Thanks for showing interest in our special needs children. To protect the privacy of these lovely children we require some information from you. This form will help us verify your interest.

After you fill in the fields below please submit this form. When approved, we will then email you and verify your username and password to access the information on the children available for adoption.

Note: The information you provide will only be used for contacting you in regards to these special children and will be kept confidential.

  Name of parent #1:
  Name of parent #2:
  City :

State: Zip:

  E-mail:
  Day Phone:
  Evening Phone:
  Preferred User name?
 (between 5-25 characters)
  Choose Password:
 (please use a minimum of 5 characters)
  Verify Password:
 (please re-type your password)
  Do you have a dossier logged into CCAA? 
 
  Do you have an active adoption application at an adoption agency?
 
  We meet the CCAA adoptive parents qualifications:
  
  We pledge to keep our username, password and the children's information confidential.
 
          Are there any specific questions we can answer at this time?

  Thank you for your interest!

Upon approval, you will receive an email with your login information usually within 24 hours, Mon- Fri.