113 LN Risk Acknowledgment 
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In recognition of the need for information on the part of the SPIRIT OF FAITH ADOPTIONS, its’ agents, employees and designees, in order to evaluate my adoption plan, I, the undersigned, hereby agree to the following regarding the protection of confidentiality, whether provided by law, bylaw, policy, or contract provision, which may pertain to my adoption plan.
Last Name *
We, the undersigned, are aware of certain risks in all foster /adoption cases that manifest in various ways, from the legal aspects of adoption to social/medical history.  These include but are not limited to: the rights of biological fathers not being severed and trying to assert their biological rights, the biological mother changing her mind prior to severing her rights, etc. The undersigned are also aware that while Spirit of Faith Adoptions will try to obtain all relevant medical and social information, the undersigned are aware that no guarantees can be given or received that the child medical information is complete.  Further, the child may have initial difficulty adjusting to you. Difficulty may be evidenced in sleep disruptions, eating habits, fussiness, crying, regressive behavior, avoidance, or aggression.  Be patient, and seek help, if needed.  With this understanding, the undersigned waive all claims of action against Spirit of Faith Adoptions, Inc. for any allegations that this agency did not provide adequate information to the undersigned.
Acknowledgment: *
Spirit of Faith Adoptions accepts and transmits unencrypted email communications. I/we understand that there may be some level of risk that information transmitted via unencrypted email to and from Spirit of Faith Adoptions could be read by a third party, and the agency is not responsible for unauthorized access of protected health information and/or any other information while in transmission to us. We understand that Spirit of Faith Adoptions is not responsible for safeguarding information once delivered. We are aware that submitting documents to the agency directly via www.spiritoffaithadoptions.org is secure and encrypted, but also understand that this still is not guarantee of absolute security.
Communication Preference *
Applicant 1 Signature *
Applicant 2 Signature *
Today’s Date *
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