PARENT FINDERS

19 English Bluff Road Delta,  BC,  V4M 2M4 Canada

ph:   (604) 948-1069 fax.  (604) 948-2036

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MEMBERSHIP REGISTRATION

Our registration fee is $25.00, payable to Parent Finders of Canada. We do understand that there are questions you may be unable to answer, however, please fill in as much information as possible and use the reverse side for any additional data you feel may be pertinent.

Name:________________________________________             Telephone:(______)_____________________

Address: ___________________________________________    City:_________________________________

Prov:. ___________________________________                       Postal Code __________________________

You are:  Adoptee     Birth Mother    Birth Father     Other (please specify) _____________________

Adoptee's Birth Date: _________________________    Birth Place __________________________________
                                       (Month/Day/Year)                                                        (City / Province)

Birth Name in full:_____________________________________________      Birth Weight:________________

Hospital:_____________________________________________________     Time of Birth:_______________
                                                                                                                                       (a.m./p.m.)
Birth Mother's name at time of birth:_________________________________________________

Birth Mother's Birth Date:________________________  Birth Place:__________________________________
                                              (Month/Day/Year)                                                   (City / Province)

Birth Father's Name:______________________________________________________________

Birth Father's Birth Date:________________________    Birth Place:__________________________________
                                               (Month/Day/Year)                                                   (City / Province)

Adopted or Foster Name in full:__________________________________________________

Adopting Parents:_____________________________________________________________

City where adoption completed:_____________________________________    Date:_____________________
                                                                                                                                 (Month/Day/Year)

**If you have a copy of the LONG FORM BIRTH CERTIFICATE, ORDER OF ADOPTION or BACKGROUND INFORMATION SHEETS, please enclose copies.

**PARENT FINDERS is staffed by unpaid volunteers - it is not a government agency and does not receive any funding. The registration fee is used to cover operating costs only. Services provided are registration and search in the computerized Canadian Adoption Reunion Register (CARR), search advice, reunion match notification and reunion support.

*** ALL LONG DISTANCE CALLS WILL BE MADE TO OUR MEMBERS COLLECT ***

***IF YOU MOVE, PLEASE BE SURE TO ADVISE PARENT FINDERS OF YOUR NEW ADDRESS***
 Reunion matches may be delayed by out-of-date addresses or telephone numbers.

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