Bankruptcy Lawyer Canton GA | Family Law Attorney, Divorce & Personal Injury Lawyer Alpharetta, Marietta & Woodstock GA - HE&K

Adoption Intake Form

Your Contact Information:

Last Name:
First Name:
Date of Birth:
(Maiden Name):
Street Address:
Apt #:
City:
County:
State:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Email Address:

Emergency Contact Information:

Emergency Contact:
Phone No:

Other Parent's Contact Information:

Last Name:
First Name:
Street Address:
Apt #:
City:
County:
State:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Email Address:

Step Parent's Contact Information:

Last Name:
First Name:
Street Address:
Apt #:
City:
County:
State:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Email Address:

Adoption Information:

Date of Marriage:
Date of Divorce:
Grounds For Adoption:
Failure to establish a meaningful relationship with the child
Failure to pay child support for at least a year
Failure to exercise visitation for at least a year
Commission of a crime against the child
Other (explain)

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185 Stockwood Drive Suite 100, Woodstock, GA 30188 1326 Concord Road, Smyrna, GA 30080
142 South Park Drive Suite D, Marietta, GA 30060 11545 Park Woods Circle Suite C, Alpharetta, GA 30005

Our lawyers represent clients in Woodstock, Smyrna, and Marietta, Georgia as well as the cities of Atlanta, Canton, Acworth, Kennesaw, Roswell, East Cobb, West Cobb, Holly Springs, Austell, Powder Springs, Dallas, Ball Ground, Waleska, Hiram, Cartersville, Jasper, Rome, and throughout Cherokee, Cobb, Fulton, Bartow, and Paulding counties.

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