Families Interested in Adoption and/or Foster Care
Not Yet Working With an Agency
(open to Michigan families only)

Thank you for your interest in registering with MARE.  The information you provide will be made available to adoption workers around the state that are looking for families to study for foster care and/or adoption, who will meet the needs of their waiting children.  Workers will be able to search families and contact them through our office regarding their interest in adoption and/or foster care (to protect family's privacy, no identifying contact information will be listed on the MARE website).  The following information is voluntary, but the more information you provide, the better understanding workers will have of your family and the type of child or children you hope to foster or adopt.

(NOTE: All fields must be completed, unless otherwise optional.)

YOUR FAMILY INFORMATION
FIRST APPLICANT
SECOND APPLICANT
Name (first and last)
Date of Birth
Gender
Marital Status
Race (optional):
Email Address:
Telephone:
 (XXX-XXX-XXXX)
City:
State:
YOUR FAMILY DESCRIPTION
Please tell us about other members of your household, including children, relatives, exchange students, even pets:
ADOPTION / FOSTER CARE INFORMATION
Are you interested in:
 
 

 

 


Have you adopted or provided foster care in the past?  If so, which agency or agencies have you worked with?

Age range of child or children you are interested in fostering or adopting:

Youngest:           Oldest:

Interested in adopting an infant only.             Interested in adopting internationally only.

Race of child or children you are interested in fostering or adopting (select as many as you wish):
 African American
African American/Caucasian
Asian
Caucasian
Hispanic / Latino
Native American
Other
Doesn't matter

Do you want to foster or adopt:


Gender of the child or children you wish to foster or adopt:
BEHAVIORS / IMPAIRMENTS CHECKLIST

Below is a list of physical, developmental, learning or behavioral issues that children may experience.  Please indicate whether you will consider a child or children with these issues (“Yes”), if you won’t consider this issue at all (“No”), or if you are unsure whether you will consider this issue (“Maybe”). For more information or an explanation, simply click on the issue.
Yes
No
Maybe
Abuse, history of
Allergies
Anxiety
Asperger Syndrome
Asthma
Attachment Disorder
Attention Deficit Disorder
Autism
Bipolar Disorder (“Manic Depression”)
Cerebral Palsy
Cleft lip
Cleft palate
Criminal behaviors, current
Criminal behaviors, history of
Cruelty to animals, current
Cruelty to animals, history of
Cystic Fibrosis
Depression
Developmental delays
Diabetes
Down Syndrome
Dwarfism
Dyslexia
Eating disorders
Education delays caused by lack of attendance
Emotionally clingy / needy
Excessive lying
Failure to thrive
Feces-smearing
Feeding tubes
Firesetting, history of
Hearing impairment
Heart defect
Hyperactivity
Language disorder - receptive
Language disorder - expressive
Learning impairment
Lifelong care, will need
Mental illness in birth family
Mental retardation
Missing limb(s)
Mobility issues
Multiple placements, history of
Muscular Dystrophy
Neglect, history of
No background history on birth parents/family
Obsessive-Compulsive Disorder ("OCD")
Opposition Defiant Disorder ("ODD")
Paralysis
Physical aggression towards adults
Physical aggression towards peers / other children
Physical aggression towards younger children
Post Traumatic Stress Disorder ("PTSD")
Pregnancy, history of / already a parent
Prenatal alcohol exposure
Prenatal drug exposure
Reactive Attachment Disorder ("RAD")
Running away, history of
Schizophrenia
Seizure disorder
Separation anxiety
Sexual abuse, history of
Sexual acting out, current
Sexual acting out, history of
Shaken Baby Syndrome
Sickle Cell Anemia
Sickle Cell trait
Sign language, needs
Soiling ("encopresis")
Speaks other language:
Special education requirements
Speech disorders
Stealing, current
Stealing, history of
Takes psychiatric medication
Tourette Syndrome
Vision impairment
Wetting ("enuresis")
Wheelchair-bound
Will never live independently

 

 

 

 

 

 

 

 
ADDITIONAL INFORMATION

Please add any other information about your family, such as parenting experience or strengths: