Application to Adopt - TO BE COMPLETED BY ALL APPLICANTS & RESIDENT BIRTH PARENT AS APPLICABLE

 I / we give permission to One Adoption West Yorkshire to make enquiries and obtain references in relation to my application to adopt.  I / we understand that information received will be in confidence to assist the Local Authority in determining my suitability to adopt.

 I / we understand that this will include:

• To local authorities where I have previously lived
• Local Authority Social Services Department
• Child Protection
• DBS (Disclosure and Barring Service)
• Employers and previous employers, if required
• Personal
• Family
• Previous Partners
• Probation Service
• Schools/Nurseries
• Health Visitor (if necessary)
• Adult Children in your family
• Other Members residing in your household
• Voluntary Work e.g. brownies/scouts/football coach etc.
• Checks in respect of Serving or ex-Service Army or Air Force Personnel.
• Other checks as deemed necessary and agreed by all parties including adult children and previous partners.

I / we consent to checks with local Mental Health Trusts with regards to any treatment ever received in relation to my / our mental health which may have a bearing on my / our ability to care for a child.  This might include issues of depression, stress related illness or other diagnosed mental health conditions.

I / we understand that the data supplied will be held in line with Data Protection Act 1988.

I / we declare that the information I / we have provided is true and to the best of my knowledge and belief and that I / we have not withheld any relevant information.