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I/We agree to fulfill the 8 responsibilities outlined in
this application including but not limited to: keeping USCIS approvals current,
consulting medical professionals when reviewing a referral and reading the
details of the process in the WC Guidelines Program Packet.
Mother's Initials:
Father's Initials:
I/We agree and understand that a special needs adoption is
pending on my/our ability to obtain an approved home study for a special needs
child, as well as gaining approval from the CCAA.
Mother's Initials:
Father's Initials:
I/We understand that by signing the Rehabilitation and
Nurture Plan, receiving an approved home study, and/or receiving a Pre-Approval
does not grant official approval from the CCAA regarding a specific special
needs child. Official approval is obtained once the Referral Acceptance and
Travel Approvals are received as well as the adoption is finalized in China.
Mother's Initials:
Father's Initials:
I/We recognize that by signing this application I/we are not
required to adopt a waiting child. Signing this application does not guarantee
I/we will receive a referral for a waiting child.
Mother's Initials:
Father's Initials:
I/We have read and completed this application for America
World to the best of my/our ability. All information given is true and
complete.
Mother's Initials:
Father's Initials:
I/We agree to read through the WC Program Guidelines Packet
which we will receive upon our application approval.
Mother's Initials:
Father's Initials:
I/We have an America World social worker. I/We understand
our WC program application will be reviewed by our social worker before being
approved.
Mother's Initials:
Father's Initials:
OR
I/We have a social worker through another home study agency.
I/We promise to fax or scan a copy of our WC program application to that social
worker and understand that America World will copy my/ our social worker on the
application approval email.
Mother's Initials:
Father's Initials:
For families who signed the statement of strong preference:
I/We have discussed our WC Program application with a medical professional.
Name of Doctor:
Date of Conversation:
Mode of Conversation:
Mother's Initials:
Father's Initials:
OR
For families who have not signed the statement of strong
preference: I/We have not discussed our WC Program application with a
medical professional but have done initial research on the special needs we
have listed above. Additionally, I/we know I/we must consult a medical
professional when reviewing a referral and I/we agree to do so at that time.
Mother's Initials:
Father's Initials:
I/We are aware I/we have the right to update my/our
application requests or temporarily suspend my/our application at any time
during my/our participation in the program. I/We agree to notify my/our Family
Coordinator if there are family circumstances that have occurred where I/we
feel I/we are not able to review referrals for a certain period of time. I/We
understand a temporary suspension is optional, can be any length of time, and
has no affect on our application once I/we re-enter the program.
Mother's Initials:
Father's Initials:
I/We understand if I/we suspend from my/our adoption process
or decide to pursue a concurrent family building option, I/we will be
temporarily suspended from the Waiting Children Program.
Mother's Initials:
Father's Initials:
I/We understand this program involves a referral review
process and understand I/we have the right to accept or decline a referral.
Declining a referral has no bearing on future matching or referral
opportunities for my/our family.
Mother's Initials:
Father's Initials:
Mother Signature and Date
Father Signature and Date
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