ALG ADOPTION INTAKE FORM

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Adoption Petition Packet
This form gathers information for all adoption types. You will receive the adoption petition, consent (for step-parent or same sex couple adoption), proposed order for hearing, the proposed final judgment of adoption, and a checklist of other necessary documents (e.g. birth certificate).

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Sample Letters for Sperm / Egg donation providers and IVF clinic.
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The relationship status of the person seeking to adopt (e.g. married, single, separated, divorced, widowed, cohabitating, etc.*
The Full Legal Name of Your Spouse / Partner

First NameLast Name
The date of birth of your spouse partner

MonthDayYear
Date
Your spouse/partner's current full address (please include zip code)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your spouse/partner's previous addresses within the past five years
Your spouse/partner's occupation
Your spouse/partner's Employer
USA CitizenPermanent ResidentOther
Your spouse/partner's race/ethnicity
The religion of your spouse / partner
The names, dates of birth, and all residences within the past five years of all other adults in the adoptive home. INCLUDE ALL INFORMATION.
Full current legal name of Child to be adopted*
The date of birth of Child to be adopted*

MonthDayYear
Date
The sex of the Child to be adopted. *
The birthplace (City/State) of the Child to be adopted*
The race/ethnicity of Child to be adopted*
The religion of the Child *
The date that the Child to be adopted came to live in your home.*

MonthDayYear
Date
The legal name by which the Child shall be known following the adoption*
Describe your relationship, if any, to the current legal parents of the Child:*
the parental rights of both biological parents have been terminated by the Court.the parental rights of the biological mother have been terminated.the parental rights of the biological father have been terminated.the child was conceived using a sperm donor, who waived all parental rights.the child was conceived using an egg donor, who waived all parental rights.there is a pending petition for the termination of parental rights of one of the current legal parents.there is a pending petition for the termination of parental rights of both of the current legal parents.The biological parents of Child 1 are both deceased.The biological mother of Child 1 is deceased.The biological father of Child 1 is deceased.Other
YesNo
The donor is known to the person wishing to adopt or the other biological parent.The donor is NOT known to the person wishing to adopt or the other biological parent.
The name of the egg / sperm donation clinic (a letter will be needed for the Court's file):
The name of the IVF Doctor or Medical Practice (a letter will be needed for the Court's file):
A full description of all property belonging to the Child to be adopted: (this is usually N/A, but, it must be asked.)*
This typically refers to large inheritances, trust funds, etc. There is no need to include toys or clothing. Type N/A if nothing exists.
Please indicate whether you are fully capable of supporting the Child financially using your household income.*
Please indicate whether there are other children within the home.*
Neither the child nor the child's biological parents are members or eligible to be members of a federally recognized Indian tribe in accordance with the requirements set forth in R. 5:10-6.The child and at least one of the child's biological parents are members or eligible to be members of a federally recognized Indian tribe in accordance with the requirements set forth in R. 5:10-6.
YesNo
Explain criminal or substance abuse history and steps taken to overcome the criminal / substance abuse past.
YesNo
In order to adopt a child with two living biological parents: If neither of the parents have had their parental rights terminated by court order, you must first file a petition to terminate the parental rights of one or both of the biological parents. A note, a letter, or a notarized written request to terminate parental rights does not suffice.

Please note: This does not apply to sperm donors or egg donors who are unknown to the person(s) seeking to adopt the child. In most cases, these persons have already waived parental rights.

This does, however, apply to egg or sperm donors who are known to the person(s) seeking to adopt the child. Parental rights must be terminated by court order to be a valid termination.
YesNo
The Name of Biological / Legal Parent 1, whose parental rights should be terminated in favor of the person adopting the child.

First NameLast Name
The Address of Biological / Legal Parent 1, whose parental rights should be terminated in favor of the person adopting the child.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Why do you believe Biological / Legal Parent 1's rights should be terminated with respect to the child? Please explain in detail. Please state whether this parent has seen the child within the last six months.
The Name of Parent 2, whose parental rights should be terminated in favor of the person adopting the child.

First NameLast Name
The Address of Biological / Legal Parent 2, whose parental rights should be terminated in favor of the person adopting the child.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Why do you believe Biological / Legal Parent 2's rights should be terminated with respect to the child? Please explain in detail. Please state whether this parent has seen the child within the last six months.
Any other pertinent information that you believe the Court should know.*
Type "N/A" if none.
AMES LAW GROUP, LLC
24 Veterans Square | Media, PA 19063
(888) 200-1270 | paa@getameslaw.com | www.getameslaw.com
Licensed in Pennsylvania | New Jersey | New York

LIMITED SCOPE REPRESENTATION AGREEMENT

CLIENT UNDERSTANDS THAT THE ATTORNEY AND CLIENT MAY AGREE TO ENTER INTO A FULL REPRESENTATION ARRANGEMENT FOLLOWING A CONSULTATION. AN ATTORNEY MAY ENTER AN APPEARANCE IN A LEGAL MATTER AT ANY STAGE OF THE CASE. THIS LIMITED SCOPE LEGAL SERVICE IS BEING MADE AVAILABLE TO CLIENTS WHO NEED IMMEDIATE ASSISTANCE, PRIOR TO THE NEXT AVAILABLE CONSULTATION.

This Limited Scope Representation Agreement ("Agreement") is entered into between Patricia A. Ames, Esquire, of Ames Law Group, LLC (hereinafter "Attorney"), and the undersigned client (hereinafter "Client"). By submitting this Agreement electronically and/or checking the acceptance box, Client acknowledges reading, understanding, and agreeing to all terms set forth herein.

1. NATURE AND SCOPE OF REPRESENTATION
Attorney agrees to provide limited scope legal services only, as selected by Client through the Ames Law Group self-service portal. This representation is strictly limited to the specific task(s) identified at intake and does not constitute full or general representation of Client in any matter. Attorney is not entering an appearance with any court, agency, or tribunal on Client's behalf unless separately and expressly agreed to in writing.

Limited scope services may include, but are not limited to:
•Preparation or review of a specific document, pleading, or legal form;
•Drafting a response, answer, or motion based on information provided by Client;
•Providing written legal guidance on a discrete legal issue;
•Assisting Client in completing intake information for a full-representation bankruptcy matter.

This Agreement covers matters arising in or governed by the laws of the Commonwealth of Pennsylvania, the State of New Jersey, and/or the State of New York, within Attorney's licensed jurisdictions.

2. CLIENT RESPONSIBILITY TO PROVIDE COMPLETE AND ACCURATE INFORMATION
Client bears full and sole responsibility for providing Attorney with all information, documents, facts, and records that are relevant, material, or necessary to the requested legal task. This includes but is not limited to: court documents, pleadings, complaints, summonses, orders, agreements, correspondence, financial records, and any other materials that bear upon the matter at hand.

Client acknowledges and agrees that:
•Attorney can only work with the information and documents provided by Client;
•Attorney is not responsible for independently investigating, researching, or discovering facts, information, or documents that Client fails to disclose or upload;
•Any inaccuracy, incompleteness, omission, or misrepresentation in the information or documents provided by Client — whether intentional or unintentional — is solely Client's responsibility;
•Attorney's work product is based entirely upon the materials and representations submitted by Client, and Attorney makes no warranty as to outcomes where Client has provided incomplete or inaccurate information;
•If Attorney determines that insufficient information or documentation has been provided to complete the requested task, Attorney will contact Client via email to request the missing materials. If Client does not respond or does not provide the requested materials within a reasonable time, Attorney reserves the right to decline the matter and issue a refund of any fees paid, less any administrative costs incurred.

WAIVER: To the fullest extent permitted by applicable law, Client hereby waives and releases any claim against Attorney arising from or related to Attorney's reliance on incomplete, inaccurate, or misleading information or documents provided by Client. Client acknowledges that this waiver is a material term of this Agreement and a condition of Attorney's agreement to provide limited scope services.

3. CLIENT'S OBLIGATION TO MONITOR EMAIL
All communications from Attorney regarding this matter, including but not limited to requests for additional information, delivery of completed work product, notices of declination, and status updates, will be sent exclusively by email to the address provided by Client at intake. Client is solely responsible for monitoring their email account, including spam and junk folders, and for responding in a timely manner. Attorney shall have no liability for any failure by Client to receive, read, or respond to email communications.

4. FEES AND PAYMENT
Fees for limited scope services are collected at the time of submission through the Ames Law Group self-service portal. All fees are non-refundable once work has commenced on Client's matter. If Attorney declines the matter prior to commencing work, a full refund will be issued, less any applicable processing fees.

Clients covered under a legal insurance plan (LegalEASE, ARAG, LawPoint, or similar) are subject to the terms of their respective plan coverage, which will be verified prior to the commencement of work.

5. NO GUARANTEE OF OUTCOME
Attorney makes no representation, warranty, or guarantee regarding the outcome of any legal matter. All work product is provided based on the information supplied by Client and the applicable law at the time of preparation. Client is encouraged to review all documents carefully before filing or relying upon them.

6. CONSULTATION AND POTENTIAL FULL REPRESENTATION
Client is strongly encouraged to schedule a consultation with Attorney to discuss the matter in greater depth, even after limited scope services have been delivered. A consultation allows Attorney to assess the full scope of Client's legal needs, identify issues that may not have been apparent at intake, and determine whether full representation is appropriate.

This Agreement does not create an obligation on the part of Attorney to accept Client for full representation. If Attorney agrees to undertake full representation following a consultation, the parties will execute a separate retainer agreement governing the full representation. Until such a separate agreement is executed, this Agreement governs and the scope of representation remains limited as described herein.

7. JURISDICTION AND VENUE FOR DISPUTES
Any dispute arising out of or related to this Agreement or the legal services provided hereunder shall be governed by the laws of the Commonwealth of Pennsylvania. The exclusive venue for any legal action arising hereunder shall be the Court of Common Pleas of Delaware County, Pennsylvania. Client expressly consents to personal jurisdiction in Delaware County, Pennsylvania and explicitly waives any objection to venue in that jurisdiction.

8. CONCLUSION OF LIMITED REPRESENTATION
Attorney's representation of Client under this Agreement concludes upon delivery of the specific work product requested, or upon written notice of declination by Attorney, whichever occurs first. Attorney has no obligation to provide follow-up services, supplemental filings, or ongoing representation beyond the specific task agreed upon, unless a separate written agreement is executed.

9. ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior discussions, representations, or understandings. This Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, estates, executors, administrators, successors, and assigns.

ACKNOWLEDGMENT AND ELECTRONIC SIGNATURE
By signing below (or by checking the acceptance box on the online intake form), Client certifies that: (1) Client has read and understands this Agreement in its entirety; (2) Client agrees to be bound by all terms and conditions set forth herein; (3) Client's electronic signature or checkbox acceptance constitutes a legally binding signature under applicable federal and state electronic signature laws, including the Electronic Signatures in Global and National Commerce Act (ESIGN) and, where applicable, the Uniform Electronic Transactions Act (UETA).
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