Across the World Adoptions

Information Request

Child

Please complete this form to receive a brochure by mail.

Feel free to email us if you have any questions or download an Application if you are ready to begin your intercountry adoption.

Name(s):
Mailing Address:
City, State, Zip:
Home Phone:
Work Phone:
E-mail Address:

Adopting Mother's Age: Adopting Father's Age:
Number of years married: Number of current children:

Age of Child you are interested in adopting:
Gender of Child: Boy    Girl    Either
Number of Children interested in:
Are you interested in adopting a child
with special needs?

Countries you are interested in:   Kazakhstan Russia
Guatemala     Other (Please describe below)

Comments: