Information Packet - Forms

The law specifies that anyone relinquishing an unharmed newborn to a designated safe haven in Illinois – hospitals, emergency care facilities, manned fire stations, or police stations – be offered an information packet containing the following documents. Please note that this packet may or may not be accepted by the relinquishing parent.

1. Summary of Abandoned Newborn Protection Act - English

           Summary, Spanish

2. Explanation of Illinois Adoption Registry

3. Illinois Adoption Registry Application

4. Illinois Adoption Registry Application. Section C (2 pages)

5. Birth Parent Registration Identification

6. Information Exchange Authorization

7. Denial of Information Exchange

8. Illinois Adoption Registry Medical Questionnaire (2 pages)

9. Illinois Adoption Registry web site address and toll-free phone number

10. Written notice of procedures related to termination of parental rights

11. A resource list of providers of counseling services, including grief counseling, pregnancy counseling, and counseling regarding adoption and other available options for placement of the infant.