Adoption Disclosure - Social History Update If you wish to update your file for the purpose of disclosure, complete the Social History Update Information form below. The Society will file your updated information, which can be shared (in non-identifying format) with your birth relative if/when they contact the Society for Adoption Disclosure services. The Society does not have the authority to “reach out” to your birth relative and cannot share the updated information unless contacted by your birth relative. You may wish to visit Service Ontario at https://www.ontario.ca/page/search-adoption-records for more information about adoption disclosure legislation. Please contact the Adoption Disclosure Department at 519-252-1171 ext 3724 or by email at AdoptionDisclosure@wecas.on.ca if you have any questions. Consent For Updated Social History InformationPrior to providing any information you must provide your consent by clicking the checkbox below. Once you provide your consent the form will become available.Consent by clicking here, I hereby permit the Windsor-Essex Children’s Aid Society to share the information I provide (in non-identifying format) with my birth relative if/when they contact the Society for Adoption Disclosure services. I will keep the Society advised of any address and contact changes for myself. I understand that I can choose to provide or decline this consent and that, even though I am now consenting, I am able to withdraw this consent in the future, by providing notification in writing to the Adoption Disclosure department at the Windsor-Essex Children’s Aid Society. I further understand that any withdrawal of my consent will not affect anything done in accordance with this consent prior to such withdrawal. Applicant DetailsRequest Date*dd/mm/yyyy Name*If no middle name enter spaces into the box First Middle Last Birth Date*dd/mm/yyyy Email* Address* Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Daytime Phone NumberCan a message be left for you at number provided? Yes No Applicant Relationship*Indicate your relationship to the adopteeFamily InformationPlease complete the name and birthdate details for family members to the best of your knowledge.This information assists in locating your records. If you do not know the names type "unknown" in each box, if you do not know birthdate leave the box blankAdoptee’s Full Birth Name:*Enter "Unknown" if not known First Middle Last Adoptee's Date of Birthdd/mm/yyyy Adoptee’s Full Adoptive Name:*Enter "Unknown" if not known First Middle Last Adoptee’s Date of Birth:dd/mm/yyyy Birth Mother’s Full Name:*Enter "Unknown" if not known First Middle Last Birth Mother’s Date of Birth:dd/mm/yyyy Birth Father’s Full Name:*Enter "Unknown" if not known First Middle Last Birth Father’s Date of Birth:dd/mm/yyyy Adoptive Mother’s Name:*Enter "Unknown" if not known First Middle Last Adoptive Mother’s Date of Birth:dd/mm/yyyy Adoptive Father’s Name:*Enter "Unknown" if not known First Middle Last Adoptive Father’s Date of Birth:dd/mm/yyyy Updated Social History InformationCurrent Family Situation ( ie. married, divorced, children, grandchildren - how many, their ages and sex etc.)Physical Description ( ie. height, weight, colour of hair and eyes, outstanding features etc.)Health ( ie. any serious illness and/or diseases, include immediate family members etc.)Education and Employment (ie. grade completed, special training etc.)Interests and Lifestyle (ie. Hobbies, likes and dislikes etc.)Personality/Temperment (ie. Outgoing, quiet, energetic, friendly etc.)Family Support ( ie. are they supportive of you seeking disclosure information and/or are they aware, how do they feel)Thoughts About a Possible Reunion ( ie expectations, hopes, fears and possible concerns etc.)Additional Information/Special Message (ie any other information you would like to share) Δ
