ADOPTION DISCLOSURE REQUEST Please complete the following form if you wish: To receive your Non-Identifying Information If you wish to receive information from your file, complete the Request for Non-Identifying Information section. Your request will typically be processed within a thirty-day period. However, that time frame begins only after the Society receives a completed application (including proof of identification) and clarification from you as to what information you are seeking. In most cases, you will receive a copy of your file. However, all the identifying information will be redacted, as per the current adoption disclosure legislation. If it is not practical to redact a copy of your file, the Society will provide you with a summary of the involvement. To update your file for future disclosure to a birth relative If you wish to update your file for the purpose of disclosure, complete the Updated Social History Information section. Updated and current information can be provided when the parties involved have updated their file for the purpose of disclosure. 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. A copy of your identification (i.e. birth certificate, health card, driver’s license) will be required for verification purposes. 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. Applicant detailsDate*dd/mm/yyyy Name*If no middle name enter spaces into the box First Middle Last 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 Number*Can a message be left for you at number provided?* Yes No Applicant must meet one of the following criteria to be eligible (please check the one that applies to you)* An adopted person aged 18 years or older An adopted person under 18 years of age, with adoptive parents written consent A birth parent An adoptive parent A birth grandparent A child of a deceased adopted person, and you are aged 18 or older A sibling of a birth parent, and you are aged 18 or older An adopted person aged 18 or older, applying to receive information about an adopted birth sibling A birth sibling aged 18 or older, applying to receive information about an adopted birth sibling Applicant RelationshipIf applying as a birth relative, indicate your relationship to the adopteeHave you registered with the Adoption Disclosure Register (through ServiceOntario)? Yes No If you registered with the Adoption Disclosure Register, when?Provide proof of identification*To proceed with the request, a copy of photo identification must be provided to confirm your identity. Indicate which method proof will be provided.email: AdoptionDisclosure@wecas.on.cafax: 519-256-1820mail: Windsor-Essex Children’s Aid Society Attn: Adoption Disclosure 1671 Riverside Drive East Windsor, ON N8Y 5B5Type of Request*If you wish to provide an update for the file, click "I am providing an update to the file" to complete the “Updated Social History" section. This will be kept on file and then shared with any birth relative if/when they request Adoption Disclosure from WECAS. Your contact information will be redacted prior to sharing. Keep in mind, the Society does not have the authority to “reach out” to your birth relative and cannot share the updated information unless we are contacted by your birth relative. I am requesting non-identifying information for my use I am providing an update to the file (Updated Social History Information) CONSENT FOR RELEASE OF NON-IDENTIFYING INFORMATIONConfirmation of identity* By clicking here, I confirm I am the person to whom the information pertains and I release the Windsor-Essex Children’s Aid Society from any liability or consequences pertaining to the release of this information. REQUEST FOR NON-IDENTIFYING INFORMATIONHave you requested/received any non-identifying information from the Society in the past? Yes No If yes, specify when (approximately):Have you updated your file for the purpose of disclosure? Yes No Please complete the name and birthdate details for family members to the best of your knowledge. 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:* First Middle Last Adoptee's Date of Birthdd/mm/yyyy Adoptee’s Full Adoptive Name:* First Middle Last Adoptee’s Adoptive Date of Birth:dd/mm/yyyy Birth Mother’s Full Name:* First Middle Last Birth Mother’s Date of Birth:dd/mm/yyyy Birth Father’s Full Name:* First Middle Last Birth Father’s Date of Birth:dd/mm/yyyy Adoptive Mother’s Name:* First Middle Last Adoptive Mother’s Date of Birth:dd/mm/yyyy Adoptive Father’s Name:* First Middle Last Adoptive Father’s Date of Birth:dd/mm/yyyy What information are you requesting?*CONSENT FOR UPDATED SOCIAL HISTORY INFORMATIONConsent by clicking here, I hereby permit the Windsor-Essex Children’s Aid Society to share the below information (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. 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/TEMPERAMENT (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
