Applicable for children in foster care - Are any members of your household children in foster care awaiting adoption? No Yes If yes, please explain: Applicable for children surrendered directly to a voluntary authorized agency Are any members of your household pre-adoptive children waiting for adoption finalization? No Yes If yes, please explain: Other children (under 18) Relationship to Date of birth Address outside the household applicant / / / / / / / / / / / / Adult children outside the Relationship to Date of birth Address household applicant / / / / / / / / / / / / Boarders/Renters Date of birth Relationship to applicant / / / / / / / / / / / / Pets/other animals – Type Vaccinated? Licensed? per local ordinance No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes
Applicable for children in foster care - Are any members of your household children in foster care awaiting adoption? No Yes If yes, please explain: Applicable for children surrendered directly to a voluntary authorized agency Are any members of your household pre-adoptive children waiting for adoption finalization? No Yes If yes, please explain: Other children (under 18) outside the household Date of birth Address Relationship to applicant / / / / / / / / / / / / Adult children outside the household Date of birth Address Relationship to applicant / / / / / / / / / / / / Boarders/Renters Date of birth Relationship to applicant / / / / / / / / / / / / Pets/other animals – Type per local ordinance Vaccinated? Licensed? No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes