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Search and Reunion Services

CONCERN offers Search and Reunion Services to adoptees who are 18 years of age or older and whose adoption was finalized through CONCERN. Birthparents may also request this service if the child they placed for adoption is 21 years of age or older and was adopted through CONCERN. Siblings, grandparents, and aunts and uncles of the child may also request this service.

CONCERN’s authorized representative, as established by Act 101 of 2010, is a trained and experienced adoption professional who can provide non-identifying information, identifying information with proper authorization, and search and reunion services. A reasonable fee has been established for each level of service. Requests for services must be made in writing. CONCERN will acknowledge the receipt of your request within 30 days.

Form

You may request information about your own adoption or the adoption of a family member as listed below. If we have any information on file, we will provide it to you within 30 days. Any information on file will be mailed to the requester. If no information is on file at the time of the request, a notice of that fact will be mailed. It is important to notify us of any change in your contact information.

Requestor's Contact Information

I am one of the following:


Birth sibling if both adoptee and sibling are at least 21 (check one):

Sibling remained in the custody of the birth parent who has given consent for release of this information or who is incapacitated or deceased.Sibling was adopted out of the same birth family as the adoptee for whom I am requesting information.Sibling was not adopted out of the same birth family and did not remain in the custody of the birth parent.


Date of Request:

Name (Last, First, Middle):

Date of Birth:

Mailing Address:

City, State, ZIP:

Email:

Telephone:

I am requesting information about:


I am requesting:

Identifying Information will induce names and contact information.

Non-Identifying Information will not include names and contact information but could include medical, social and educational information, etc.

Request for Information About the Person Listed Below

Please provide as much information about the person as you know.

Current Name (Last, First, Middle):

Name Recorded on Birth Certificate (Last, First, Middle):

Date of Birth:

Gender:

MaleFemale


Place of Birth

County:

City/Municipality:

State:

Hospital (if applicable):

Birth Parent's Name (Last, First, Middle, Maiden):

Date of Birth:

Birth Parent's Name (Last, First, Middle, Maiden):

Date of Birth:

Adoptive Parents' Names (Last, First, Middle):

Legal Guardian's Name (Last, First, Middle, Maiden):

I certify that the above information is accurate and compete to the best of knowledge and belief and submitted as true and correct under penalty of law (section 4904 of the Pennsylvania Crimes Code). Further, I understand that it is my responsibility to notify the registry of any change in address.

Act 101 Information

In late 2010, former Pennsylvania Governor Edward G. Rendell signed into law an amendment to the Adoption Act. The amendment, known as Act 101, became effective on April 25, 2011. Act 101 provides 1) an option for adoptive parents and birth relatives to enter into an enforceable voluntary agreement for ongoing communication or contact; 2) the requirement that the Pennsylvania Department of Public Welfare create and maintain an adoption medical history registry and social history information registry (The Pennsylvania Adoption Information Registry – PAIR); and 3) a process and response time for requesting the release of information and access to records.

© 2017 CONCERN - Professional Services for Children, Youth, and Families

Corporate Office
One West Main Street, Fleetwood, PA 19522
(610) 944-0445


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