IV. OTHER INFORMATION
Have you been convicted of a felony?________ or misdemeanor?________
If yes, you must include a detailed explanation, including dates. If necessary, attach a separate page. (You will also need to obtain a copy of the arrest record, court documents and disposition of the case for INS records.)
Have you ever been found guilty of a crime or pled guilty or nolo contendre to a criminal charge, in order to qualify for deferred adjudication? _________
If yes, please include a detailed explaination, including dates. If necessary, attach a separate page. (You will also need to obtain a copy of the arrest record, court documents and disposition of the case for INS records.)
Have you ever been arrested? (Even if that arrest did not lead to charges or a conviction.) _____
If yes, please include a detailed explaination, including dates. If necessary, attach a separate page. (You will also need to obtain a copy of the arrest record, court documents and disposition of the case for INS records).
Have you ever applied for adoption? ____ With whom?__________________ Approved?_____
If not approved, explain.
If approved, why are you seeking another agency?
Are you a member of a Gladney Family Association? ________
If yes, which one? ______________________
Are you acquainted with anyone who has adopted? ________
If yes, whom: ______________________ How are you acquainted?__________
***** Section for Volunteer Registration *****
* Please indicate if you are available for volunteering your time or resources
to help out during Bright Futures Camp.
I am available to be a Camp Helper:
(List days and times you are available to help): _________________________________________
I can donate the following items to help with the Bright Futures Camp (needs are for meal for officials traveling with the children, suitcases, humanitarian aid, etc.):
__________________________________________________
List a personal reference (Name and Phone #): ______________________________________________________
How did you hear about Bright Futures Camp? ______________________________________________________
I understand that this is a preliminary form and not an application to adopt. I affirm that the information provided is true and correct to the best of my knowledge. I further understand that failure to provide true and correct information may result in the rejection of my application.
Signed:__________________________________________________ Date:_____________
Signed:__________________________________________________ Date:_____________
Check here if you are only interested in sponsoring a child. ______________________