Home About Us International Adoption Domestic Adoption Waiting Adoptive Couples Birthmother Services Contact Login Contact Us home  >  contact us  >  request information Information Request Form   Any information submitted on this site will be for our exclusive use only. We do not share this information with any other organization. Please read and fill-in this information request completely. Since there are different requirements for different programs, it will help us to assist you better. Thank you.   Husband's full name: Husband's age: For the sake of our birthmothers information, please voluntarily indicate your race. Please Select Caucasian African American Hispanic Other   Wife's full name: Wife's age: For the sake of our birthmothers information, please voluntarily indicate your race. Please Select Caucasian African American Hispanic Other   Number of years married: Number of children: Can you travel? Yes  No   Single adoptive mother's name: Single adoptive mother's age: For the sake of our birthmother's information, please voluntarily indicate your race. Please Select Caucasian African American Hispanic Other   Street Address:     City:            State:            Zip:       Telephone Number: Email address:   What is your religious background? What is your denomination?   Do you have a current home study? Yes  No Do you have BCIS approval? Yes  No Number of children requested: Please Select 1 Child 2 Siblings 3 Siblings Nationality of child Please Select Russian Eastern European Asian Latin American African American American Description of child What age of child would you like to adopt? Please Select infant (under 1 year) 1 to 2 years 3 to 5 years 6 to 9 years 10 to 15 years over 15 years Medical condition of child Please Select good physical condition minor physical handicap minor development delay physical handicap developmental delay Gender of children requested Male  Female  Either Both Would you consider Twins/Siblings?Yes  No Your comments and/or questions: Please let us know how you heard about us:      Contact Us    Request Information    Information Packet Download PHONE: (229) 228-6339 - FAX: (229) 228-4726 - EMAIL: opendoor@rose.net    218 E. Jackson Street   Thomasville, GA 31799    © 1998-2005, An Open Door Adoption Agency Inc. All rights reserved