Reference Forms For Adoption

Request Reference From a Friend or Family Member

Name

Phone

Address

Are you a reference for a couple or single individual?

A couple

A single individual

Are you a friend or family member?

Friend

Family member

If a family member, how are you related to this applicant?

I am the adult child of applicant(s)

Mother/Father

Brother/Sister

Aunt/Uncle

Cousin

Grandparent

If a couple, are they hoping to adopt their first child or second child?

First

Second

Prospective adoptive parent name

Parents Name

Prospective adoptive parent names

How often do you visit your parents in person? By telephone? Through correspondence?

How do you feel about having an adopted sibling?

How do you feel about having an adopted family member?

What is your feeling about having adopted family members?

Please describe this couple as parents in regards to: Sharing responsibilities

Please describe this couple as parents relating to their child/children's needs

Please describe the growth and development of their child/children

Please describe how the child/children respond to their parents

Based on your observations, please comment on the readiness of the parents and their child/ren for a new baby in the home

Describe this couple's relationship since they have had children

If your daughter/son were to adopt a child from another race or culture, how do you think the extended family members would welcome that child?

Briefly state the outstanding personal qualities and limitations of your son or daughter

Briefly state the outstanding personal qualities and limitations of the applicant

Describe his/her potential ability as a parent, or if he/she has children, describe his/her demonstrated ability as a parent

Describe his/her potential ability as a parent, or if they have children, describe his/her demonstrated ability as a parent

Briefly state the outstanding personal qualities and limitations of your son's or daughter's partner

How has your son's/daughter's partner fit in with your total family?

What is the most important thing you learned as a parent that you would like to share with new parents?

As you reflect upon your parenting experience, what is the most important thing you learned as a parent that you would like to share with new parents?

If your son/daughter adopted a child of another race or culture, how would extended family members welcome that child?

Do you give your approval for us to share your reference letter with another adoption agency, if the family requests that we do?

Yes

How do you feel about having an adopted family member of a different race or culture?

If your parents were to adopt a child from another race or culture, how do you think the extended family members would welcome that child?

Say a little about what living with your family is like.

What is the best thing about being a part of your family? What do you wish was different?

Phone

Do you give your approval for The Cradle to share your reference letter with another adoption agency if your parents request that we do so?

Yes

Is there anything else you think we should know or additional comments you wish to make?

Select the applicant's adoption counselor

I don't know the counselor's name

Dori Fujii

Katie Gattone

Carmen Knight

Kathy Santangelo

Lorrin Potts

Prospective adoptive parent names

How long have you known the applicant?

How long have you known this family as a couple?

How long have you known the applicant 1?

How long have you known the applicant 2?

What is your relationship to the applicant, e.g. friend, neighbor, relative, co-worker, business associate, churchgoer, or in an

What is your relationship to the applicants, e.g. friend, neighbor, relative, co-worker, churchgoer, or in any other way?

How often do you have contact with the applicant, e.g. daily, weekly, monthly, and so forth?

How often do you have contact with the applicants, e.g. daily, weekly, monthly, and so forth?

Have you ever observed the applicant disciplining children? If so, how did the applicant discipline the child(ren)?

Have you ever observed the applicants disciplining children? If so, how did the applicants discipline the child(ren)?

What skills or abilities does the applicant have that would be helpful in caring for children?

What skills or abilities do the applicants have that would be helpful in caring for children?

Have you ever seen the applicants interacting with children? If so, please describe the circumstances.

Would you have any concern for safety or well-being of any child placed with this family?

Yes

If yes, please explain

If you have (or had) children, would you allow the applicant to care for them?

Yes

If you have (or had) children, would you allow the applicants to care for them?

Yes

If no, please explain

Have you observed or have knowledge of any drug/alcohol, domestic violence, treatment of mental/emotional illness, and/or substance abuse by the family or any of its members?

Yes

If yes, please explain

Please check one of the following: To my knowledge, the applicant is

Please check one of the following: To my knowledge, the applicants are

Single

Married

Separated

Would you have any concern for safety or well-being of any child placed with this family?

Yes

If yes, please explain

Have you ever seen the applicants interacting with children?

Yes

If so, please describe the circumstances.

Select the applicant's adoption counselor

I don't know the counselor's name

Dori Fujii

Katie Gattone

Carmen Knight

Kathy Santangelo

Lorrin Potts

Any other comments you would like to make?

Do you give your approval for us to share your reference letter with another adoption agency, if the family requests that we do?

Yes

Unplanned Pregnancy?

Call our 24-hour toll-free number to speak to a Cradle counselor

800-CRADLE4 (800-272-3534)

Text CRADLE to 66746

Email Us | Chat Us

Adoptive Families & General Inquiries

Call our Main Office: 847-475-5800

Post Adoption Support Schedule a Call Here

Join Our List

Want to stay connected with The Cradle? Enter your email address to receive updates.

I'm Pregnant

Adoption Services

Counseling, Education & Training

I'm Pregnant

Adoption Services

Counseling, Education & Training

Request Reference From a Friend or Family Member

Unplanned Pregnancy?

Adoptive Families & General Inquiries

Join Our List

EMAIL ME THIS LIST