Birth Father Application

Name

First Last

BIRTH FATHER - GENERAL INFORMATION

Do you know the birth father?

If No, please explain

Birth Father's Name

First Last

Birth Father's Date of Birth

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email

Phone Number

Cell Phone Number

Does the birth father know you are pregnant?

Does Birth Father know you are making an adoption plan?

If yes, how does he feel about the pregnancy?

If yes, how does he feel about making an adoption plan for this child?

If no and does not know about the adoption plan, please describe the situation.

Please describe your relationship (past and or present), if any, with the birth father.

Marital Status

Religion

Ethnicity (please check all that apply)

What is his national heritage (ex: Irish, Haitian, Puerto Rican, etc.)

Height

Approximate Weight (before pregnancy)

Eye Color

Skin Color

Hair Color

Hair Texture

Has the birth father ever placed a child for adoption before?

If Yes, please describe in detail

Does the birth father have any other children?

If Yes, are they living with you?

If No, please describe the circumstances:

Comments or Questions