Prospective Mother's Name: 
Mother's Age:

Prospective Father's Name:              
Father's Age: 

Address: 
 

City: State: Zip/Postal Code:
Country (if not in the U.S.):

Home Phone:   Daytime Phone:  
E-mail:  
(Please know that we will not give your email address to anyone, and will only use it in the future to occasionally update you on our programs or let you know of Cradle of Hope events in your area.  Your email address is not provided to us unless you fill in the Email box above.)

Adoption Programs of Interest (check all that apply):
Russia     China     Guatemala    Bridge of Hope

Why are you considering international adoption? (check all that apply):
Domestic adoption too uncertain 
Speed of process 
No birthparent issues 
Flexible eligibility criteria 
Ethnic/cultural reasons 
To help an orphan 
Other:

Do you have a homestudy?     Yes No    
Do you have BCIS approval?   Yes No

Please add any additional comments or questions here:

Would you like to subscribe to our email newsletter (please provide e-mail address above), mailed every 1 to 2 months, updating you on Cradle of Hope and news affecting international adoptions?
Yes No

Would you like to receive a quarterly mailing of our Waiting Russian Children Flyer, featuring photos of Russian children available for adoption?
Yes No