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

    *You must be 25 years of age or older to adopt.

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