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ATTENTION: AOL USERS & OTHERS: If your browser doesn't
support forms you may email your information to me
for inclusion in the registry.


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ATTN: Searchers
Make Sure That You Submit Your Search,
Even If You Don't Find A Matching Entry On The Search Pages,
Or Think You Have Enough Information,
Please!!! It's To Your Benefit. :)



NOTE: "Refresh or Reload Your Browser When Visiting As New Submittals Are added Daily"





NOTE TO REGISTRANT:

"Once registered, you will receive an acknowledgement from the Registry Owner, via the email address mentioned in your identifying information. The submitted form will be reproduced in the online SEARCH page, minus any identifying information such as your email address, last names, telephone number, and postal address. If at ANY time you wish to change any registrant information, submit your new additions and present yourself by prior identifying information. This protects you from unknown changes by any other person. If at ANY time you wish your withdraw your registration, you may do so by emailing Registry Owner personally, and all online information will be withdrawn and hardcopies destroyed. Online information will be ready within 7days for viewing."





NOTE:You Must at LEAST Register Your own DOB, Adoptees DOB,
Reliable Return Email Address, Adoptee's City of Birth,
For this Registry to WORK... Anything Less, Your Submital Is Almost Futile.
Thanks,
Registry Owner.



    Information to be included in the online registry:


    Adoptee's Date of Birth:[required]
    (ex. 00/00/00)

    Adoptee's gender (M/F):[required]

    Adoptee's City of Birth:[required]

    Adoptee's State of Birth:[required]



    I am the:[required]


    Adoptee
    Birthparent
    Adoptive Parent
    Adoptive Sibling
    Birth Sibling
    Adoptee Spouse
    Other

    If other is checked, please describe:


    I am searching for:[required]



    Identifying information for my records only:


    Your Name (Registrant):


    Email Address (required):


    Street address:


    City:


    State:


    Zip Code


    Area code and Phone:


    Relinquishment information:



    Name of hospital where born:

    Attending physician:

    Time of birth:

    Name of Maternity Home:

    Name of Agency:

    Name of Agency worker:

    Agency Case/File #:

    Date of Relinquishment:

    Date Adoption Finalized:

    Court of Jurisdiction:

    Court Case/File #:

    Original Birth Cert #:

    Amended Birth Cert #:





    Adoptee Birthname:


    First:


    Last:



    Middle:

    If no birthname was given, check here:





    Birthparent information:

    Birthmother's first name:

    Birthmother's middle name:

    Birthmother's last name:

    Birthmother's DOB:

    Birthfather's first name:

    Birthfather's middle name:

    Birthfather's last name:

    Birthfather's DOB:



    Additional Information:




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