Travel Date
From to
Proposed Date of Visiting Orphanage
Nationality
Adoptive Children
English Name
Gender
□male
□female
DOB
Chinese Name (pin yin)
Adoptive Registration Certificate No.
Date of Adoption
Province of Child(ren) Adopted From China and Orphanage City
Province Orphanage
Adoptive Parents
Name
Occupation
Passport No.
Relationship to Adoptee
Companion
Special Requirements
Contacts
Home Phone: Fax: E-mail: