Contact Register « Adoption Jigsaw

Contact Adoption Jigsaw

2A Curtin Avenue, Cottesloe 6011

Post Box 819
Cottesloe 6911

Phone: 08 9384 0222
Fax: 08 9384 7192
Email address:
jigsaw@jigsaw.org.au
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Postcard Project

"Adoption Secrets"
What is the Project?
View Postcards.
Adoption Books

Adoption Jigsaw stock a range of quality books for your reading. Find out more about how to buy these books.
Join Adoption Jigsaw

Adoption Jigsaw is only partially government funded, and as a result, we're always after new members. Your Contribution can help worthwhile projects.
Reconnections

Adoption Jigsaw has conducted over 4000 reconnections. We're hoping for many more...

Contact Register

A Contact Register is a means of letting another party to the adoption know that you are interested in some information and/or contact.

All information is held in absolute confidence and identifying information will not be disclosed to a third party without your consent.
Documentation is not required until a potential match is established and you want Jigsaw to assist you.
Registration is free and no-one will be refused. We ask those able, to make a donation to support our work.

If there is a ‘match’ on our register we will try and inform both parties. We will need one of the parties to join Jigsaw and provide documentation of the relationship ie birth certificates, court records etc. Please note that Adoption records/documents need to be obtained from the relevant Government authority and can take many months. You may want to apply for your records even if you do not plan on searching at this time.

WA Adoptions
You can apply below to receive a WA Dept for Child Protection Application Form. Details at end of form.

When DCP receive your completed form, they will:

check whether there is a veto
check whether there is a contact register match on their register
compile non-identifying information – ie information known about your birth parents/child at the time of adoption
arrange for court records to be sent to you
send you a letter of authority to enable you to apply for the relevant birth certificate.

Adoptions in other states: You are welcome to register, we do not keep their forms, you can obtain more information in the section “How do I begin”.

Foster Care/Other Separation: You can place your details on the Register. If applicable you should apply for your documents from the relevant agency/government department.

Your Contact Details

How are you involved in adoption/family separation?	*Required
If other, please specify
Title
If other, please specify
Surname	*Required
First Name	*Required
Second Name
Address	*Required
Suburb	*Required
State	*Required
Country	*Required
If other, please specify
Post Code
Home Phone ((xx) xxxx xxxx)
Work Phone ((xx) xxxx xxxx)
Mobile (xxxx xxx xxx)
Email	*Required
Can we leave a message identifying Jigsaw at these phone numbers?	*Required
Comments

Adoption Details (only fill in what is known)

Adoptive name of child:
Same as details above?
If not the same as above please enter the details below:
Surname
First Name
Second Name
Adoptive mother:
Surname
First Name
Second Name
Adoptive father:
Surname
First Name
Second Name
Where did the adoption take place?	*Required
If other, please specify
Comments
Do you have any documents regarding the adoption?	*Required
If Yes, please specify
Who do you want contact with?	*Required

Contact Register

Please leave any fields blank if information is unknown.

Birth Details (name given at birth - not adoptive or other name):

Original Name of Adoptee - Surname
First Name
Second Name
Gender
Birthday (dd/mm/yyyy)
Place of Birth - Hospital
Place of Birth - Town
Place of Birth - State
Place of Birth - Country
If Other, please specify

Birthmother

Name at time of birth - Surname
First Name
Second Name
Date of Birth (dd/mm/yyyy)
Age at time of birth
Address at time of birth
Occupation at time of birth
Marital status at time of birth
Nationality
Current name
Any other significant information

Birthfather

Name at time of birth - Surname
First Name
Second Name
Date of Birth (dd/mm/yyyy)
Age at time of birth
Address at time of birth
Occupation at time of birth
Marital status at time of birth
Nationality
Does he know of pregnancy/birth?
Any other significant information

The following questions are optional, your answers will enable us to understand your situation and better prepare for contact.

Adoptees

Have you had contact with any member of your birth family?
If yes, with whom
Do your adoptive parents know of your interest?

Birthmother

If you have a husband/partner, does he know?
Have you had other children?
If yes, do they know?
If the birthfather registers can we tell him of your registration?

Birthfather

If you have a wife/partner, does she know?
Have you had other children?
If yes, do they know?
If the birthmother registers can we tell him of your registration?

Child of birth parent

Does your mother/father know you are registering?
If yes, do you have their support?
Does your mother/father want contact with the adoptee?

Others

How are you involved?
Can we tell anyone of your interest?
Is there anything else we need to know?

What action do you want taken?

*Required

Registration is free and no-one will be refused, however we rely on donations to provide services. Donations are tax deductible.

Do you want to make a donation?	*Required
Comments

Please enter the this security code into the field below: jigsaw

Security Code (from above)

Click here for PayPal donation.
Click here for other method of donation.

Thank you, we hope one day to be able to assist you.

Contact Adoption Jigsaw

Make a Gold Coin Donation

Postcard Project

"Adoption Secrets"

Adoption Books

Join Adoption Jigsaw

Reconnections

Contact Register

Your Contact Details

Adoption Details (only fill in what is known)

Contact Register

Birth Details (name given at birth - not adoptive or other name):

Birthmother

Birthfather

The following questions are optional, your answers will enable us to understand your situation and better prepare for contact.

Adoptees

Birthmother

Birthfather

Child of birth parent

Others