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Preliminary Application

Please provide the following information and click the SUBMIT button to send to Adoption by Shepherd Care. Upon its receipt, we will confirm that we received it and we will mail to you an information packet
Wife's
First Name		   Wife's
Last Name 		  Wife's
Birth date

  //
         M/ D/ Y
Husband's
First Name		 Husband's
Last Name		 Husband's
Birth date

//
         M/ D/ Y
Address Line 1    
Address Line 2  
City State Zipcode
Phone (home)
area
code		 Phone
(work)
area
code		 Marriage
Date		  
Provide date M/D/Y
or  type not married
Email  
Children's Name Age Gender Bio/Adopted
1) Male Female Biological Adopted
2) Male Female Biological Adopted
3) Male Female Biological Adopted
Adoption Interest: Check off as many as are applicable 
infant Older Domestic International
Special Needs Caucasian Black Asian
Hispanic Mixed Race If so, what mix?
 
Domestic
      Designated		 If so, Mother's Name
Mother's State
Contact Person
Comments about your interest in characteristics of child
(2-3 sentences)
Infertility
Its nature:
Treatment
Probability of Conception:
Other Important Information: (2-3 sentences)
Please Click on the Submit Button Once
You may need to wait a few seconds for your application to be sent.

If you are not sent to the confirmation page (after you submit), please email us directly. We are changing servers this week and the application form may not be working properly
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Adoption by Shepherd Care

Corporate mailing address:  5935 Taft Street, Hollywood, FL  33021

Toll Free: 1-(800)-966-2060     Southern Florida (954) 981 - 2060     Northern Florida (407) 265-9599
EMAIL: Click on button

E-Mail Hollywood FL

E-Mail Orlando FL

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