AR 187/2004 ADOPTION REGULATION (Consolidated up to 192/2013)
alberta regulation 187/2004
Child, Youth and Family Enhancement Act
ADOPTION REGULATION
Table of Contents
1 Definitions
1.1 Forms Part 1 Licensed Adoption Agencies
2 Definitions
3 Application for licence to operate agency
4 Fees
5 Inspection
6 Licence to be displayed
7 Application for adoption placement
8 Acceptance or refusal of application for adoption placement
9 Home assessment report
10 Decision of agency
12 Consents and counselling
13 Placement of a child for adoption
14 Post-placement assessment
15 Prohibition
16 Termination of adoption placement
Direct Placement Adoption
17 Direct placement
General
18 Post-placement counselling services
19 Additional information
20 Transfer of documents
21 Duties of agency
22 Program director
23 Fees and expenses
24 Trust account
25 Advertising
Part 2 International Adoption
26 Definitions
27 Application for international adoption
28 Dealing with application
29 Notification of changes
30 Approval of adoption placement
31 Adoption where no approval required
32 Designation of competent authority
Part 4 Repeals, Expiry and Coming into Force
34 Repeal
35 Expiry
36 Coming into force
Forms
Definitions
1 In this Regulation,
(a) “Act” means the Child, Youth and Family Enhancement Act;
(b) “agency” means a licensed adoption agency;
(c) “Appeal Panel” means an Appeal Panel established under section 118 of the Act;
(d) “director” means a person designated by the Minister as a director for the purposes of the Act;
(e) “qualified person” means a qualified person as defined in the Child, Youth and Family Enhancement Regulation.
Forms
1.1 The forms referred to in this Regulation are the forms set out in the Schedule.
AR 251/2009 s2
Part 1 Licensed Adoption Agencies
Definitions
2 In this Part,
(a) “adoption placement” means the placement of a child with an approved applicant for the purpose of adoption of the child by the approved applicant;
(b) “applicant”, except in sections 3 and 5, means a person who applies to an agency for an adoption placement;
(c) “direct placement” means the placement of a child directly by the child’s parent in the custody of a person who intends to adopt the child.
Application for licence to operate agency
3(1) In this section and section 5, “applicant” means a person who applies to a director for a licence to operate an agency.
(2) An application for a licence to operate an agency must be in Form 1 and must be accompanied by the following documentation:
(a) evidence satisfactory to the director
(i) that the applicant is a corporate body described in section 87(1) of the Act, and
(ii) that the applicant has obtained general liability insurance, satisfactory to the director, covering the proposed agency and its employees;
(b) a list of contract and staff positions, including a job description for each position and the qualifications and experience required for each position;
(c) a written description of the applicant’s proposed program and procedures, including an explanation of the applicant’s policy regarding
(i) recruitment and assessment of persons who apply for an adoption placement,
(ii) recruitment of persons who wish to place a child for adoption through the agency,
(iii) provision of counselling services for persons who apply for an adoption placement and for adoptive parents,
(iv) provision of counselling services for persons who wish to place a child or who have placed a child for adoption through the agency,
(v) advertising of adoption services, and
(vi) processing or assistance with the processing of direct placement adoptions;
(d) a fee schedule for the services provided by the agency;
(e) any other information that the director considers necessary to enable the director to determine the capacity of the applicant to provide the services and carry out the responsibilities of an agency.
(3) An application for the renewal of a licence to operate an agency must be in Form 1 and must be accompanied by
(a) if there has been a change in any of the information referred to in subsection (2)(a)(ii), (b), (c) or (d) since that information was last provided by the applicant, a statement of the changes, and
(b) any other information that the director considers necessary to enable the director to determine the capacity of the applicant to continue to provide the services and carry out the responsibilities of an agency.
AR 187/2004 s3;251/2009
Fees
4(1) The fee payable with an application under section 3 is
(a) $200 for an initial licence, or
(b) $100 for a renewal of a licence.
(2) A fee referred to in subsection (1) is non‑refundable.
AR 187/2004 s4;117/2008
Inspection
5 On receiving an application for a licence to operate an agency, a director may inspect or cause to be inspected the premises from which the applicant proposes to operate the agency for the purpose of determining whether the applicant will be in compliance with the Act and this Regulation.
