Adoption Centre of Kansas

Preliminary Adoption Form for
Adoptive Parents.


Name:
Email:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Race of Child desired (check as many as apply).
	Full Caucasian
	Full Hispanic
	Full African American
	Full Asian
	Bi Racial (specifiy mix)

Age of child (check as many as apply)
	Newborn
	Up to Age 2
	Up to Age 5
	Over Age 5
Would you consider adopting a special needs child.
	Yes
	No
If yes, specify to what degree?

Would you object to meeting the birth mother prior to placement?
	Yes
	No
Would you object to post pictures?
	Yes
	No
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