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Christian Homes And Special Kids

Birth Parent's Line 1-800-266-9837 Contact CHASK 208-267-6246

Please submit your adoption application below.

CHASK Adoption Application

	First Name			Last Name
	Street1			Street2
	City			State
	Zip Code			Email
	Business Phone			Home Phone
	Mobile Phone
	Describe briefly your family including children or anyone else living in the home.

	Describe Your Faith In Christ.

	What are your reasons for wanting to adopt a special needs child?

	What age would you prefer?
	Are you interested in adopting a sibling group?
	Are you Open to adopting a clid of color or mixed race?
	What kind of conditions do you feel you can handle?
	Church Name
	Pastor or Minister Name
	Pastor Phone
	Other Reference Name
	Other Reference Phone
	Letter To Birth Mother (please write a note to the birth mother):