ADULT ADOPTION QUESTIONNAIRE

This questionnaire: 1) helps Randy know more about your planned adoption so he can fully advise you during your consultation, and tell you if there might be any problems; and 2) is used as the source of information in preparing your legal documents. So please complete it very accurately. If you do not retain Randy the information will be shredded.

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Information About Adopting Parent #1

1A. Full LEGAL name (first-middle-last) of adopting parent (or stepparent if this is an adult stepparent adoption):

1B. Phone

1C. E-mail:

1D. Home address (street, CITY, STATE, zip):

1E. If married, the date of marriage and state in which it occurred:

1F. Is the person you are adopting related to you, or the child of your spouse (your stepchild)? Please explain:

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Information About Adopting Parent #2 (or Existing Parent if a Stepparent Adoption)

2A. Is the adopting parent married to the parent of the adoptee (an adult stepparent adoption)? If yes, provide the full legal name of the spouse, his/her date and city/state of birth, phone and e-mail:

2B. If there are two adopting parents, the full name of the spouse (the other adoptive parent). If only one adopting parent, skip to question 3A.

2C. Phone:

2D. E-mail:

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Additional Adopting Parent Information

3A. Have either of the above parties adopted an adult within the last year?

3B. Is either of the above a provider/employee of board and care, treatment or other services to persons with developmental disabilities?

3C. Please describe the nature of the relationship between the adopting parent(s) and the adoptee and details on why the adoption is desired. Please limit reply to 4 sentences.

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Information about the Adoptee (the Person Being Adopted)

4A. Full LEGAL name (first-middle-last) of the adoptee:

4B. After the adoption, what does the adoptee want their FULL LEGAL NAME to be (first-middle-last)?

4C. Phone:

4D. E-mail:

4E. Home address (street, city, state, zip):

4F. Adoptee’s date of birth and city/state of birth:

4G. Is the adoptee married? If yes, full legal name of spouse (s/he will need to consent):

4H. Does the adoptee have any adult children?

4I. Legal name of adoptee’s mother. (Note: adoptee’s parents are not required to be given notice but the court requires they be identified in the Petition for Adoption.)

4J. Legal name of adoptee’s father:

4K. Does the adoptee have any developmental disabilities?

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Final Questions

5A. Name of person completing this questionnaire:

5B. How did you learn about Randall Hicks’s services? Referred by a past client? If an online search, please tell us if by Google, Yahoo, Yelp, Avvo or ?