Assisting Families
For More Than 30 Years

Our Practice Is Limited to Adoption & Children's Law

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Custody Intake Form

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Contact Information

Husband Wife

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Children

If more than 4, please list under additional notes section at the end of this form)

Additional Client Information


Yes No


Yes No

Information of Child(ren) to be Adopted

Custody Information

Birth Mother Information


Yes No

Birth Father Information

Yes No


Yes No

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