Last Name: Your last name will not be posted on your listing.
Husband's First Name: Wife's First Name:
Your Email Address (you@aol.com): Phone Number (with area code):
Street Address: Street Address:
City/Town: State: Zip code:
$50 Photo Registry renewal for 6 months $100 Photo Registry plus Web Page renewal for 6 months Other:
Fill in CHANGES ONLY to your registry listing:
Box 1: First Names:
Box 2: Age & Gender of Child you want: Age of Child Either Boy or Girl Girl Boy The families that pick EITHER BOY OR GIRL get the most contacts!
Box 3: Race of Child you want: The families that pick ANY RACE get the most contacts. Any Race Caucasian Hispanic African American Asian Native American Biracial/Mixed Race Other (please specify)
Box 4: Religious/Church Denomination:
Box 5: State you live in: Please spell out state name
Box 6: Number of children in your home currently:
Box 7: Marriage Length OR Openness of Adoption: Open Semi-open (pictures and letters only) Closed Open or closed
Box 8: Working or Stay Home Mom
Stay Home Mom Fulltime Working Mom Part-time Working Mom
Box 9: Home Study Ready
Yes No OR Other
Box 10: Phone Number Listed OR Other
Box 11: E-Mail Address:
Box 12: Web Page Address OR Other Item
A short 3-5 sentence paragraph describing your family.
