GENERAL ENQUIRY FORM ADOPTION
This form is to provide us with more information and also enables you to provide any other details you
may feel relevant. If you are enquiring as a couple please ensure to fill in both sections.
Once we receive your completed enquiry form, we will contact you to discuss your enquiry in more
detail. Please return this questionnaire to us either via post at Adoption Matters, 14 Liverpool Road,
Chester, CH2 1AE or via email: please email to: info@adoptionmatters.org
If you have ANY queries or require assistance in completing this form, please do not hesitate to
contact us on 0300 123 1066. Thank you for your interest in adopting with Adoption Matters.
(Applicant 2 if applicable)
(Applicant 1)
Applicant/s’ surname/s
First name/s
Age (the law states that all
applicants who would like to
adopt must be aged 21 years
old and above)
Address
Post code
Home Tel
Tel (mobile)
Tel (mobile)
Tel (work)
Tel (work)
Preferred email address
as you will be sent some
documentation by email
(1)
(2)
Please provide us with times/dates
when you will be available for us to
contact you to arrange a general
discussion/initial meeting. Please also
provide your preferred contact method,
i.e. telephone number/email address
Occupation
(1)
(2)
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Ethnic background
(1)
(2)
Religion
(1)
(2)
Relationship status, e.g.
married, civil
partnership, single, cohabiting
How long have you lived
together?
Details of others in your household, including children:
Name
Age
Relationship to you
Age
Relationship to you
1.
2.
3.
Details of children living elsewhere:
Name
1.
2.
3.
Do you have a spare bedroom available for a child in your home?
YES/NO
As part of our assessment process, we have to ask the following question and we understand that this is
very sensitive. Can you please advise details of any children who are now deceased.
Name
Age & date of death
Relationship to you:
1.
2.
Do you consider yourself a person with any disabilities?
If ‘Yes’, please give details:
YES/NO
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It would be helpful if you could tell us something about yourself/ves below, covering the following points:
1.
The reasons why you are considering adoption.
2.
A little about your way of life, jobs, interests and hobbies.
Can you please advise if you have any thoughts about the children you might be interested in adopting.
Don’t worry if you are unsure at this stage, this is just to provide some more information, we can discuss this
further when we meet with you.
Age/s:
Single child or brothers and sisters?
If you can consider any particular issues or
difficulties, please give details here, eg
medical issues, disability, learning
difficulties:
Please tick the areas of adoption you are
interested in:
 Domestic Adoption (which means Adoption in the UK)
 Concurrent Planning
If you are in contact with other agencies,
please indicate the current situation:
Have you made a previous application to
adopt or foster a child. If so, please give us
the name of the agency or local authorities
with the approximate dates and outcome:
Are you currently undergoing infertility
treatment or investigations?:
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How did you hear about Adoption Matters? You may choose more than one if applicable
Enquiry Source:
Yes / No
Local Newspaper
National Newspaper
Google
Facebook
Twitter
Radio
Leaflet/Poster
Event
My GP/Doctors
My own local authority/council
Word of mouth – recommendation
I/we have adopted before
Through employer – please list name:
Other organisation:
Adoption UK
Adoption Link
Adopt North West
CoramBAAF
First4Adoption
Home for Good
Other:
If other, please list name:
Other – please advise:
Please add any other information here you think is relevant to your enquiry.
You can use additional sheets if required.
Signed
(1)……………………………..……..……. (2)………………………………………………………..
Date
………………………………………………
………………………………………………………..
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