Adoption Disclosure Request

If you were adopted or related to someone who was adopted through Linck Child, Youth & Family Supports and you would like to request non-identifying information, please fill out the Adoption Disclosure form.

If you are a descendant of an adult adoptee who is deceased, a copy of the death certificate will be required. You must attach one copy of valid government issued photo identification along with your request.

For copies of birth registration and adoption orders for all adoptees, you must apply to the Ministry of Community and Social Services at Service Ontario or toll free at 1-800-461-2156.

"*" indicates required fields

Relationship:

I am the:*

Adoptee

Adoptive Parent

Birth Relative

Personal Details

Current Name*

First Name Last Name

Alternate Name (e.g. maiden name, preferred name, alias)

Date of Birth*

Personal Details

Alternate Name (e.g. maiden name, preferred name, alias)

Date of Birth*

Contact Information

Address*

Number and Street Name Unit Number City Select Province Postal Code Country

Phone Number*

Preferred Phone Number*

Home

Work

Cell

Email Address

Adoptee Information

Adoptive Name*

First Name Last Name

Birth Name

First Name Last Name

Date of Birth*

Place of Birth (hospital, township, county, city, etc)

Adoptive Parent Information

Adoptive Parent #1 Name*

First Name Last Name

Adoptive Parent #1 Date of Birth*

Adoptive Parent #2 Name

First Name Last Name

Adoptive Parent #2 Date of Birth

Address at time of adoption

Number and Street Name Unit Number City Select Province Postal Code Country

Birth Parent Information

Birth Parent #1 Name

First Name Last Name

Birth Parent #1 Date of Birth

Birth Parent #2 Name

First Name Last Name

Birth Parent #2 Date of Birth

Address at time of child’s birth

Number and Street Name Unit Number City Select Province Postal Code Country

Adoptive Parent Information

Adoptive Parent #1 Name*

First Name Last Name

Adoptive Parent #1 Date of Birth*

Adoptive Parent #2 Name

First Name Last Name

Adoptive Parent #2 Date of Birth

Child’s Information

Adoptive Name*

First Name Last Name

Birth Name

First Name Last Name

Date of Birth*

Place of Birth (hospital, township, county, city, etc)

Birth Parent Information

Birth Parent #1 Name

First Name Last Name

Birth Parent #1 Date of Birth

Birth Parent #2 Name

First Name Last Name

Birth Parent #2 Date of Birth

Birth Parent Information

Birth Parent #1 Name*

First Name Last Name

Birth Parent #1 Date of Birth*

Birth Parent #2 Name

First Name Last Name

Birth Parent #2 Date of Birth

Address at time of child’s birth

Number and Street Name Unit Number City Select Province Postal Code Country

Child’s Information

Birth Name*

First Name Last Name

Adoptive Name (if known)

First Name Last Name

Date of Birth*

Request Details

Request Description

Brief description of information being requested:

Additional Information

Please attach information to support your request.

Additional Information File 1

No file chosenMax. file size: 300 MB.

Additional Information File 2

No file chosenMax. file size: 300 MB.

Additional Information File 3

No file chosenMax. file size: 300 MB.

Additional Information File 4

No file chosenMax. file size: 300 MB.

Confirmation & Consent*

I certify the above information to be accurate.

Confirmation & Consent Checkbox 2*

I consent to a search of the provincial Child Protection Information Network (CPIN) and of Linck Child, Youth & Family Support’s legacy system in order for the agency to fulfil my request.

Confirmation & Consent Checkbox 3*

I agree that my submitted data is being collected and stored by Linck Child, Youth & Family Supports. Please Note: Linck Child, Youth & Family Supports must abide by the privacy rules set out in the Child, Youth and Family Services Act, 2017.