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Durham County Council Information Service

Home > Online Services > Online Forms > Adoption in County Durham - Registration of Interest

Adoption in County Durham - Registration of Interest

Our Privacy Statement.

Fields in bold are required.

If you would like any further information about adoption please contact us by email at scd@durham.gov.uk, or via telephone at one of these offices.
The information gathered in this form may constitute personal data as defined in the Data Protection Act 1998. Any personal data will be processed in accordance with the requirements of that Act.
Your details will be checked on our database when we receive this form.

About You

Title:

First Name:

Surname:

Address:

Postcode:

Email:

Daytime Telephone No (including STD code):

Evening Telephone No (including STD code):

Date of Birth (e.g. 01/02/1973):

Gender:

About Your Partner (if applicable)

Title:

First Name:

Surname:

Date of Birth (e.g. 01/02/1973):

Gender:

Who are the other members of your household (adults and children)?

First (if applicable)

First Name:

Surname:

Gender:

Date of Birth (e.g. 01/02/1973):

Relationship to you (e.g. parent, son, lodger):

Second (if applicable)

First Name:

Surname:

Gender:

Date of Birth (e.g. 01/02/1973):

Relationship to you (e.g. parent, son, lodger):

Third (if applicable)

First Name:

Surname:

Gender:

Date of Birth (e.g. 01/02/1973):

Relationship to you (e.g. parent, son, lodger):

Fourth (if applicable)

First Name:

Surname:

Gender:

Date of Birth (e.g. 01/02/1973):

Relationship to you (e.g. parent, son, lodger):

Fifth (if applicable)

First Name:

Surname:

Gender:

Date of Birth (e.g. 01/02/1973):

Relationship to you (e.g. parent, son, lodger):

What bedroom space can you offer a child?

Their own room A shared room

Ethnicity?

Background:

What is your religion, if any:

Do you practice your religion:

Language(s) spoken at home:

Your interest in adoption

What ages / sexes of children are you interested in adopting? (Please tick as many boxes as applicable)
Boys

Aged under 1 Aged 1-4 Aged 5-9 Aged 10-15 Aged 16 and over

Girls

Aged under 1 Aged 1-4 Aged 5-9 Aged 10-15 Aged 16 and over

Are you interested in particular types of adoption? (Please tick as many boxes as applicable)

Groups of brothers and sisters Disabled children

When are you available to be visited by an adoption officer? (Please tick as many boxes as applicable)

Mornings Afternoons Evenings

Have you had any previous contact

with any council or any other agency in connection with fostering or adoption?:

If yes, please describe:

How did you hear about adoption (e.g. newspaper advert, leaflet, poster, radio, other)

If other, where did you hear about us?

Please tick here if you would like us to send you information on adoption

Data Protection Act

I understand that personal data which I have supplied on this form will be held and processed by Durham County Council for the purpose of administering the "adoption - registration of interest" service. This service records details of individuals who are interested in adoption, and this information may be shared with people from other organisations involved in arranging or providing such services.

By completing this form I consent to Durham County Council processing sensitive personal data, such as health related information or details about my/our personal circumstances, where this is required.

Durham County Council Council is the Data Controller for the purposes of the Data Protection Act.

Do you agree to the above conditions: Yes No

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