FAIR Warm Line Volunteer Information Form

If you are willing to be a Warm Line Volunteer, please complete the following form.

Important:  This is a completely voluntary questionnaire.  If you choose to participate, please do so at your own level of comfort.  Your willingness to share is appreciated and the information will be used only for the voluntary, non-profit work of FAIR, a support group which is not connected to any agency.   The information will be kept for the confidential use of the Warm Line Coordinator.  One form could be used for two parents, if both are willing to participate.  Dads, your participation is needed!
 

Name:
Address:
Home phone:
Work phone:

Times you can be contacted:  Days   Evenings  Weekends

Number of children in your family:
        U.S. adopted children
        Internationally adopted children
        Children born to you

Ages of your children:

Ages of adopted children when they joined your family:
 

Type of adoption:  Confidential  Open  Independent Agency
(which agencies)
Internationalcountries:
U.S. adoption

Children with special needs.  Check all that apply.
Learning Disabilities Emotional Physical  Physical abuse Neglect Deprivation due to poverty Sexual abuse Came as part of a sibling group Experienced orphanage life
Other

Situations you have experienced:
        Bonding/attachment adjustments
        Single parenting
        Birthparent contacts
        AAP (Adoption subsidy for a child with special needs)
        Fost/adopt
        Financial struggles related to adoption
        School problems              Special Education
        Problems with termination of birth parents rights
        Death of spouse or child
        Divorce
        Infertility
        Adoption of siblings
        Immigration problems
        Use of the services of a child or family therapist.
        Transracial adoption
        Medical problems
        Behavior problems
        Emotional problems
 
        Other information which would help direct callers to you:
 
 
 

We would be willing to be a resource family for another family doing
an adoption similar to ours.

Release of information:
I give FAIR permission to give out my name, address and phone number as
part of the Warm Line Volunteer program.   I understand that I may
withdraw my name at any time.  Neither I nor any member of my family
will hold FAIR responsible for any inappropriate contact resulting from
my participation in the Warm Line Volunteer program.