Waiting Child Non-Disclosure Agreement

To protect the identity of orphans, we require a signed non-disclosure form before we can release any detailed information or photos of waiting children waiting for homes. You may simply complete the agreement on-screen or at the bottom of this screen you will find the agreement in .pdf format which can be mailed or faxed or scanned and emailed.

Non-Disclosure Agreement

Kids To Adopt is a Hague Accredited, licensed child placing agency in the State of Washington.
Our standards of privacy and confidentiality in regards to a waiting child’s information exceed those put forth by the Hague. We do not disclose information at the time of inquiry that could be used to identify the waiting child such as full birth name, place of birth, exact birth date and current location. All waiting children are referred to by a name randomly assigned to them by us.

Information relayed to prospective adoption parents in regards to waiting children is confidential and/or legally privileged information. Information on waiting children provided by Kids To Adopt is not to be forwarded to any other person and copying or distributing said information is strictly prohibited.

I/we respectfully acknowledge this confidentiality and will not post online, forward by email or share with any other individual(s) any documents about children including, but not limited to, pictures, descriptions, medical reports, testing, evaluations and video, provided by Kids To Adopt without the express permission of Kids To Adopt.

Signature of this document in person or electronically, signifies acceptance of this agreement and acknowledgment that you will abide by the terms set forth above. This agreement shall be valid for one year from the date of signature. Failure to comply with this agreement may result in legal action.

Prospective Parent 1 First & Last Name *

Prospective Parent 2 First & Last Name *

If you are a single parent, type N/A here.

Address *

City *

State *

Zip *

Country

Please enter your country ONLY if NOT United States

Reason for completing this form (check all that apply) *

I have spoken with someone in your office

I would like info on a specific child

I would like info on a child, but not one in particular

I'm not sure

Contact Information

We require that you give us your contact information before we can release information on children. This is just to verify your identity. This information will not be added to any list or shared with parties outside of Kids To Adopt unless expressly requested below.

Phone *

Email *

Additional Information *

Please enter any additional information here.

Electronic Signature - Prospective Parent 1 *

Please type your full name in the space above to indicate your agreement.

Electronic Signature - Prospective Parent 2 *

Please type your full name in the space above to indicate your agreement. If you are single, type "N/A" in the field above.

Check all that apply: *

I would like to follow you on Facebook!

I would like to follow you on Twitter!

I would like to receive the KTA Newsletter!

None of the above

Untitled

After downloading the form, you may sign it electronically (type in your name) and email it back to us at: katie@kidstoadopt.org or you may fax a hard copy to 360.695.6882.

.PDF format: 2011 KTA Non- Disclosure Form