Adoption Interest Form - Child Welfare Maine DHHS: OCFS

Please fill out this form to be considered for the child you are interested in.

If you want more information about this child, please fill out the form below - it will go to the MAINE adoption staff who will have more information on the child. Please include your e-mail address in order to receive the caseworker's name and e-mail address.

Parent 1: First Name:		Last Name:
Parent 2: First Name:		Last Name:
Address:
City:		County:
State:		Zip Code:
Daytime Phone:		Evening Phone:
E-mail Address:

Do you have an approved homestudy? Yes No

Agency's Name:

Please enter the names and ID numbers of the child(ren) you are interested in below:
Child's Name:		ID#:
Child's Name:		ID#:

	A Family for ME
	P.O. Box 754
	Gardiner, ME 04345

	Phone: 877-505-0545
	207-588-0996
	FAX: 207-582-9027
	E-Mail: affme@aol.com

ADOPTION INFORMATION