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Pre-Inscription Form
1st Applicant
First and last name :
Age :
Occupation :
Employer :
2nd Applicant
Informations on the couple
Address:
City :
Province :
Country :
Postal code:
Telephone number:
Email :
Married? Yes No
Have been married for? 0 - 1 year 1 year - 2 years 2 years - 3 years 3 years - 5 years 5 years - 7 years 7 years - 10 years 10 years - 25 years 25 years and more
Have any children? Yes No
How many? 1 2 3 4 5 6 7 8 9 10 and more
Age?
Adoption preferences
Sex of desired child? Boy Girl Doesn't matter
Age of desired child? 0 - 35 months 0 - 71 months 36 months - 71 months 60 months or more Doesn't matter
Comments
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