Enquiry Form (for domestic adoption only)

To make your initial enquiry, please complete the form below and click the 'Submit' button. We will send you an e-mail confirmation of receipt of your enquiry form within one working day. If you do not receive an e-mail confirmation, please telephone our Chester office on 01244 390938.

However, before you complete this form, please make sure that you have read our Information Pack and the information on this website. In addition, we need to make you aware of a couple of things. Adoption Matters Northwest is primarily concerned with finding families for older children. We do place some younger children in the 0 - 2 years age range, but they invariably have a disability, learning difficulties, a medical problem, developmental delay or a background issue such as mental illness.

If you can consider young children with these needs, or older children or sibling groups, we would be delighted to hear from you. For further clarification or discussions about this information, please ring our office on 01244 390938 and speak directly to a duty social worker.

	(1)	(2)
Applicant/s' surname/s
First name/s
Dates of birth
Gender
Address


Post code
Home Tel
Work Tel
Mobile Tel
Home E-mail
Work E-mail
Occupation
Ethnic background
Religion

If married or in a civil partnership, please give date of marriage / ceremony.

Details of children already in your household:
	Name	Date of Birth	Relationship to you
1
2
3
4

Details of children living elsewhere or deceased
	Name	Date of Birth / Death	Relationship to you
1
2
3
4

Please given us some idea about the children you might be interested in adopting.
Age/s:
Single child or brothers and sisters?
If you can consider any particular issues or difficulties, please give details here, eg medical issues, disability, learning difficulties
How did you hear about this agency?
If you are in contact with other agencies, please indicate the current situation
Have you made a previous application to adopt or foster a child. If so, please give us the name of the agency or local authorities with the approximate dates and outcome
Are you currently undergoing infertility treatment or investigations?

Do you consider yourself a person with any disabilities? Yes No

Are you a registered disabled person? Yes No

It would be helpful if you could tell us something about yourself/ves below, covering the following points:

The reasons why you are considering adoption
A little about your way of life, jobs, interests and hobbies

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Adoption Matters Northwest, a company limited by guarantee. Registered in England (No. 1617324).
Registered Charity No. 512892 incorporating Blackburn Diocesan Adoption Agency and Chester Diocesan Adoption Services.
Approved as an Adoption Agency by Ofsted.