Birth Father'S Adoption Plan

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Birth Father’s Adoption Plan
Print Name:_____________________________________________________________
PREGNANCY AND ADOPTION DECISION
When and how did you first find out that your child’s mother was pregnant?
_______________________________________________________________________
_______________________________________________________________________
D
oes anyone in your family know about the pregnancy?
Yes
No
If yes, what are the names and relationship to you of those who know of the
pregnancy? _________________________________________________________
___________________________________________________________________
D
oes anyone in your family know about the adoption plan?
Yes
No
If yes, what are the names and relationship to you of those who know of the
adoption plan? _______________________________________________________
___________________________________________________________________
Of those family members who know of your adoption plan, do any oppose the plan of
a
doption? Yes
No
If yes, what are the names and relationship to you of those who oppose the
adoption plan? _______________________________________________________
___________________________________________________________________
Do you currently live with the child’s mother? Yes
No
On a scale of 1 to 10 with 1 representing a mild interest/curiosity about the adoption option
and 10 representing an absolute resolve to place the baby for adoption, where would you
consider yourself to be at this time? ________
1

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