THURROCK ADOPTION AGENCY - POST ADOPTION REFERRAL FORM
If you would like adoption support please answer the following questions and a member of the Thurrock Adoption Team will get back to you as soon as possible.
Please tick the appropriate box that applies to you.
· Access to Records ( )
· Adoptee and birth relative reunions ( )
· Support for Adopted Child ( )
Access to records
Your details:
Name…………………………………………………….
Name if different at birth……………………………………..DOB……………………….
Current Address……………………………………………………………………….
…………………………………………………………………………Telephone……………………
If known the agency where you were adopted from……………………………….
Adoptee and birth relative reunions
Your details
Full name………………………………………………………………………
Address......
…………………………………………………………………………Telephone……………………
Name of the person you would like to trace……………………………………………………..
How is this person related to you………………………………………………………………..
Support for Adopted Child
Your details
Name…………………………………………………………………
Address......
…………………………………………………………….Telephone………………………………….
Child’s name…………………………………………………DOB……………………………..
Brief summary of your concerns......
………………………………………………………………………………………………………..
………………………………………………………………………………………………………..
(Attach an extra sheet if necessary)