Free Adoption Application
  1. First Name:
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  2. Last Name:
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  3. Spouse/Partner's First Name:
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  4. Spouse/Partner's Last Name:
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  5. Street Address (include apt/unit #):
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  6. City:
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  7. State:
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  8. Zip:
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  9. Email:(*)
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  10. Home Phone:
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  11. Cell Phone:
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  12. Best time to reach you
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  13. How did you hear about LifeLong?
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  14. To help us determine your adoption time frame please tell us when you will be ready to start the adoption process?
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  15. Gender of Child You Wish To Adopt: LifeLong Adoptions only deals with newborn babies.
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  16. Preferred Race of Baby:
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Employment
  1. Your Occupation:
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  2. Spouse/Partner's Occupation
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General Descriptions
  1. Your Date of Birth:
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    *You must be 25 years of age or older to adopt.

  2. Your Race:
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  3. Your Hobbies, Talents and Interests:
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  4. Your Community Service:
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  5. Religion:
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  6. Spouse/Partner's Date of Birth:
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  7. Spouse/Partner's Race
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  8. Spouse/Partner's Hobbies, Talents and Interests:
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  9. Spouse/Partner's Community Service / Activities:
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Marital History
  1. Currently Married
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  2. Date of Marriage:
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Education
  1. Your Education Level:
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  2. Your Year Graduated:
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  3. Spouse/Partner's Education Level:
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  4. Spouse/Partner's Year Graduated
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Financial Summary (Remains Confidential)
  1. Household Income:
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  2. Own or Rent?
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Children (Please enter the age of your children and indicate if the child is adopted or biological.)
  1. Child 1 Age:
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  2. Child 1 Gender:
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  3. Child 1 Adopted or Biological:
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  4. Child 2 Age:
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  5. Child 2 Gender:
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  6. Child 2 Adopted or Biological:
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  7. Child 3 Age:
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  8. Child 3 Gender:
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  9. Child 3 Adopted or Biological:
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  10. Child 4 Age:
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  11. Child 4 Gender:
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  12. Child 4 Adopted or Biological:
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Personal History
  1. Declared Bankruptcy?
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  2. Been under psychiatric care?
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  3. Dishonorable discharge from the military?
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  4. Been arrested?
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  5. Placed a child for adoption?
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  6. Past due on court ordered child support?
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  7. Explain any of the above:
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  8. Reasons for wanting to adopt:
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Lifestyle Information
  1. Describe your neighborhood and home:
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  2. What do you enjoy doing together & individually?:
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  3. How will your life change after adoption?:
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Home Studies
  1. Have you completed a home study?
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  2. Completed home study by?
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  3. Signed up with other adoption agencies?
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  4. Names and numbers of other agencies:
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Photo
  1. Please Upload a Photo
    Choose File
Read & Submit
  1. Please note: We will contact you within one to two weeks of receipt of your complete application. Contact will be made by email or phone.
  2. Please check the box stating you understand the cost of adoption.
  5. Evening Phone:(*)