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Adoption: Application for approval as adopterDownload application form (pdf)
Date of receipt at the Regional State Administration (stamp): Full name of applicant (male): | Full name of applicant (female): | Civil registration no.: | Civil registration no.: | Nationality: | Nationality: | Address: | Address: | Municipality: | Municipality: | Phone at home (cell-phone): | Phone at home (cell-phone): | Phone at work: | Phone at work: | E-mail address, if any: | E-mail address, if any: |
For how long have you been cohabiting? | When were you married? | Have you been married before? | Have you been married before? |
Do you have any children of the marriage/relationship? (name and civil registration no.) | Do you have any children of a previous marriage? (name and civil registration no.) | Do you have any children of a previous marriage? (name and civil registration no.) | If yes, is the child (children) living with you? | If yes, is the child (children) living with you? |
What education do you have? | What education do you have? |
What is your present occupation? | What is your present occupation? |
Employment and place of employment within the past five years: | Employment and place of employment within the past five years: |
Have you previously been convicted? | Have you previously been convicted? | If yes, when and for what? | If yes, when and for what? |
Information about your dwelling: | Brief description of the dwelling, the type of dwelling and the surroundings of the dwelling: | Size of dwelling: (m2 og number of rooms): |
Financial information: | Monthly income before tax: | Monthly income before tax: | Monthly income after tax: | Monthly income after tax: | Fixed monthly expenses: | Fixed monthly expenses: | Arrears of contribution, taxes or any other debt to the public authorities: | Arrears of contribution, taxes or any other debt to the public authorities: |
Have you received economical assistance from the public authorities? | Have you received economical assistance from the public authorities? | If yes, | If yes, | What type of economicil assistance? | What type of economicil assistance? | When? | When? | Where? | Where? |
Do you belong to the Danish National Church or to a religious community? | Do you belong to the Danish National Church or to a religious community? | If yes, which community? | If yes, which community? |
*** I/we apply for approval for adoption of (tick box on left side): | | a child from abroad
| | a Danish child | | a specific child that we know (name of the child) |
I/we apply for approval for adoption (tick box on left side): | | one child | | a pair of twins | | brothers and sisters , number ___________ | I/we apply for approval for adoption of a child/children at the age of: |
Special comments, including the reason for the desire to adopt: |
Have you previously applied for adoption? | If yes, | 1) which county/Regional State Administration dealt with your application? | 2) was a specific child suggested to you? | If yes, did you receive the child?
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I am aware that the information is given under penalty of section 163 of the Danish Criminal Code, according to which any person who for use in legal matters affecting the public authorities makes an incorrect statement in writing or gives false evidence in writing of something of which he has no knowledge is liable to a fine or simple detention or imprisonment for a term not exceeding four months.
I give the Regional State Administration permission to obtain the necessary information from the National Register about my residence as well as information from the Criminal Register.
I give the Regional State Administration permission to obtain a statement from the local authority as to whether the local authority has any objections to the granting of a care permission. Further, I give permission for disclosure of the information of the case to the adoption agency with a view to, among other things, subsequent disclosure of the information to the foreign contacts and to the local authority in connection with the issue of a care permit.
I am aware that during the case I am under an obligation immediately to notify the Regional State Administration of any pregnancy or other significant changes in my family, social and health situation.
Further, I accept that the Regional State Administation collects, processes and discloses personal data in connection with the processing of the case. If, during the processing of the case, the State Administration submits the case to the National Adoption Board or the Department of Family Affairs or a complaint is made to the Board or the Department, these authorities, too, may process and otherwise deal with personal data.
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According to the Danish Act on Processing of Personal Data (Act No. 429 of 31 May 2000), data subjects have the following rights: - Right to request access to the data that are being processed
- Right to object to the processing of the data
- Right to demand rectification, erasure or blocking of data which are inaccurate or misleading or in any other way processed in violation of Danish legislation.
For details about the legal basis of the Danish Act on Processing of Personal Data please see the Danish Data Protection Agency's home page www.datatilsynet.dk. Date: | Date: | Signature: | Signature: |
The application form should be sent to the Regional State Administration in which you are resident or staying.
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Provisions from the Executive Order on the approval of adopters:
3. Application for approval as adopter shall be filed with the Regional State Administration. A married couple shall file the application jointly.
4. (1) The application shall be filed on an approved form. The following documents must be enclosed with the application: - certificates of birth and baptism (name),
- marriage certificate if the applicant is married,
- tax certificate and default declaration,
- health statement and
- health certificate.
(2) The health statement must be completed by the applicant on an approved form.
(3) The health certificate must be issued by the applicant's usual doctor on an approved form. If another doctor issues the certificate, the applicant must give an adequate reason herefor. At the time of delivery of the application, the health certificate must not be more than three months old.
23(3). The applicant must notify the Regional State Administration of any relevant changes in the applicant's affairs. |
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