Fillable Project Family Registration Form (Vermont)

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Project Family Registration Form (Vermont)

On average this form takes 18 minutes to complete

The Project Family Registration Form (Vermont) form is 2 pages long and contains:

  • 2 signatures
  • 45 check-boxes
  • 41 other fields

Country of origin: US
File type: PDF

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Project Family Registration Form
To register with Project Family, you MUST have a current, approved adoption
homestudy in any state or foster care license in Vermont.
OFFICE USE ONLY
Date Received Family Number
Accepted
Not Accepted
Restrictions/Comments
APPLICANT #1 APPLICANT #2
Full Name
Date of Birth
Gender
Marital Status
Single
Married
Civil Union
Living with Partner
Other
_________________
Single
Married
Civil Union
Living with Partner
Other
________________
Mailing Address
Phone - Home ( ) ( )
Phone - Cell ( ) ( )
Phone - Work ( ) ( )
Email
CHILDREN LIVING AT HOME
List each child’s name, age and gender and whether they are in foster care.
1.
Foster? Yes No
4.
Foster? Yes No
2.
Foster? Yes No
5.
Foster? Yes No
3.
Foster? Yes No
6.
Foster? Yes No
HOW DID YOU HEAR ABOUT PROJECT FAMILY?
Newspaper Radio TV Internet Brochure Friend Other ____________________
-2-
THE CHILD(REN) YOU’D LIKE TO ADOPT
Age Range
Under 7
7 to 10
11 to 14
15 to 18
Any age
Gender
Are you open to
any gender?
Yes
No
Transracial adoption
Are you open to
transracial adoption?
Yes No
Willing to consider
Siblings
Are you willing to adopt siblings?
Yes
No
If yes, what’s the maximum number
you’d consider? _____________
SOCIAL WORKER/ LICENSOR YOU’RE WORKING WITH
Name
Agency
Phone Number
Email
Rev. 8/2018

CERTIFICATION & SIGNATURE OF APPLICANTS
By signing below, I /we certify that all information on this registration form is correct and complete to
the best of my/our knowledge. I/we understand that Project Family may verify information, and that
untruthful or misleading answers are reason to reject this registration.
By signing below, I/we acknowledge that there are unforeseen risks associated with adoption, that
children/youth in foster care could be impacted by the special needs listed below, and that we are
prepared to adopt a child/youth in foster care.
Alcohol exposed
Drug exposed
History of multiple placements
Mental illness in birth family
Anxiety/ Depression
Behavioral problems
Emotional disabilities
Learning disabilities
Mental disabilities
Physical disabilities
Attention deficit disorder
Eating disorder
Hyperactivity
Oppositional defiant disorder
Reactive attachment disorder
Applicant #1:
Applicant #2:
________________________________________________
Signature
________________________________________________
Signature
_____________________
Date
_____________________
Date
To register with Project Family, send your completed form and either:
A copy of your current, approved adoption homestudy OR
A letter from the licensing agency confirming the status of your Vermont foster care license
Project Family at DCF, 280 State Drive Waterbury, Vermont 05671-1030
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Project Family Registration Form (Vermont)

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Completed 19 February 2021

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