AR 187/2004 s5;251/2009
Licence to be displayed
6 A licence or conditional licence to operate an agency must be kept on the premises of the agency and must be available for inspection by any person.
Application for adoption placement
7(1) Any adult who maintains his or her usual residence in Alberta may apply to an agency for an adoption placement.
(2) On receiving an application under subsection (1), an agency must
(a) ensure that the applicant has been provided with a written description of the adoption services provided by the agency and the fee schedule for those services,
(b) advise the applicant that the results of an intervention record check are required and provide the applicant with a copy of the form approved by the director for that purpose,
(c) advise the applicant that the results of a criminal record check, including a vulnerable sector search and dated not earlier than 6 months prior to the date of the application, are required, and
(d) provide a director with a copy of the application within 14 days of receipt of the application.
AR 187/2004 s7;251/2009
Acceptance or refusal of application for adoption placement
8(1) After the receipt by an agency of
(a) the results of the intervention record check referred to in section 7(2)(b),
(b) the results of the criminal record check referred to in section 7(2)(c), and
(c) any other documentation requested by the agency from the applicant for the purpose of processing the applicant’s application,
the agency must accept or refuse to accept an application received under section 7.
(2) An agency must forthwith notify an applicant in writing of
(a) its decision under subsection (1), and
(b) if its decision is to accept the applicant’s application, the date of the acceptance.
Home assessment report
9(1) An agency must
(a) within 90 days of accepting an application for an adoption placement, complete a home study report in respect of the applicant in Form 9, and
(b) require the applicant to provide an update report in Form 4 every 12 months until the applicant receives an adoption placement.
(2) Notwithstanding subsection (1), if for any reason acceptable to a director an agency is unable to complete a home study report within the 90-day period, the director may, in writing, extend the time for completion of the home study report.
(3) An agency may require an addendum to a home study report, in Form 10, where the agency has reason to believe that there has been a significant change in circumstances such that the suitability of the applicant to have the care and custody of a child might be affected.
(4) Any update report prepared in accordance with subsection (1)(b), and any addendum to a home study report prepared in accordance with subsection (3), must be attached to and forms part of the home study report.
AR 187/2004 s9;251/2009
Decision of agency
10(1) On completion of a home study report in respect of an applicant, an agency must
(a) if in its opinion the applicant is a fit and proper person to have the care and custody of a child, approve the applicant for an adoption placement, or
(b) if in its opinion the applicant is not a fit and proper person to have the care and custody of a child, refuse to approve the applicant for an adoption placement.
(2) No approval shall be given under subsection (1)(a) until the applicant has received pre‑placement counselling services from a qualified person regarding the adoption process and the parenting of an adopted child.
(3) If, as a result of an intervention record check referred to in section 7(2)(b), a director has identified a concern regarding the suitability of an applicant to have the care and custody of a child, the agency shall not approve the applicant under subsection (1)(a) without the prior written consent of the director.
(4) An agency may, at any time before a child is placed for adoption with an applicant who has been approved under subsection (1)(a), rescind the approval if, in its opinion, circumstances have arisen or evidence has become available indicating that the applicant is not a fit and proper person to have the care and custody of a child.
(5) If an agency
(a) refuses to approve an applicant for an adoption placement, or
(b) rescinds the approval of an applicant for an adoption placement,
the agency must, not later than 10 days after that decision, provide a written notice to the applicant and a director setting out the decision and the reasons for it.
AR 187/2004 s10;251/2009
11 Repealed AR 251/2009 s7.
Consents and counselling
12 If the guardian of a child wishes to place the child for adoption through an agency, the agency must
(a) ensure that the guardian has been provided with a written description of the adoption services provided by the agency,
(b) make counselling services concerning the proposed adoption available to the guardian and to the child, if the child is 12 years of age or older, and ensure that the counselling services are provided by a qualified person,
(c) advise the guardian and the child, if the child is 12 years of age or over, that counselling services concerning the proposed adoption are also available through a director, and
(d) refer the guardian and the child, if the child is 12 years of age or over,
(i) to a director or lawyer for the completion of a consent to adoption, and
(ii) to a director for counselling services concerning the proposed adoption, if the guardian or the child, or both, request those counselling services from the director.
Placement of a child for adoption
13(1) No agency shall place a child for the purpose of adoption with an applicant
(a) who has not been approved by the agency in accordance with section 10, or
(b) if the applicant has received an adoption placement in the previous 12‑month period.
