AFN Registration Form

Please note: To register in AFN, you must have an approved home study. If you are not yet approved within your state, please go to your state web site and begin the process in your state. If you are from Texas, please fill out an adoption interest form to begin the approval process in your area.

Your registration will be active for six months. Please fill out the information below.


* Fields in red are required.

Adoption Family Network Information
No
Yes

Your Adoption Agency Information
Select the DFPS approved home button only if DFPS completed your home study otherwise complete the other agency approved home section.
Texas Department of Family and Protective Services Approved Home
Other Agency Approved Home

Agency Address







Your Caseworker Information
Please enter your caseworkers correct phone number and email. This will facilitate our communication with them regarding your family.
( ) - Ext.

Your Family Information

Please fill in.
   
( ) - Ext.
( ) - Ext.
Best time to call:


Re-Type Your e-mail address:
Your mailing address

Other Family Information

Please fill in.
Married  
Single  
Separated  
Divorced  
Widowed  
Last name:
   

 

My Adoption/Parenting Preferences
Please fill this in correctly. It will ensure that any preliminary electronic matching results are as accurate as possible.
1-2   3-4   5 or more  
13-17   7-12   0-6  
Does not matter
Boy's only
Girl's only

Does not matter
Hispanic/Latino
African American
Anglo

Asian/Pacific Islander
Native American
Multi-racial
Other
 
 
*Check all conditions that you and your caseworker have determined you can parent.
Developmental Conditions
Medical Conditions
Autism
Developmental Delay
Developmental Disability-Diagnosed
Downs Syndrome-Diagnosed
Learning Disabled-Diagnosed
Limited English Proficiency
Mental Retardation-Diagnosed
Teen Parent
Enuresis/Encopresis-Diagnosed
Failure to Thrive
Medically Complex
HIV positive/AIDS-Diagnosed
Medically Fragile-Diagnosed
Pregnant-Current
Sexually Transmitted Disease
Terminal Illness-Diagnosed
Traumatic Brain Injury
Emotional Conditions
Physical Conditions
Previously Adopted
ADD/ADHD Diagnosed
Alcohol Abuse/compulsive use or need
Animal Cruelty History
Assaultive Behavior
Attachment Disorder
Bipolar
Depression-Diagnosed
Eating Disorder
Emotionally Disturbed DSM Diagnosed
Fire Setting History
Gang Activity/Affiliation
Oppositional Defiant Disorder
Post-traumatic Stress Syndrome
Psychotic Disorder
Self Abuse
Sexually Acting Out

Drug Abuse - compulsive use or need
Hearing Impaired/Diagnosed
Inhalant Abuse
Infant alcohol addiction/prenatal exposure to alcohol/fetal alcohol syndrome or effect
Infant drug addiction/prenatal drug exposed
Mobility Impaired
Physically Disabled - Diagnosed
Speech Disabled - Diagnosed
Visually Impaired - Diagnosed
Spina Bifida
Cerebral Palsy
None
Description of None
Mild
Description of Mild
Moderate
Description of Moderate
Severe
Description of Severe

Optional Information

This will help us with our recruitment efforts.
 
Yes No
If so, when and where:
  
Month and Year:
  
How were you referred to our web site? (check all that apply):
Foster/Adoptive Parent
AdoptUSKids.org
Other Web site
TV Announcement
Radio Announcement
Newspaper
Self-search
Faith-Based/Event or Referral
Community Presentation/Event
Billboard
Friend
Other (describe):
Thank you!

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