Massachusetts Adoption Resource Exchange Home Page

FAMILY REGISTRATION FORM
(For Homestudied Massachusetts Families Only)

We are pleased that you are interested in registering your homestudy with MARE. Massachusetts families with completed and approved homestudies can register with MARE. Once registered, your criteria will be compared with the needs of the children registered with MARE to identify potential matches. When matches are identified, MARE will forward your homestudy to the child’s social worker. Follow-up on such referrals is at the discretion of the child’s social worker. There is no fee for this service. Please note that a completed and approved homestudy is required for registration. If you are not yet homestudied and would like to request information, please complete the Information Request Form.

Click here to download the Family Registration Form for you to print, complete and fax to MARE at
617-542-1006.

HOMESTUDY & FAMILY WORKER INFORMATION

Date Homestudy Completed/Last Updated: (mm/dd/yy)

Family Worker:
Agency:
Address:	(Number, Street)
	(Apt., Suite, Floor)
	(City) (State) (Zip)
Phone #:
Fax #:
Email:

FAMILY INFORMATION

Contact 1:	First Name:
	Last Name:
	Date of Birth:	(mm/dd/yy)
	Gender:	Male Female
	Ethnicity: (for demographic purposes only; please check all that apply)	African American Asian Caucasian Hispanic/Latino Native American If other, please specify:
	Occupation:
	Work Phone #:
	Email:

If Applicable, Contact 2:	First Name:
	Last Name:
	Date of Birth:	(mm/dd/yy)
	Gender:	Male Female
	Ethnicity: (for demographic purposes only; please check all that apply)	African American Asian Caucasian Hispanic/Latino Native American If other, please specify:
	Occupation:
	Work Phone #:
	Email:



Mailing Address:	(Number, Street)
	(Apt., Suite, Floor)
	(City) (State) (Zip)
Home Phone #:

HOUSEHOLD COMPOSITION

Children currently living at home: (if no child is in the home, type NONE)

Total Males: Ages: Number of Biological: Number of Adopted:

Total Females: Ages: Number of Biological: Number of Adopted:

Other adults currently living in home:

Primary Language spoken at home:

Other Language(s):

FAMILY'S CHILD PREFERENCES

Sex: Male Female Either Legal Status: Free Legal Risk Either

Age Range: Number of children preferred:


Will your family be open to child contact:
With Siblings?:	Yes No
With Birth parents?:	Yes No

Ethnicity: (Please check all that apply)	Any racial background African American Asian Caucasian Hispanic/Latino Native American Mixed background: (please specify)
Areas of Special Needs: (Please choose the highest level of need your family will consider.)
Physical:
Emotional:
Intellectual:

How did you hear about MARE and come to visit this website?

*Would you like to be added to the MARE News* (MARE quarterly e-newsletter) mailing list:** Yes No
Would you like to be added to our Adoption Party e-mailing list: Yes No (held in MA only)
*Would you like information about our Friend of the Family* Mentoring Program?:** Yes No
Would you like to receive information on how to create a Family Profile?: Yes No
To complete this registration you are: Mailing Faxing Emailing us your homestudy
Additional Questions or Comments: NON DISCRIMINATION POLICY: MARE welcomes and serves all constituents without regard to an individual’s actual or perceived race, creed, color, ethnicity, national origin, religion, age, sex, sexual orientation, gender identity, gender expression, physical or mental ability, veteran status, domestic partnership or marital status. This policy also applies to employment practice, internal promotions, training, opportunities for advancement, terminations, outside vendors, service clients, use of contractors and consultants, and dealings with the general public.