Adoption Questionnaire Megan S. Monsour – Hinkle Law Firm LLC Adoption Questionnaire Adoptive Parent #1 - First Name*Middle Name*Last Name*Address*City*State*Cellphone Number*Email Address*Date of Birth*Place of Birth*Specific Religion*Ancestry*Tribal Affiliation*RegisteredYesNoRegistered Tribe*Any Tribal Indian Heritage*Occupation*Health Status or limitations*Adoptive Parent #2 - First Name*Middle Name*Last Name*Address*City*State*Cell Phone Number*Email Address*Date of Birth*Place of Birth*Specific Religion*Ancestry*Tribal Affiliation*RegisteredYesNoTribe*Tribal Indian Heritage*Occupation*Health Status of limitations*Biological or adopted children*Please include sex, date of birth and whether they are biological or adoptedReason for adoption*Budget*Your budget should only include funds that can be readily accessed within 48 hours of the match. Would you accept a situation where the baby was exposed in utero to the following illegal substances by the expectant mother:*MethHeroinCocaineMarijuanaTobaccoAlcoholNo I would not acceptAny further details you would like to provide that will help us understand your openness to drug exposure:Would you accept a situation where the expectant mother has been diagnosed with the following mental health concerns:*BipolarDepressionADD/ADHDNo I would not acceptAny further details you would like to provide that will help us understand your openness to mental health concerns:Race of Child*CaucasianAfrican AmericanNative AmericanAsianPuerto Rican/HispanicBiracialCheck all that you would openly acceptIf you would accept biracial, please list the races you would openly acceptHome Study: Must be current within one year of baby's birth date*Please include name of agency or social worker, their phone number and email address, date of FBI Clearances, and date of Child Abuse ClearancesHow did you hear about Megan Monsour*Optional Photo Release* Yes No Please choose yes or no to permit us to use photos provided by you on our website and on social media sites. Your choice will have no impact on the service we provide and is completely optional. If you choose to allow us to use your photo, you may request removal of the photo in the future and we will make every effort to remove it from this site in a reasonable time frame. Notwithstanding, certain social media sites may have delayed or differing removal policies and we are not responsible for those sites.Please initialTransmission of the information is not intended to create, and receipt does not constitute, an attorney-client relationship.
