Informed Consent Please enable JavaScript in your browser to complete this form. - Step 1 of 2The following procedure is used to to obtain or organize your home study report. This is used so that the Courts or other placing agencies may make a decision about the suitability of your family for an adoption situation. The home study report is designed to give you an opportunity to describe your family as well as to assess whether now is the appropriate time and circumstance for an adoption. Your cooperation is essential and it is important that you are honest and open with information regarding your home, family, marriage, health, criminal history background, and finances. Carefully read the entire document and write your initials in the space to the left of each of the items to document that you have read, understood, and agree to the conditions of the home study process. Signing this document indicates that you understand the adoption process and agree to participate as specified by the conditions set forth in these documents. Please complete this form for each applicant.NextI understand that this is an application only and acceptance is not guaranteed. Additional documentation will be required, this will include, but not limited to: medical statements, background checks, three letters of reference, financial statements, and/or any additional information requested by AGTA or our affiliates. *I understand and agreeI do not agreeCaseworkers must make objective recommendations regarding the suitability of your family for a placement. *I understand and agreeI do not agreeIf there are any significant changes in life situations, including but not limited to: health changes marital status, residence, family composition, employment, or criminal charges; you must promptly notify AGTA but no later than 7 calendar days. *I understand and agreeI do not agree I give permission to AGTA to contact any personal references I provide, including adult children, or other agencies for information or documentation *I understand and agreeI do not agree I give permission for AGTA to access information in the Statewide Automated Child Welfare Information System (SACWIS). *I understand and agreeI do not agreeI cannot sue AGTA or our associated social workers if a recommendation against adoption placement is made. *I understand and agreeI do not agreeThe caseworker completing your home study will remain impartial throughout the application process. If there is any prior personal relationship with any of the participants, then the home study will be stopped and another caseworker will continue the process with you. *I understand and agreeI do not agreeThe caseworker has a duty to report all information that they discover during the course of this home study, whether the applicant wants the information disclosed or not. This information is crucial for the caseworker in order to determine the best interest of the potential adoptive child(ren). *I understand and agreeI do not agreeThe applicants have complete confidentiality. All information provided will be held in the strictest of confidence and will not be shared with any person other than the applicants. Information will not be shared with the applicants attorney, or persons named as references- without consent. Confidentiality will be broken without consent in the event of reporting harm to self or others, or the abuse of a child. *I understand and agreeI do not agreeAll allegations of abuse, neglect, or substance use will be taken seriously. *I understand and agreeI do not agreeIt is the applicant's responsibility to provide AGTA all required documentation that pertains to the home study. *I understand and agreeI do not agreeWe understand that every adoption has a legal risk. To ensure that a child is legally free for adoption, in the case of an infant adoption, the Adoption Placement and Finalization Coordinator works with birth parents and with legal counsel to create an adoption plan and to follow protocol necessary for termination of parental rights; To ensure that a child is legally free for adoption, in the case of adoption from the US Foster Care System, the Adoption Placement and Finalization Coordinator works with the child’s referring agency or the state-specific foster care program manager to only place in adoptive homes children whose biological parents rights have been terminated or will be terminated once an adoptive family has been identified; In the case of intercountry adoption, the Adoption Placement and Finalization Coordinator works with the intercountry agency to obtain verification from the child’s country of origin that all USCIS criteria are met and that the child will be approved to enter the United States as a legal orphan *I understand and agreeI do not agreeThe caseworker is free to contact any parties who may have beneficial information. These are referred to as collateral contacts. Contacting the collateral contacts will be at the discretion of the caseworker. If they are not willing to participate, the interview will not be completed or included in the report, but applicants are required to provide 3 letters of reference. *I understand and agreeI do not agreeAfter the applicants provide all required material and other documentation, a final report will be written. This process could take up to 30 days and a copy will be provided to you. Please keep this copy as it will be required when it is time to go to court to finalize your adoption. *I understand and agreeI do not agreeWe understand and are agreeing to AGTAs outlined costs and fees. *I understand and agreeI do not agreeWe understand to notify AGTA of any changes in the household within one day, including new members moving in or out. Any new adult member must complete a criminal background check. *I understand and agreeI do not agreeSignature *Clear SignatureName *FirstLastSubmit