 |
|
|
| Date and Time _____________________________________ |
| Person Calling _____________________________________ |
|
|
|
| Child's Chinese Name _____________________________________ |
| Translation _____________________________________ |
| Date of Birth _____________________________________ |
| Height | ______________ |
Weight | ______________ |
Date Taken | ______________ |
|
| Other Medical Information?____________________________________________________ |
| __________________________________________________________________________ |
| What does she / he look like?_________________________________________________ |
| __________________________________________________________________________ |
|
|
|
| Full name of orphanage _____________________________________ |
| City / Province _____________________________________ |
| Other referrals from this orphanage? _____________________________________ |
| Foster Care? With who? For how long?__________________________________________ |
| __________________________________________________________________________ |
|
|
|
| Can you e-mail us a picture? _____________________________________ |
| When will you mail our info? _____________________________________ |
| FedEx/UPS Tracking Number? _____________________________________ |
| Current Travel Estimate? _____________________________________ |
|
|
|
| Is there anything else we need to know?_________________________________________ |
| __________________________________________________________________________ |
| __________________________________________________________________________ |
| What should we do next?_____________________________________________________ |
| __________________________________________________________________________ |
|