(2) Subsection (1)(b) does not apply if
(a) the child who is proposed to be placed with the applicant is a sibling of the child previously placed with the applicant for the purpose of adoption, or
(b) the applicant’s previous adoption placement is no longer subsisting.
(3) Before placing a child with an approved applicant, an agency must
(a) ensure that it has obtained
(i) a report in Form 5 prepared by a qualified person setting out
(A) the social history of the child and the biological parents of the child, and
(B) the medical history of the biological parents of the child,
and
(ii) a medical report on Form 6 in respect of the child prepared by a physician,
(b) be satisfied that the child is a Canadian citizen or has been lawfully admitted to Canada for permanent residence, and
(c) make every reasonable effort to obtain
(i) a consent to adoption signed by the guardian of the child and witnessed by a director or lawyer, and
(ii) if the child is 12 years of age or over, a consent to adoption signed by the child and witnessed by a director or lawyer.
(4) If a consent referred to in subsection (3)(c)(i) cannot reasonably be obtained before placement of a child, the agency must notify a director of the reason why a consent cannot reasonably be obtained before placement and may place the child with an approved applicant only if the director, on being satisfied that the consent will be given by the guardian within a reasonable time period, agrees to the placement.
(5) An agency must ensure that copies of the reports referred to in subsection (3)(a)(i) and (ii) are provided
(a) to the approved applicant prior to the placement of the child with the approved applicant, and
(b) to a director within 21 days after the adoption placement.
(6) In the case of a proposed adoption placement of a child whose biological father is not also a guardian of the child, the agency must, before placing the child with the approved applicant, notify or make reasonable efforts to notify the child’s biological father of the proposed adoption placement.
(7) The agency must document the notification or the efforts to notify the biological father required under subsection (6) and must provide the documentation to a director within 21 days after the adoption placement.
(8) The agency must, within 21 days after the adoption placement, notify a director in writing of the adoption placement.
AR 187/2004 s13;117/2008;251/2009
Post-placement assessment
14(1) The agency must ensure that the home of the approved applicant is visited by a qualified person, as soon as practicable but not later than 21 days after the child is placed in the home, for the purpose of commencing a post‑placement assessment of the approved applicant.
(2) A post‑placement assessment of the approved applicant must be in Form 7 and must be
(a) completed as soon as appropriate, in the opinion of the agency, after the adoption placement, and
(b) attached to the approved applicant’s home study report.
AR 187/2004 s14;251/2009
Prohibition
15(1) No agency shall
(a) place a child for the purpose of adoption outside Alberta,
(b) place or attempt to place a child for the purpose of adoption unless the child is a Canadian citizen or has been lawfully admitted to Canada for permanent residence,
(c) place or attempt to place a child for the purpose of adoption, if the child is in the custody of a director within the meaning of section 1(5) of the Act, unless the agency has the written authorization of a director, or
(d) place or attempt to place a child for the purpose of adoption if the child is in the custody or under the guardianship of a child welfare authority in another province, unless the agency has written authorization from that child welfare authority.
(2) Subsection (1)(a) does not apply to an agency that is permitted by the laws of another province or territory of Canada to place children for adoption in that province or territory.
Termination of adoption placement
16(1) An approved applicant may terminate an adoption placement prior to the granting of an adoption order by advising the agency in writing of the termination.
(2) On receiving a notice of termination in accordance with subsection (1), the agency must forthwith
(a) notify a director of the termination,
(b) notify the guardian and a parent, if the guardian is not a parent, of the termination, and
(c) advise the guardian of the guardian’s right to resume custody of the child.
(3) Before placing the child with an alternative approved applicant, the agency must, in accordance with section 12, refer the guardian and the child, if the child is 12 years of age or older, to a director or lawyer for the completion of a consent to adoption.
AR 187/2004 s16;251/2009
Direct Placement Adoption
Direct placement
17(1) A person with whom a child has been placed for adoption through a direct placement may apply to an agency to process, or for assistance with the processing of, the adoption.
(2) On receiving an application under subsection (1), an agency must
(a) ensure that the adopting person has been provided with a written description of the adoption services provided by the agency and the fee schedule for those services, and
(b) advise the adopting person of the requirements of section 63(3) of the Act.
