Adoption Consultants, Inc.
Birth Parent Line:
1-800-605-4588
(1-800-605-4LUV)
Adoptive Parents:
(818) 766-2222
Adoption Consultants, Inc.
E-mail: info@adoptionconsultantsinc.com
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Adoption Consultants, Inc.
ADOPTION BOOK OF WAITING FAMILIES
FORM AND AGREEMENT
In order to have your profile included in Adoption Consultants, Inc.'s Adoption Book of Waiting Families, please remit a non-refundable flat processing charge in the sum of either $ 80 for
6 months inclusion or $ 120 for 1 year inclusion, remittance to be made either in the form of either a money order or cashier's check made payable to ***Adoption Consultants, Inc.*** or via our on line PayPal/Credit Card processing option.
You understand and agree this book is distributed only to organizations that assist pregnant women as part of Adoption Consultants, Inc.'s current outreach program, and not by the office directly to an expectant mother. (For those seeking remittance of their profile directly to an expectant mother by the office, please consider our Contractual Facilitation Program or Registration Program.) Initial: ________ Initial: _________
Should an expectant mother choose to place her child/children with you as a result of having your profile appear in Adoption Consultants, Inc.'s Adoption Book of Waiting Families, and should you accept to her and/or ACI, agreeing to proceeding forward with an adoption plan with said expectant mother (known as “mutually matching”), you understand and agree within 24 hours of mutually matching you will be required to contract on as a client of ACI’s through ACI’s Contractual Facilitation Program by remitting a signed and dated copy of ACI’s Facilitation Contractual Agreement to ACI, along with ACI’s full facilitation fee to arrive at ACI’s office within 48 hours of mutually matching. Initial:_____ Initial: _______
Upon mutually matching, you understand and agree should you fail to remit a signed and dated copy of ACI’s Facilitation Contractual Agreement along with full facilitation fee to ACI according to the terms noted in preceding paragraph above, you will be deemed in breech of this Agreement and ACI will have the right to promptly terminate this Agreement and cease to render any further services on your behalf. Initial: __________ Initial: _________.
You understand and agree, no identifying information pertaining to yourself and/or the expectant mother will be shared until a mutual match has occurred and a signed and dated copy of ACI’s Facilitation Contractual Agreement has been received by ACI, along with full facilitation fee remitted via either Money Order or Cashier’s check (No personal checks accepted) made payable to ***Adoption Consultants, Inc.*** to arrive at ACI’s office within the 48 hour period as designated above and payment has been processed through. Initial: _______ Initial: _______
At the time of a mutual match, you understand and agree you must seek legal advice and services of a competent adoption attorney and/or licensed agency to handle the legal aspects of your adoption plan. Recommendations of licensed agencies/attorneys are available upon requested.
Initial: ____________ Initial: __________
In the event your adoption plan does not successfully complete, the facilitation fee in its entirety will be rolled over towards a re-match and you will continue forward as a contracted client of ACI’s in the Contractual Facilitation Program for the duration and under the existing terms of ACI’s Facilitation Contractual Agreement. You understand and agree, a failed adoption attempt will not be grounds for a refund of any part of any fees paid. Initial: _____ Initial: _______
Please print out this document in its entirety, sign, date and return along with:
1) Appropriate processing charge in the sum of either $ 80 for 6 months inclusion or
$ 120 for 1 year inclusion in Adoption Consultants, Inc.'s Adoption Book of Waiting Families, payment to be made in the form of either a money order or cashier's check made payable to ***Adoption Consultants, Inc.***. (No personal checks accepted.)Alternatively, for those preferring to remit payment online and/or charge this program'sfee to your credit card, you may use our on line PayPal/Credit Card processing option. Note: A nominal processing charge will apply to all PayPal/credit card transactions to cover2) A copy of your home study, if applicable and available (copy may follow).
Please note: Any processing charges remitted to ACI are strictly non-refundable. No exceptions. Initial: __________ Initial: __________
Remit to:Adoption Consultants, Inc.
Adoption Consultants, Inc. 11271 Ventura Blvd., # 380 Studio City, CA 91604It is advised you remit your package in a traceable manner, i.e. Federal Express/Priority Mail with Delivery Confirmation Signature Required, as ACI is not responsible for lost packages. Once the office receives your package, you will be notified and ACI will open a file on you and log you into our Adoption Book of Waiting Families Registry. Additionally, you will receive a Biographical Form and Questionnaire via e-mail to fill out and return to the office to assist the office in knowing what types of expectant mother situations are of interest to you. Should an expectant mother wish to speak with you as a result of having reviewed your profile in the Adoption Book of Waiting Families, you will be contacted by ACI to further explore the situation and possibility of mutually matching. You always retain the right to pass on any potential match situation presented to you.
I/WE HEREBY ACKNOWLEDGE AND DECLARE I/We have read the above contents of this Form and Agreement and I/We understand, approve, accept and agree to all of the contents, terms and conditions of this entire agreement.
Dated:_____________________________________________________________
_________________________________________ Print Name:Dated:_____________________________________________________________
_________________________________________ Print Name: