Official Registration Form
Mail to: Karen Sterner
Please type or print legibly
This is a
____ New Registration _____Updated
Registration
Name
________________________________________________ Birth Date
________________________________
Address
_______________________________________________________________________________________
Telephone: (home) (work)
(email)____________________________
Social Security Number
____________________________ Referred by ______________________________
________
Triad Position: (
Adoptee Birth Date
______________________________________________
Sex (please circle) Male or
Female
Hospital (Birth
Place)______________________________________ Attending Physician
_______________________
City of
Name given at Birth
______________________________________________________________________________
Name given at Adoption
__________________________________________________________________________
Birth Certificate #
_________________________________________ File #
_________________________________
Adoptive Parent's Names
_________________________________________________________________________
Birthmother's Maiden Name
____________________________________________Birth date ___________________
Birthfather's Name
___________________________________________________Birth
date____________________
Court of Jurisdiction
____________________________________ City __________________________ State
______
Attorney of Record
_______________________________________ Date of final decree
______________________
This adoption was (check one) _____Private
_____ By an Agency
Name of
Placement Agency or
Intermediary______________________________________________________
I, the undersigned hereby give my
permission to PARR to release this information to the person(s) for whom this
search is conducted. I understand this
permission is necessary for verification of identity and my relationship to the
missing person.
Signature
_____________________________________________________ Date______________________________
Please indicate how you would like us
to contact you in the event that we have a match:
_____Via Mail _____ Via telephone
My designated agent is: Name:
____________________________________________
Address: __________________________________________
City, State,
Zip:
_____________________________________
Telephone: ________________________________________
Please check one:
____ I would like my mailing address shared
with other PA organizations for mailings of special events or promotions.
____ Please
do NOT share my information with any
other organization for mailing purposes or any other reason.
NOTE:
Due to recent Federal Regulations, please be advised any personal information
pertaining to you or your adoption search will not be shared with any
organization without your prior approval.
c/o Karen
Sterner,
INSTRUCTIONS
- Please read this carefully before filling out the registration form.
1. Fill out
this form will all known facts.
2. Do not
abbreviate!
3. Fill out a
separate registration form for each child.
4. Do not send
original documents with this form.
Try not to feel overwhelmed if all information is not
known. Updated forms can be submitted at
a later date.
WHAT
IS A
PARR is a
system for matching persons who desire contact with their next of kin by birth.
WHO
CAN REGISTER?
1. Any child/adoptee who is 18 years of
age or older;
2. Birth parents;
3. Adoptive parents of adoptees who are
under the age of 18;
4. Birth Grandparents and others searching
in the state of PA
HOW
DOES IT WORK?
When a registration
is received the information is computerized.
If the data matches and if it is determined a relationship exists, both
parties will be notified immediately.
HOW
MUCH DOES IT COST?
There is no
fee for this service at this time.
However, donations are welcome.
Please make all donations payable to KAREN D. STERNER
This is a
volunteer maintained registry and we have to keep our expenses to a minimum.
PARR
POLICY
This registry
is for those who are searching in the State of
This registry
does not perform a search or provide search advice.
Voluntary
registration by adults desiring contact or reunion with their next of
kin-by-birth, is deemed legal consent for contact between parties to a match.
Registrants
are held responsible for all information provided on their form and any
documentation attached hereto.
PARR will not
notify you unless a "match" is made.
PARR
will not accept an unsigned registration form.
Registration
in the Pennsylvania Adoption Reunion Registry does not replace the
International Soundex Reunion Registry (I.S.R.R.)
HOW WILL I KNOW IF THERE IS A MATCH?
You or your
designated agent will be contacted by phone or mail. It is important that you notify PARR of any
change of name, address or phone number. Remember that someone could register looking
for you at any time in the future.
NOTES:
__________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
.