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
BIRTHPARENT-BIRTHSIBLING-OTHER PERSON SEEKING CHILD
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: _____________________________
Birthmothers FULL name at time of childs birth: ___________________________________
Birthmothers FULL name at time of childs placement: ________________________________
Alias used by birthmother if any: _________________________________________________
Birthmothers FULL maiden name if married at time: __________________________________
Birthmothers husbands FULL name if married at time: ________________________________
Birthmothers Date of Birth: ________________ Birthmothers Race: __________________
Birthmothers birthplace: ____________________ Birthmothers Religion: ______________
Full Name of Birthmothers father: __________________________________________________
Full Name of Birthmothers mother: __________________________________________________
Birthfathers name: ________________________________________________________________
Were birthparents married to each other at the time? ______________________________
When did birthmother relinquish child?(at birth, x weeks,x months, x years):
____________________________________________________________________________________
Did birthmother sign papers at agency, court, attorneys office, when, where, etc:
____________________________________________________________________________________
Childs full name at birth: ________________________________________________________
Alias used given to child if any (by birthparent or agency: ________________________
Child's date of birth: ___________ Time: __________Weight: _______ Length: _______
Sex: ____________ Race: ________________ Religion specified: ____________________
Hospital: ________________________________ Doctor: _______________________________
Address of hospital_________________________________________________________________
City: ________________________ County: ______________________ State:______________
Was child baptized prior to relinquishment or during foster care? Yes (__) No (__)
If yes, when and where: __________________________________________________________
Permanent residence of birthmother at time of relinquishment: _____________________
____________________________________________________________________________________
Residence at time of birth if different then above: _______________________________
____________________________________________________________________________________
Name of Maternity Home: ____________________________________________________________
Address: __________________________________________________________________________
Name of placement agency: __________________________________________________________
Address: ___________________________________________________________________________
Name of Social Worker: Then: ____________________ Now: __________________________
Last contact with agency: _________________________________________________________
Non-identifying information known about the adoptive family of child:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
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.
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