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Online Adoption Voluntary Registry Form

To request a Voluntary Registry packet, complete the form below. The registration packet, including all forms and instructions, will be mailed to you.

Bold indicates required fields

Name
(First, Last)
Address
City
State
Zip Code
E-mail
Phone Number
(555) 555-5555
Date of Birth
mm/dd/yyyy
Registry Type
Must be 18 years of age, or parent of a minor registrant