Kinsolving Investigations
P. O. Box 1917
Matthews, North Carolina 28106
Office: 704-537-5919 or 1-800-527-8698
Fax: 704-846-5123
URL: http://kinsolving.com
Email: kinsolving@aol.com

CLIENT INFORMATION SHEET
ADOPTEE or PERSON SEEKING PARENT

Name:  _____________________________________________________________________________ 
(First,   middle,    maiden,      last)

Street Address:  ______________________________  Apt/Suite: ________________________

City:  ______________ State: _________  Country:  ______  Postal Code:  ____________

Mailing Address if different than above:  __________________________________________

Home Phone: ___________________________ Work Phone: ________________________________

Pager:  __________________ Cellular: _________________ Fax: ________________________

Email Address: _____________________________________________________________________

Social Security No (optional): ____________  Drivers Lic. No: ______________________

Current Employment: ________________________________________________________________

Length of Employment:  ___________________ Position/Title: _________________________

Your Date of Birth:  _______________________ Race:  ________________________________

Adoptees Date of birth:  _______________________Race:  _____________________________

Place of birth:  City:  ____________ County ______  State ______ Country: __________

Time:  __________________ Weight:  ____________________ Length:  ___________________

Hospital __________________________________ Doctor _________________________________

Address _______________________________________ City&State _________________________

Date of Baptism if any:  ______________   Religion: ________________________________

Place of baptism: __________________________________________________________________

What Religious affiliation is the adoptive family?  ________________________________

Adoptee placed in:  

City __________________ County __________ State _______ Country: ___________________

Current Name of Placement Agency:  _________________________________________________

Address of Agency:  ________________________________________________________________

If agency has changed names since placement of child, specify such and indicate
if you have knowledge of current location of agencies records:

____________________________________________________________________________________

Name of Social Worker with whom you have dealt:  ___________________________________

When was last contact with the agency?  ____________________________________________

Court of adoption finalization:  ___________________________________________________

Non-identifying information received:  _____________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Birthname: (if known) ______________________________________________________________

Birthmothers name at time: _________________________________________________________

Birthmothers maiden name if married at time: _______________________________________

Birthmothers husbands name if married: _____________________________________________

Birthfathers name:  ________________________________________________________________

A COPY OF YOUR AMMENDED BIRTH CERTIFICATE MUST BE SENT IN.

Adoptive name:  ____________________________________________________________________

Adoptive Father:  __________________________________________________________________

Adoptive Mothers Maiden Name:_______________________________________________________

PLEASE send copies of all correspondence you have obtained from all agencies. 
Completion of this form is for a fee quote to have a search conducted on your
behalf.There is NO obligation whatsoever. Upon submission of this form you will then 
receive an exact quote from Kinsolving Investigations.

Your cooperation in completing this form is greatly appreciated. We realize 
that some people may have difficulty in answering certain questions on this
application. In the event you DO NOT know the answer to a particular question or 
would prefer not to divulge said information, that is solely your prerogative. 
Should the lack of certain information prevent our agency from disclosing a quote to 
you, our agency will contact the applicant for consultation.