Hold Registration Form for Child Being Adopted by
a Recruited Family
(other than a foster parent or relative)

When completing a Hold Registration form in order to remove a child from the MARE photolisting book, it is also necessary to complete and submit a MARE Removal Form.

The last page of the Family Assessment MUST accompany this form; you may either fax (517-783-5904) or mail the last page of the Family Assessment to the MARE office.

(NOTE: All fields in RED must be complete, or form will not be accepted)

Child's Last Name:
Child's First Name:
DHS Case No.:
MARE C No.:
Date of Birth:
(mm/dd/yy) 		 Permanent Custody Date:
 (mm/dd/yy)		 Gender:
  
County of Commitment:  

 

Is this a transfer case:

If you this is a transfer case, please provide the name of the referring agency and the transfer date:

Referring Agency:   Date of Transfer:  (mm/dd/yy)

 

 

Registering Agency:  
Adoption worker:   Phone number:  
Your email address:   (e.g., you@isp.com)
Family's First and Last Name(s):
Family's Agency:

 

Notes:

 

PLEASE NOTE: Agencies must still follow up with anPCA 320 in order to close this case. If at any time the family decides not to proceed with the adoption and no other approved family is available, the child must be registered in the MARE photolisting book by sending a standard (blue) MARE Child Registration Form and a clear, well-defined photo. If a new family has been identified, please send a new Hold form.