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Kids in a park

Disclosure Request Form - Non-identifying Adoption Information 


Please have ready all required supporting documentation before beginning this form. This includes:

  1. Two (2) pieces of identification, one of which should be a photo identification (i.e. Passport, Driver's License, Health Card, etc.)
  2. Filled and signed Consent to Disclose Personal Information to a Third Party Form from all individuals you are requesting information about, including any children 16 years of age or older and two (2) pieces of identification of the person who signed the consent form
How would you like information provided to you?
Please identify if you are: (please select one from the following categories)
A birth parent:
A birth grandparent:
Other:
How would you like information to be provided to you? *

Information about the adopted person AFTER adoption

(Please fill out as much information as possible.)

Has the person named above had a legal name change after adoption?

Place of birth of adopted person

Adoptive parent "A" at the time of adoption

Adoptive parent "B" at the time of adoption

Information About the Adopted Person PRIOR to Adoption

(Please fill out as much information as possible)

Information about Birth Parents

Please fill out as much information as possible about the adopted person's birth parents at the time of the adopted person's birth.

 

Birth Mother

Birth Father

Adoptive Parent Signature

If you are an adopted person under 18 years of age, this section must be signed by your adoptive parent who has lawful custody.

hereby confirms that:
1. I am the adoptive parent of 
2. I have lawful custody of 
I provide my consent for his/her application for non-identifying information under section 11 of O. Reg 464/07 made under the Child and Family Services Act.

Signed Statement by the Applicant

 

By signing this form, I hereby consent to a search being conducted of the records of Children's Aid Societies in Ontario and the examination and disclosure of any information in the possession of or under the control of a Children's Aid Society in Ontario, regarding myself. I understand that some Ontario Children's Aid Societies are using CPIN (Child Protection Information Network) as their documentation system. I understand that when an agency using CPIN searches for my record, it will find all records of my involvement with all Ontario Children's Aid Societies also using CPIN. I further understand that when an agency uses CPIN, now or in the future, my information will be entered in the Provincial Child Protection Information Network.

 

Document Submission

Documents to be Submitted with this Application:

Proof of Identity

Please provide copies of 2 different pieces of identification, one which contains an address matching the mailing address listed in this application form, and one which shows your signature. Examples of accepted identification are your provincial driver's license, health card, passport or certificate of aboriginal status. Please ensure that you copy both sides of each piece of identification.

Proof of Relationship

To the applicant - If you are not the adopted person, an adoptive parent or one of the birth parents but belong to one of the other categories listed in Part A, you will be required to provide proof of your relationship to the adopted person. The following is a list of documents that may contain information which can be used to demonstrate proof of your relationship to the adopted person (for some categories of applicant, a combination of documents listed below might best demonstrate proof of relationship):

  • Birth Certificate (long form) 
  • Statement of Live Birth
  • Medical records containing genealogical information
  • School records containing genealogical information or family ties
  • Church records containing genealogical information or family ties (e.g. Baptismal or marriage certificates)
  • Sworn court documents containing genealogical information or family ties
  • Obituary or death notice (mandatory when requesting information on a deceased adopted person)
  • Documentation of change-of-name status

Please check all the information and make sure all the supporting documents are attached before submitting this form.  Alternatively, email all documentation to disclosure@peelcas.org

 

Once you have successfully submitted this form, an automatic confirmation email will be sent to the email address you provided. The Disclosure office will also email you within 2 business days to acknowledge receipt of your request and provide an intake number. If you have not received your intake number after 2 business days, please contact us at disclosure@peelcas.org or call 905-363-6131 ext. 2504 to confirm that we received your request.

Terms of Acceptance and Signature

I, the requester, for this Disclosure Request Form, warrant the truthfulness of the information provided in this form.
I understand that checking this box constitutes a legal signature confirming that I acknowledge and agree to the above Terms of Acceptance.*
Please note: Peel CAS will not sell your email address or disclose your personal information to third parties without your consent.