Adoption Intake and Information Form

Full Legal Names:

First Name

Last Name

First Name

Last Name

Current Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Telephone#:

(###)

###

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Husband's Work#:

(###)

###

####

Husband's Cell#:

(###)

###

####

Wife's Work#:

(###)

###

####

Wife's Cell#:

(###)

###

####

Email address:

Date and Location of Marriage:

Names and ages of other children living in home, not including child to be adopted:

Name of Agency: (fill out this section if applicable)

Telephone Number of Agency:

(###)

###

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Address of Agency:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Caseworker or Contact Person at Agency:

First Name

Last Name

Name of Social Worker (who did your home study):

First Name

Last Name

Address of Social Worker:

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Telephone Number of Social Worker:

(###)

###

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Name of Agency Completing your Post Placement:

Sherriann Hicks has handled cases in the metro-Atlanta area for years. She practices in Gwinnett, Dekalb, Fulton, Forsyth, Barrow, Hall, Cobb and Walton Counties.

Email • shicks@shickslaw.com
Call • (678) 985-1000 or (404) 786-7365
Fax • (678) 985-2347
Office • 368 South Perry Street, Lawrenceville, Georgia 30046