General
Post-placement counselling services
18(1) An agency must provide post‑placement counselling services to the following persons, if requested by that person:
(a) an approved applicant;
(b) a person who has applied under section 17(1);
(c) an adoptive parent with whom the agency has placed a child for adoption.
(2) An agency must provide post‑placement counselling services to a guardian who has placed a child for adoption through the agency at any time after the adoption placement, for a period of up to 6 months following the granting of the adoption order, if the guardian requests those services.
(3) An agency must ensure that post‑placement counselling services are provided by a qualified person.
Additional information
19 Any information obtained by an agency following the granting of an adoption order and relating to the social or medical history of
(a) the child who is the subject of the adoption order, or
(b) the biological parents of the child who is the subject of the adoption order
must be forwarded to a director for retention for the purposes of disclosure under Part 2, Division 2 of the Act.
AR 187/2004 s19;251/2009
Transfer of documents
20 On the granting of an adoption order, an agency must transfer to a director all copies of the documentation in the possession of the agency that was filed with the Court in support of the application for an adoption order.
AR 187/2004 s20;251/2009;164/2010
Duties of agency
21(1) An agency must, on or before the last day of the 3rd month immediately following the end of the agency’s fiscal year, submit to a director
(a) an annual financial statement prepared by a registrant within the meaning of the Regulated Accounting Profession Act, and
(b) an annual report on the operation of the agency during the year to which the annual report relates, including the number of
(i) applications for adoption placements received,
(ii) home study reports completed,
(iii) applicants approved under section 10,
(iv) adoption placements,
(v) cases where an adoption placement was terminated under section 16 and the circumstances surrounding the termination,
(vi) cases where a child who was placed with an approved applicant for the purpose of adoption was removed from the approved applicant and the circumstances surrounding the removal,
(vii) applications under section 17(1),
(viii) adoption orders granted, and
(ix) contested court hearings relating to an application for an adoption order and the circumstances relating to each contested hearing.
(2) At the request of a director, the agency must provide to the director
(a) any statistical information and reports relating to the operation of the agency, or
(b) copies of any documentation or other records relating to an adoption or an adoption placement.
AR 187/2004 s21;251/2009;164/2010
Program director
22(1) An agency must designate a qualified person as the program director of the agency, who is responsible for the day to day operation of the adoption program of the agency.
(2) A program director designated under subsection (1) is considered to be the officer of the agency for the purposes of the Act and this Regulation.
(3) An agency must notify a director in writing not later than 10 days after
(a) the designation of a program director, and
(b) any change in the designation of a program director.
(4) The responsibilities of the program director include
(a) the supervision of qualified persons delivering the services of the agency, and
(b) the supervision and review of home study reports and addendums to home study reports, but do not include the preparation or completion of those reports or addendums.
AR 187/2004 s22;251/2009
Fees and expenses
23(1) An agency may charge to a person, other than a guardian who wishes to place or who has placed a child for adoption through the agency, the fees and expenses incurred in providing the following services:
(a) processing an application for an adoption placement;
(b) processing or assisting with the processing of a direct placement adoption;
(c) preparation of social histories of
(i) a child who is adopted or intended to be adopted, and
(ii) the biological parents of the child;
(d) preparation of a medical history of the biological parents of a child who is adopted or intended to be adopted;
(e) preparation by a physician of a medical report in respect of a child who is intended to be adopted;
(f) preparation of a home study report;
(g) preparation of an addendum to a home study report;
(h) pre‑placement counselling services for an applicant;
(i) transportation relating to the placement of a child for adoption;
(j) preparation of a post‑placement assessment;
(k) preparation, filing and service of documents and notices relating to an adoption and an application for an adoption order;
(l) post‑placement counselling services provided under section 18(1);
(m) transfer between agencies of an application for an adoption placement;
(n) legal services provided in connection with an adoption;
(o) any other services relating to an adoption that, in the opinion of a director, are necessary.
(2) An agency may charge to each approved applicant a flat rate fee to cover
(a) counselling services concerning a proposed adoption placement that are requested by a guardian who wishes to place a child for adoption through the agency, and
(b) post‑placement counselling services requested by a guardian who has placed a child for adoption through the agency.
(3) An agency may charge to a person whose child has been adopted the fees and expenses incurred in providing that person with counselling services relating to the adoption, where
(a) the counselling services have been requested by that person, and
(b) 6 months has passed since the granting of the adoption order, if the adoption was processed through the agency.
