middle Name

Adoptee 5 New Last Name

Adoptee 6

Adoptee 6 First Name*

Adoptee 6 Middle Name*

Adoptee 6 Last Name*

Adoptee 6 Gender*

Adoptee 6 Birthday*

Adoptee 6 State of Birth*

Adoptee 6 Race*

Adoptee 6 City of Birth*

Adoptee 6 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 6 name changed on the birth certificate?*

Yes

Adoptee 6 New First Name

Adoptee 6 New Middle Name

Adoptee 6 New Last Name

Adoptee 7

Adoptee 7 First Name*

Adoptee 7 Middle Name*

Adoptee 7 Last Name*

Adoptee 7 Gender*

Adoptee 7 Birthday*

Adoptee 7 State of Birth*

Adoptee 7 Race*

Adoptee 7 City of Birth*

Adoptee 7 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 7 name changed on the birth certificate?*

Yes

Adoptee 7 New First Name

Adoptee 7 New Middle Name

Adoptee 7 New Last Name

Adoptee 8

Adoptee 8 First Name*

Adoptee 8 Middle Name*

Adoptee 8 Last Name*

Adoptee 8 Gender*

Adoptee 8 Birthday*

Adoptee 8 State of Birth*

Adoptee 8 Race*

Adoptee 8 City of Birth*

Adoptee 8 Full Social Security Number*

Length of time with adoptive parent*

Hospital Of Birth*

Conceived using an anonymous donor?*

Yes

Name of Cryobank*

Did you use a fertility clinic?*

Yes

Fertility clinic name*

Fertility doctor name*

Do you wish for the child’s name to be changed on the birth certificate?*

Yes

I don't know

Adoptee 8 name changed on the birth certificate?*

Yes

Adoptee 8 New First Name

Adoptee 8 New Middle Name

Adoptee 8 New Last Name

Other Children

Please list any children that reside in the home other than those being adopted.

Please use full Legal / Government names.

Child 1 Legal Name (First, Middle, Last)

Child 1 DoB

Child 2 Legal Name (First, Middle, Last)

Child 2 DoB

Child 3 Legal Name (First, Middle, Last)

Child 3 DoB

Child 4 Legal Name (First, Middle, Last)

Child 4 DoB

Court

Please list any other Court cases that the parties or minor children have been involved in, including case number and the county of filing.

Court Details

You can submit and revisit the form as many times as needed. When fully finished, please check the Filling the form is finalized checkbox

Filling the form is finalized

Adoptive Parent Information

Emergency Contact

Adoptive Parent Employment Information

Biological Parent Information

Biological Parent Employment Information

Additional Parties

Additional Party 1

Additional Party 2

Additional Party 3

Additional Party 4

Marriage

Children/Adult Adoptee Information

Adoptee 1

Adoptee 2

Adoptee 3

Adoptee 4

Adoptee 5

Adoptee 6

Adoptee 7

Adoptee 8

Other Children

Court

End