ADOPTION INFORMATION WORKSHEET
Information Checklist on Child Being Adopted
1. Name of child at birth:
__________________________________________
2. Name of child after adoption:
____________________________________
3. Sex of child: _______________________
4. Age of child: _______________________
5. Date of birth: _______________________
6. Place of birth: _________________________________________________
7. Hospital:
_____________________________________________________
8. Attending physician:
____________________________________________
9. Race of Child: _____________________
10. Property owned by child:
Real property:
_______________________________________________
Personal property:
____________________________________________
Remarks:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