(4) Not later than 30 days after the making of an adoption order, an agency must provide to a director an itemized statement showing the fees charged in respect of the adoption.
AR 187/2004 s23;251/2009;164/2010
Trust account
24(1) An agency that requires payment in advance for any of its services must establish and maintain a trust account in a bank, treasury branch or trust company in which the funds received by the agency from a person who will be receiving services referred to in this Regulation must be deposited.
(2) Money paid into a trust account under subsection (1) may be withdrawn from the account only with the consent of the person who paid the money and only for fees and expenses specified in section 23 incurred by the agency for services provided to that person.
(3) Money remaining in a trust account after fees and expenses are paid must be returned to the person who paid the money to the agency.
(4) An agency must keep a separate book of accounts showing the deposits and withdrawals from the trust account, the name of the person for whom each deposit or withdrawal is made and the date of each deposit or withdrawal.
Advertising
25(1) An agency may advertise only in accordance with this section.
(2) Advertising by an agency must be in good taste and
(a) must be truthful, accurate and not misleading to the public,
(b) shall not claim or imply that the services of the agency are superior to those of another agency,
(c) shall not guarantee an adoption placement or the adoption of a child, and
(d) shall not publicize any service or activity that could identify
(i) an applicant,
(ii) a person who has applied under section 17(1),
(iii) an adoptive parent or a prospective adoptive parent,
(iv) a child placed or intended to be placed for adoption, or
(v) the guardian or biological parent of a child placed or intended to be placed for adoption.
(3) If a director is of the opinion that advertising by an agency contravenes subsection (2), the director may in writing order the agency to take the measures specified in the order within the time limits specified in the order.
AR 187/2004 s25;251/2009
Part 2 International Adoption
Definitions
26 In this Part,
(a) “international adoption” means
(i) an adoption to which Part 2, Division 6 of the Act applies by a person who is habitually resident in Alberta, or
(ii) an adoption by a person who is habitually resident in Alberta of a child who is not a Canadian citizen and has not been lawfully admitted to Canada for permanent residence, other than an adoption referred to in subclause (i);
(b) “relative” means
(i) a grandparent,
(ii) an aunt or uncle, or
(iii) a great‑aunt or great‑uncle.
Application for international adoption
27(1) An application to proceed with an international adoption must be submitted to a director in Form 8.
(2) A director shall not accept an application to proceed with an international adoption involving a country that has been declared by the Minister as being unacceptable for the purposes of international adoption unless
(a) the applicant is a relative of the child to be adopted, and
(b) the director is satisfied that an application under the Immigration and Refugee Protection Act (Canada) for the child’s entry into Canada will be considered.
(3) Where the director accepts an application, the director must
(a) advise the applicant of the requirements of international adoption, and
(b) provide the applicant with an authorization to obtain a home study report from an agency.
AR 187/2004 s27;251/2009
Dealing with application
28(1) An applicant must submit a completed home study report in Form 9 to a director for approval.
(2) On receiving a completed home study report, the director may
(a) approve the home study report, if the director is satisfied that
(i) the home study report was completed no more than 6 months preceding its submission to the director,
(ii) the applicant meets the eligibility requirements for adoption in the child’s country of origin,
(iii) the applicant is eligible and suited to adopt, and
(iv) the applicant has received training satisfactory to the director on preparation for international adoption,
(b) request additional information
(i) from the applicant, or
(ii) from any source concerning the eligibility requirements for adoption in the child’s country of origin,
or
(c) refuse to approve the home study report.
(3) An applicant shall submit an update report in Form 4 to a director every 12 months after approval of the report under subsection (1) until the applicant receives an adoption placement.
(4) Subsection (2)(b) applies to an update report submitted under subsection (3).
(5) An update report submitted under subsection (3) must be attached to and forms part of the home study report.
(6) A decision of the director to refuse to approve a home study report or an addendum to a home study report prepared in accordance with section 29(2) may be appealed to an Appeal Panel by serving a notice of appeal as prescribed in the Child, Youth and Family Enhancement Regulation.
(6.1) An Appeal Panel may, after hearing an appeal under subsection (6),
(a) confirm the director’s decision, or
(b) refer the matter back for reconsideration by the director.
