Children House International :: Information Request Form

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Information Request Form

Name(s):
Email Address:
Street Address:
City, State, Zip:
Home Phone:
Work Phone:
Husband Age:		Wife Age:
Years Married:		Children Now:

Country of Citizenship:
Age of Child interested in:
Sex of Child interested in:	Boy Girl Either
Number of Children interested in:

Currently accepting applications in:
China	Ethiopia	Ghana	Haiti
Hungary	India	Kazakhstan	Poland
Ukraine	USA Domestic

Would you like us to call you? Yes No

Comments:

Children’s House International, P.O.Box 1829, Ferndale, WA 98248
(Offices also located in licensed states of Utah and Florida)
Phone: (360) 380-5370 Fax: (360) 383-0640