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APPLICATION

Applicant's First Name:
Applicant's Middle Name:
Applicant's Last Name:
Previous/Other Surname:
Birth Date(dd/mm/yy):
 
Home Phone Number:
- -
Cell Number:
- -
Email Address:
Address - Street:
Town/City:
Postal Code:
If you have lived at this address for less than 10 years, list previous addresses:
1. Address - Street:
Town/City:
Postal Code:
2. Address - Street:
Town/City:
Postal Code:
3. Address - Street:
Town/City:
Postal Code:
Gender:
Male Female
Languages Spoken in Home:
 
Currently practicing faith?
Yes No
If yes, what is religion practiced?
Racial Origin:
Education (What level of education have you reached?)
Occupation:
Place of Employment:
Business Phone Number:
- -
Have you ever received services or had involvement with a Children's Aid Society in Ontario or a child welfare agency outside of Ontario? Yes No
Have you ever applied to adopt before? Yes No
Co-Applicant's First Name:
Co-Applicant's Middle Name:
Co-Applicant's Last Name:
Previous/Other Surname:
Birth Date(dd/mm/yy):
 
Home Phone Number:
- -
Cell Number:
- -
Email Address:
Address - Street:
Town/City:
Postal Code:
If you have lived at this address for less than 10 years, list previous addresses:
1. Address - Street:
Town/City:
Postal Code:
2. Address - Street:
Town/City:
Postal Code:
3. Address - Street:
Town/City:
Postal Code:
Gender:
Male Female
Languages Spoken in Home:
 
Currently practicing faith?
Yes No
If yes, what is religion practiced?
Racial Origin:
Education (What level of education have you reached?)
Occupation:
Place of Employment:
Business Phone Number:
- -
Have you ever received services or had involvement with a Children's Aid Society in Ontario or a child welfare agency outside of Ontario? Yes No
Have you ever applied to adopt before? Yes No
Relationship:
Single, never married
Married
Living common-law

Same-sex couple
Divorced

Separated
Widowed
Children in the home:
Name as per birth registration Sex (m/f) Birth Date (dd/mm/yy) Grade Name of School/Occupation
1.
2.
3.
4.
Other persons currently living with family:
Name Birth Date (dd/mm/yy) Relationship
1.
2.
3.
4.

Certification
I/We declare:
1. That the information contained in this application is complete and true to the best of my/our knowledge and that a false statement may disqualify my/our application from further consideration.

2. An acknowledgement that the Children's Aid Society will check internal records for any information relevant to this application and that a criminal record check will also be required. (The existence of a criminal record check will not necessarily result in an exclusion from the program.)