Caseworker Name
Phone number
Cell phone
Email address
Agency name
Child’s name
First
AES Number
CAP Number
Adopt US Number
Best time(s) and day(s) for scheduling portrait
If child has siblings, please list all names and ages
Date of Birth
mm/dd/year
Child’s favorite past time activities (please be
specific)
What does the child want to do when he/she grows up? How does he/she
intend to accomplish this?
What does the child excel in? (school subjects, math,
science, sports, gardening, etc.)
Child’s personal characteristics (sweet, shy, intelligent,
social, etc.)
Other things that make this child special
What type of family would the child like to be a part of?
Does the child have special needs? If so, please list.
What role, if any, do the current foster parents want
to play in this child’s future?
Child needs to be included/listed: (Please check all that
apply)
Other
