This child needs:
An Adoptive Family
Outpatient Therapy (Adoption Alliance Services)
C linical Post Adoption Services (SPAN)
Adoption Chronicle™
F amily Finding Services
Family Finding Chronicle
Waiting Child TV Services
Child Centered Recruitment
Other (Enter Below)   
• For foster care placements, please call 910-308-7539 (Sandhills area) or 336-706-1449 (Triad area).

This family/adult needs:
Licensing
Training
Home Study Services
Clinical Post Adoption Services
Confidential Intermediary Services
Information about a specific child available for adoption
Family Chronicle
Birth Parent Services
Other (Enter Below)   

 

Client Name: *	*
Comments:
Referring Agency: *	*
Referring Social Worker: *	*
Agency Address: *	*
City / State / Zip: *	*
Agency Phone Number: *	*
Email Address: *	*