Adoption Consultants, Inc.

REGISTRATION FORM AND AGREEMENT

Periodically, expectant mothers this office assists request additional profiles (Dear Birthmother Letters) to review after first having had the opportunity to review any contracted families profiles whose criteria meet her own.  When this occurs, non-contracted families may have their profile shared.  Profiles of    non-contracted families may also be shared in the event the office does not have any contracted families profiles to share with an expectant mother based on both party's individual criteria.  In order for Adoption Consultants, Inc. (ACI) to present your profile to an expectant mother for her review and consideration as a non-contracted family, you must first register in ACI’s Registration Program.   

You may choose to register as a registered participant in ACI’s Registration Program in one of two ways.  Either option includes the option of inclusion of your profile in Adoption Consultants, Inc.'s Adoption Book of Waiting Families, a publication which is distributed to organizations that assist pregnant women, including hospitals, pregnancy centers, crisis centers, shelters, maternity homes, educational institutions, religious institutions, physician's offices, etc. 

Option 1:  A non-refundable flat processing charge of $ 300 is assessed covering processing charges and costs incurred for unlimited presentations of your profile (Dear Birthmother Letter) for one consecutive calendar year (commencing the date you sign this Registration Form) to any expectant mother situations open to non-contracted families in which your criteria meets an expectant mother’s criteria, plus optional inclusion in Adoption Consultants, Inc.'s Adoption Book of Waiting Families for 1 year. 

Option 2:  A non-refundable flat processing charge of $ 400 is assessed covering processing charges and costs incurred for unlimited presentations of your profile (Dear Birthmother Letter) for two consecutive calendar years (commencing the date you sign this Registration Form) to any expectant mother situations open to non-contracted families in which your criteria meets an expectant mother’s criteria, plus optional inclusion in Adoption Consultants, Inc.'s Adoption Book of Waiting Families for 2 years. 

In either Option, you understand and agree as a registered participant your profile can only be
presented to an expectant mother ACI is assisting in the event she requests additional profiles to
review after first having had the opportunity to review profiles of ACI’s contracted families whose criteria meet her own or in the event ACI has no contracted families whose criteria meet the
expectant mother’s criteria.   Initial: _________     Initial: _________

ACI asks that you do not request your profile be presented to an expectant mother unless you are comfortable with the circumstances of the potential placement, you are agreeable as to the type of placement expectant mother is seeking, and you are fully comitted and prepared both financially and emotionally to accept a match upon selection.  Initial: _________     Initial: _________

Should an expectant mother/birthmother choose to place her unborn child/child/children with you and you accept to her and/or ACI, agreeing to proceeding forward with an adoption plan with said expectant mother/birthmother (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 current facilitation fee to arrive at ACI’s office within 48 hours of mutually matching.  Initial:_________    Initial: _________  [Note:  You agree should a baby already be born or whose
birth is imminent, remittance of ACI's contract and full facilitation fee will be due at time of
match.   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 Registration Form and Agreement and ACI will have the right to promptly terminate this Registration Form and 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/birthmother 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 Cashier’s Check or Official Check. (No Money Orders or personal checks accepted) made payable to ***Adoption Consultants, Inc.***  to arrive at ACI’s office by the timeframe
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 request.  
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: __________

You understand and agree, should you cease to remit profiles to ACI upon request and/or be
unresponsive to ACI's efforts to contact you and/or change your contact information and not
inform ACI of such change and/or indicate to ACI you wish to terminate your relationship with
ACI, ACI reserves the right to terminate this Agreement and any fees previously remitted will be forfeited.   Initial:________ Initial:________

As ACI does not wish to present profiles to expectant mothers/birthmothers of prospective adoptive parents who are not currently seeking an adoptive placement, you agree to immediately inform ACI
should you match with an expectant mother/birthmother through another avenue and/or should you determine you are no longer seeking an adoptive placement.  You understand failure to do so will
result in immediate termination of this Agreement, with forfeiture of any fees previously remitted.  Initial:______  Initial:_______

To register, print out this Registration Form, sign, date and return along with:

1)   10 profiles.  (You may start with fewer than 10 and remit additional at a later time when convenient.)

Guidelines:
a)  Profile can be any style using up to 32 lb inkjet or laser paper.
b)  Profile cannot exceed 14 pages in duration.  (You may always choose to double side your pages in
order to keep the total length of your profile at 14 pages.) 
c)  Paper dimensions cannot exceed 8 1/2 x 11. 
d)  Do not bind profile in a notebook or folder, but a spiral bind is acceptable. 
Alternative to binding may be using a hole punch and tying through a fabric ribbon or the use
of brads. 
e)   No identifying information other than first names, city and state may be included in the profile. 

2)   An electronic copy of your profile to be shared with expectant mothers who have computer access.

3)   A copy of your home study, if applicable and available. (Copy may follow.)

4)   A Cashier's Check, Money Order or Official Check (No personal checks) made payable to
***Adoption Consultants, Inc.*** in the sum of either $ 300 (Option 1) or $ 400 (Option 2),
representing processing charges and costs incurred in sharing your profile with expectant
mothers/birthmothers for either one consecutive calendar year ($ 300) or two ($400).
Note:  Alternatively, for those preferring to remit payment online, you may use our on line
PayPal/Credit Card processing option via our web site.  Note:  A processing fee of 3% + .22 cents
will apply to all online purchases of the $ 300 option and a 3% + .26 cents processing fee will apply
to all online purchases of the $ 400 option. To pay on line Click here: Payments On Line.


Please note:  Any processing charges remitted to ACI are strictly non-refundable and all profiles remitted are non-returnable.  No exceptions.   Initial:  ________    Initial: ________

If mailing, remit to:   Adoption Consultants, Inc.
       11271 Ventura Blvd., # 380
       Studio City, CA  91604

It 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 Registration Program system.  Additionally, you will receive a Biographical Form and Questionnaire via   e-mail to fill out and return to the office to aid us in presenting you to appropriate expectant mother/birthmother situations. 

As expectant mother/birthmother situations open to non-contracted families, as a registered participant your profile will automatically be remitted on by ACI for review and consideration when your criteria meets an expectant mother’s/birthmother's criteria.  Should an expectant mother/birthmother wish to connect with you, 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 Registration Form and Agreement and I/We understand, approve, accept and agree to all of the contents, terms and conditions of this entire agreement.


Dated:____________________(signature)____________________________________
  Print Name Below:



Dated:____________________(signature)____________________________________
  Print Name Below:

  Adoption Consultants, Inc.
   Birth Parent Line:
        1-800-605-4588
      (1-800-605-4LUV)
   Adoptive Parents:
          (818) 766-2222