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Names of adoptive parents:
Address:
Name of the child:
Date of birth/age:
Date of legal adoption/guardianship:
Petition number:
- General health of the child:
- Details of
immunizations:
- Feeding and sleep
patterns:
- Motor development:
- Speech and language
development:
- Adjustment to family
- adoptive parents, siblings, other adults,
peers:
- General appraisal of
the adoptive situation:
Name:
Signature:
Designation:
Date:
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