Getting Started with Your Adoption...
Congratulations! You are about to take the first step toward determining the type of adoption program that is right for your family! You may already have a particular program in mind. This INQUIRY FORM will help us answer your questions.
We will contact you within 2 business days. We wish you God’s richest blessings as you seek to build your family in His time.
Romans 8:15,
“The Spirit you received brought about your
adoption
to sonship. And by him we cry,
“Abba,
Father.”
Nightlight Christian Adoption's mission is to glorify God by helping birth parents facing crisis pregnancy, and ensuring
children and embryos have permanent, loving homes.
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Prospective Adoptive Father
Father First Name
Father Last Name
Father Cell Phone
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Father's Preferred Email
Prospective Adoptive Mother
Mother First Name
**
Mother Last Name
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Belarus
Belgium
Belize
Benin
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Botswana
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Brazil
British Indian Ocean Territory
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Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of the
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
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Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
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Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
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Hungary
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India
Indonesia
Iran
Iraq
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Israel
Italy
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Kuwait
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Latvia
Lebanon
Lesotho
Liberia
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Lithuania
Luxembourg
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Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
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Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint-Pierre and Miquelon
Samoa
San Marino
Sao Tomé and Príncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Contact
Home Phone
Enter International
Home Email
*
Current Marriage
If married, Date of Marriage
Pre-identified Child or Relative Adoption
Are you inquiring about adopting a pre-identified child or relative?
Yes
No
If yes, what is this child's country of residence?
**
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of the
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint-Pierre and Miquelon
Samoa
San Marino
Sao Tomé and Príncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Father General Information
Current Annual Salary
Citizenship
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of the
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint-Pierre and Miquelon
Samoa
San Marino
Sao Tomé and Príncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Date of Birth
Have you ever been arrested?
Yes
No
Have you ever been treated for drug or alcohol abuse?
Yes
No
Have you been diagnosed with or received treatment for a mental health condition?
Yes
No
Mother General Information
Current Annual Salary
Citizenship
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of the
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint-Pierre and Miquelon
Samoa
San Marino
Sao Tomé and Príncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Date of Birth
Have you ever been arrested?
Yes
No
Have you ever been treated for drug or alcohol abuse?
Yes
No
Have you been diagnosed with or received treatment for a mental health condition?
Yes
No
Are you currently, or have you ever, pursued in vitro fertilization (IVF)?
Yes
No
If yes, do you currently have one or more embryos in frozen storage?
Yes
No
Father Previous Home Studies
Have you ever begun a home study that was never completed?
Yes
No
If yes, please explain
Have you ever been denied a home study?
Yes
No
If yes, please explain
Mother Previous Home Study
Have you ever begun a home study that was never completed?
Yes
No
If yes, please explain
Have you ever been denied a home study?
Yes
No
If yes, please explain
Please describe the child or children you are seeking to adopt: age, gender, ethnic preference, countries in order of preference and why.
Previous Marriages
Select the number of previous marriages for both Applicant(s)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Father or Mother - Previous Marriages
Father
Mother
Other Person in Home
Other Person In Home #2
Date of Marriage
Divorce Date
Reason for Divorce
Adoptive Child Preferences
Which program are you interested in?
Snowflakes Embryo Adoption
Domestic infant
Foster Adoption (or Adopt from Foster Care, Anchored in Hope)
Foster Care
Home Study Only
International
Country of Interest
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo, Republic of the
Congo, The Democratic Republic Of The
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint-Pierre and Miquelon
Samoa
San Marino
Sao Tomé and Príncipe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City State
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Would you be willing to adopt a child with mild to moderate special needs?
Yes
No
Undecided
Unknown
Child Pref Min Age
Newborn
3 Months
6 Months
1 Year
1.5 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
Child Pref Max Age
Newborn
3 Months
6 Months
1 Year
1.5 Years
2 Years
3 Years
4 Years
5 Years
6 Years
7 Years
8 Years
9 Years
10 Years
11 Years
12 Years
13 Years
14 Years
15 Years
16 Years
Desired Race
Middle Eastern
African
African American
Asian
Bi-Racial
Caucasian
Hispanic
Native American
East Indian
Pacific Islander
Number of Children Desired
Are you open to adopting a sibling group?
Yes
No
Undecided
Unknown
Any other comments regarding child(ren) desired?
Referral Source Information
How did you hear about Nightlight Christian Adoptions?
*
A Fearless Life Foundation
Adoption Bridge
adoption.state.gov
Adoptive Family (Please specify below)
Agency (Please specify below)
Attorney (Please specify below)
Church (Please specify below)
Client Referral (Please specify below)
Clinic (Please specify below)
Conference (Please specify below)
Country's Central Authority
Creating a Family
Embryo Adoption Awareness Center
Family Member
FC Recruitment or Bridge Organization
Focus on the Family
Friend (Please specify below)
Home Study Provider (Please specify below)
Host Family (Please specify below)
IAAME
Internet Search (Please enter search terms used below)
Magazine (Please specify below)
Medical Professional (doctor, nurse, midwife, etc.)
National Down Syndrome Adoption Network
National Embryo Donation Center
News Site
Online Group (Please specify below)
Other (Please specify below)
Pregnancy Resource Center (Please specify below)
Radio Spot
Returning Client
Social Media (Please specify below)
Storage Facility
Support Group
Television
Waiting Children Constant Contact
YouTube
Please provide the name of the specific persons or places
Children Information
Do you (or your spouse) have any children?
Number of children
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
First Name
*
Last Name
*
Birth Date
Gender
Male
Female
Adopted, Biological or Foster
*
Adopted
Adopted Child
Bio-Daughter
Bio-Father
Biological
Bio-Parent 1
Bio-Son
Brother
Cousin
Foster
Where child resides (with us, other parent, etc)
Statement of Understanding
I/We affirm that by submitting this Inquiry Form that the information provided is true and accurate. I/We further understand that failure to provide accurate or to withhold information may result in the termination of services at anytime.
Submit