(7) An applicant shall not proceed with an international adoption until a director has, in accordance with this section, approved the applicant’s home study report and any addendum to the home study report required under section 29(2).
AR 187/2004 s28;251/2009
Notification of changes
29(1) An applicant must forthwith inform a director of any significant changes during the international adoption process that might affect eligibility or suitability to adopt including, without limitation, pregnancy, birth of a child, adoption of a child, absence from Alberta, poor health, changes in financial circumstances and changes in marital or adult interdependent relationships.
(2) A director may require an addendum to a home study report, in Form 10, where the director has reason to believe that there has been a significant change in circumstances such that the applicant’s eligibility or suitability to adopt might be affected.
(3) Upon receiving a completed addendum to a home study report, the director may
(a) approve the addendum to the home study report,
(b) request additional information
(i) from the applicant, or
(ii) from any source concerning the eligibility requirements for adoption in the child’s country of origin, or
(c) refuse to approve the addendum to the home study report.
(4) Any addendum to a home study report prepared in accordance with subsection (2) must be attached to and forms part of the home study report.
AR 187/2004 s29;251/2009
Approval of adoption placement
30(1) Where an international adoption, other than an international adoption to which Part 2, Division 6 of the Act applies, involves a child whose country of origin requires the director’s approval of an adoption placement, the director may, subject to subsection (2), approve the adoption placement of the child with the applicant if
(a) the applicant has agreed to the adoption placement,
(b) a home study report in Form 9 has been approved by the director and has been updated, where applicable, in accordance with section 28(3),
(c) any addendum to a home study report prepared in accordance with section 29(2) has been approved by the director, and
(d) the director and the responsible authority in the child’s country of origin have agreed that the adoption may proceed.
(2) The director may not approve an adoption placement of more than one child with an applicant in a 12‑month period unless
(a) the children to be placed with the applicant are siblings, or
(b) the director is satisfied that there are exceptional circumstances supporting the placement of more than one child with the applicant.
(3) Financial considerations related to the cost or timing of the application do not qualify as exceptional circumstances for the purposes of subsection (2)(b).
(4) A decision of the director to refuse to approve an adoption placement under this section may be appealed to an Appeal Panel by serving a notice of appeal as prescribed in the Child, Youth and Family Enhancement Regulation.
(5) An Appeal Panel may, after hearing an appeal under subsection (4),
(a) confirm the director’s decision, or
(b) refer the matter back for reconsideration by the director.
AR 187/2004 s30;251/2009
Adoption where no approval required
31 Where an international adoption, other than an international adoption to which Part 2, Division 6 of the Act applies, involves a child whose country of origin does not require the director’s approval of an adoption placement, the applicant shall
(a) obtain an adoption order in the child’s country of origin, and
(b) provide a copy of the original adoption order, and a translated copy of the adoption order, to the director.
Designation of competent authority
32 A director is designated as a competent authority for Alberta with respect to Part 2, Division 6 of the Act.
Part 3 General Provisions
33 Repealed AR 117/2008 s4.
Part 4 Repeals, Expiry and Coming into Force
Repeal
34 The following regulations are repealed:
(a) the Adoption Regulation (AR 37/2002);
(b) the Intercountry Adoption Regulation (AR 204/97).
Expiry
35 For the purpose of ensuring that this Regulation is reviewed for ongoing relevancy and necessity, with the option that it may be repassed in its present or an amended form following a review, this Regulation expires on June 30, 2017.
AR 187/2004 s35;192/2013
Coming into force
36 This Regulation comes into force on the date that sections 63 to 82 of the Child Welfare Amendment Act, 2003 come into force. Schedule
Form 1
Application for a Licence or to Renew a Licence to Operate an Adoption Agency
1 Regarding the application of (corporate name of applicant) I am (name) . I am authorized to represent the applicant.
2 Application
I am applying (check one of the following):
__ for a licence to operate a licensed adoption agency.
__ to renew a licence to operate a licensed adoption agency.
I have attached all the supporting documents required by section 3 of the Adoption Regulation.
