Adoptive Parents Forms - The Cradle

Information Exchange Authorization
I/We, _________________________________________, state that I/we am/are the person/people who
completed the Client Identification; that I am ______ years of age; that I hereby authorize The Cradle to
give the following person(s): (check as applicable)
Adult adopted person (21 or older) Birthmother Birthfather Adoptive Parent(s) Birth
Sibling adopted Adult descendant of a deceased Adopted Person Spouse of a deceased Adopted
Person
Adult relative of deceased Birth Parent all eligible relatives
the following information:
(please check the information authorized for exchange)
Release my name and contact information on this document, and/or the most recent contact
information I provided The Cradle.
Contact me first before releasing my name and contact information.
My contact information is as follows:
My Name or Name of Person Through Whom I May Be Contacted
Street Address
Home Phone
___________________
Cell Phone
City, State, Zip Code
E-mail
Signature
Date
Please be sure to keep The Cradle updated about your contact information.
State of ______________________________ County of ________________________________
I, a Notary Public, in and for this county, in the state aforesaid, do hereby certify that
is personally known to me to
be the same person whose name is signed to the foregoing Information Exchange Authorization, appeared
before me in person and acknowledged that she/he signed such certificate as her/his free and voluntary act and
that the statements in such authorization are true.
Given under my hand and notarial seal this _____ day of ___________________, ________.
(Seal)
______________________________________________
Signature