ADOPTION REUNION REGISTRY

Adoption Reunion Registry - P O BOX 1398 - Bluffton, SC 29910                      

All information is strictly confidential.  Please complete and return by e-mail or snail mail.  Over 7,000 registered mainly in Kentucky area.   This is a free registry - we only ask for reimbursement of phone charges if a reunion is made and your e-mail address is no longer valid.

Registry Form for Birth Family:

Name:

Address

City/State/Zip:

Day Phone:

Night Phone:

Social Security Number: (in case you move we can find your)

E-mail address:

I am a: (example - birth mother, sibling,)

Searching for :

Birth Information of adoptee:

Name given to child by birth mother:

Date of birth of adoptee:

Single/Twins:

Male/Female:

Race:

Weight/time of birth:

Any birthmarks:

Place of birth: City/State

Hospital/Doctor:

Any medical problems at birth of child:

Maiden Name of birth mother:

Name used by birth mother at time of birth:

Date of birth of birth mother:

City/state of birth of birth mother:

Place of residence of birth mother at time:

Name of Maternity Home

Religion:

Occupation:

Education:

B/mother siblings - brothers/sisters - names/ages

Hair/eye color of b/mother

Height/Weight of b/mother

Marital Status at time of birth of child:

Other siblings born to b/mother prior to this child:

Name of adoption agency used:

Name of Attorney used:

Birth Father Info:

Name:

Date of birth:

City/State of birth:

Last known residence at time of birth of child:

Occupation:

Religion:

b/father siblings - names and ages

Additional Information:

What you know about the adoptee: name/adoptive parents Info etc.