I have enclosed the non‑refundable application fee of
__ $200 for an initial licence.
__ $100 to renew a licence.
3 Information about Applicant
1 Information about the applying corporate body:
Registered office address:
(telephone number)
2 Information about the agency, if different from the corporate body:
(name)
(address) (telephone number)
3 (Program Director)
4 Signatures
(authorized
officer’s signature) (date) Corporate Seal
(authorized
officer’s signature) (date)
Form 2
Notice of Decision: Licensing of Adoption Agency
1 To: (name of applicant or licensee)
Address: (address)
2 Licensing
Pursuant to section 88 or 89 of the Child, Youth and Family Enhancement Act, I give notice of my decision to:
__ refuse to issue a licence to operate an adoption agency:
__ refuse to renew your licence to operate an adoption agency:
__ issue a conditional licence to operate an adoption agency subject to the following terms and conditions:
__ suspend your licence to operate an adoption agency until such time as the following terms and conditions are met:
__ cancel your licence to operate an adoption agency.
The reasons for my decision are as follows:
You may appeal any decision noted on this form in accordance with section 120 of the Child, Youth and Family Enhancement Act.
This decision takes effect 30 days after the date of service of this notice.
3 Signature of director
(director’s signature) (date)
Form 3 Repealed AR 251/2009 s16.
Form 4
Home Study Report Update
1 Name of applicant(s):
Address:
Telephone: Business (applicant #1)
Business (applicant #2)
2 Change in Circumstances
Describe under the following headings the circumstances of any changes that have occurred since the completion of the home study report:
Part A Yes No Changes
Health
Education
Sources of income
Employment
Residence
Religion
Part B Yes No Changes
Marital or adult interdependent relationships
Family composition
Understanding of adoption issues
Child desired
Any other significant changes
(including any involvement with child intervention systems or criminal legal systems for all persons aged 12 years and over living in the home)
Part C Yes No Changes
References
3 Signatures
(Signature of applicant) (date)
(Signature of applicant) (date)
Form 5
Family and Medical History
1 Section 1: Child’s Information
A Name of child: (birthdate) (gender)
Birthplace and time of birth, if known:
Religion:
Has child been confirmed in child’s faith: yes no unknown
If yes, give details:
Racial Origin: Ethnic Origin:
If registered Indian, (registration number) Band: (name) Band: (number)
If Metis: (Metis settlement name or community)
Physical description of child:
Diagnosed birth or congenital health problems of child:
B Background (if newborn do not complete)
● Provide any information regarding where the child has lived, who parented the child, etc.
● Describe relationship with family or other significant persons.
C Development (if newborn do not complete)
● Discuss academic achievement and social adjustment to school.
● Describe any interests, hobbies or participation in sports.
● Provide copies of any psychological or psychiatric assessments which have been completed.
● Provide any known information regarding the child’s emotional, social, developmental or cognitive functioning.
D Personality (if newborn do not complete)
● Discuss child’s personality and behaviour.
2 Section 2: Birth Mother’s Information
Name and address of mother: (birthdate)
Birthplace: Religion:
Racial Origin: Ethnic Origin:
If registered Indian, (registration number)
Band: (name) Band: (number)
If Metis: (Metis settlement name or community)
Marital or adult interdependent relationship status:
Physical description: (height) (weight) (colour of eyes) (colour of hair)
Any unique features:
Education: Employment:
Interests:
Personality:
Relationship with family:
Other children born to birth mother:
(name) (birthdate) (gender)
(name) (birthdate) (gender)
Who is caring for these children:
Birth mother’s parents, brothers and sisters
(name) (address) (birthdate) (gender)
(name) (address) (birthdate) (gender)
● Describe any special talents, skills, traits within the family.
Additional comments of birth mother:
(signature of birth mother)
3 Section 3: Birth Mother’s Medical Information
● Describe the mother’s general state of health.
● Describe physical, mental, emotional or medical conditions and treatment obtained for those conditions.
● Describe extent of use of any drugs, alcohol or tobacco (including prenatal use).
● Describe prenatal care received by mother.
● Describe any significant physical, mental, emotional or medical conditions within the extended family and any treatment obtained.
4 Section 4: Birth Father’s Information
Name and address of father: (birthdate)
Birthplace: Religion:
Racial Origin: Ethnic Origin:
If registered Indian, (registration number)
Band: (name) Band: (number)
If Metis: (Metis settlement name or community)
Marital or adult interdependent relationship status:
Physical description: (height) (weight) (colour of eyes) (colour of hair)
Any unique features:
Education: Employment:
Interests:
Personality:
Relationship with family:
Other biological children of birth father:
(name) (birthdate) (gender)
(name) (birthdate) (gender)
Who is caring for these children:
Birth father’s parents, brothers and sisters
(name) (address) (birthdate) (gender)
(name) (address) (birthdate) (gender)
● Describe any special talents, skills, traits within the family.
Additional comments of birth father:
(signature of birth father)
5 Section 5: Birth Father’s Medical Information
● Describe the father’s general state of health.
● Describe physical, mental, emotional or medical conditions and treatment obtained for those conditions.
● Describe extent of use of any drugs, alcohol or tobacco.
● Describe any significant physical, mental, emotional or medical conditions within the extended family and any treatment obtained.
6 Section 6: Adoption Information
● Describe the relationship between the birth parents.
● Describe the circumstances surrounding the decision to choose adoption.
● Is a letter, picture or gift being left for the child?
● Have the birth parents been given background information about the adoptive family?
● Have the birth parents prepared a contact preference? (if yes, attach contact preference)
Is the birth father aware that the child has been placed for adoption? ___ yes ___ no
Additional comments of person preparing history:
(prepared by) (date) (reviewed by) (date)
Form 6 Medical Report
1 Regarding the child (name) , born (date)
Personal Health Number .
2 Referral
Date: (date)
To: (physician’s name) From: (caseworker)
(worksite)
(address)
(phone)
3 Information from Most Recent Care Giver
Feeding
__ seems normal for age
__ I am concerned about
Sleeping
__ seems normal for age
__ I am concerned about
Elimination
__ seems normal for age
__ I am concerned about
Development
__ seems normal for age
__ I am concerned about
Temperament
__ seems normal for age
__ I am concerned about
I also have concerns about:
(e.g. developmental delays,
abuse, behaviour)
4 Information from Human Services
Child’s medical history: Prenatal:
Mother’s health, nutrition, use of alcohol, tobacco, other substances;
Birth:
Describe delivery and child’s birth health, including vital stats and apgars, chronic illness, hospitalization, abuse:
Immunizations: Up to date
Not up to date
Name of public health centre:
Allergies:
Medications or Supplements:
I also have concerns about:
5 To be completed by a registered physician
5A Laboratory Findings (complete as necessary)
Test Date Results
Blood type
HB
Urinalysis
Urine C/S
TB test
Newborn
metabolic screening
Other
5B Physical Examination (complete as applicable)
Head circumference %tile
Height %tile
Weight %tile
Blood pressure %tile
Normal Abnormal N/A
Ant Fontanel
Head (shape/size)
Ears
Eyes
Oropharynx
Teeth
Lymph nodes
Skin
Nutrition/Iron
Endocrine
Respiratory
Heart
Abdomen
Umbilicus
Femoral pulses
Hernias
Genitalia
Nervous system
Upper limbs
Lower limbs
Hips
Vision
Hearing
Concerns
Summary
5C Assessment Summary
Healthy child; no concerns
Diagnosis
Prognosis
Care plan and/or recommendations: (describe follow-up plan)
6 Examining Physician
(name) (area of practice)
(address)
(phone) (date)
(physician’s signature)
Form 7
Post-placement Assessment
1 Name of applicant
Name of child (birthdate)
2 Assessment Information
I, (name) , (position) a qualified person under the Child, Youth and Family Enhancement Act, have assessed the adjustment of the applicant(s) and the child to the placement of the child in the home of the applicant(s) and report as follows:
1. Describe the child’s physical, mental and emotional level of development.
2. Describe the child’s contact with any health professionals and the child’s immunization program.
3. Describe the adjustment and bonding between the child, the applicant(s) and other family members.
4. Describe the home environment (including other people in the home, parenting abilities, quality of spousal relationship or adult interdependent relationship).
5. Describe any efforts that have been made to retain the child’s cultural identity.
6. Describe the applicant’s understanding of being an adoptive parent.
7. Provide comments by references regarding the adjustment of the child and the family to the adoption.
8. Do you believe the completion of this adoption is in the child’s best interests?
(completed by) (position) (date)
(reviewed by) (position) (date)
Form 8
International Adoption Application
1 Applicant Information (please print)
Applicant: (surname) (given names) M F
(telephone (residence)) (telephone (business)) (fax) (e-mail)
Applicant: (surname) (given names) M F
(telephone (residence)) (telephone (business)) (fax) (e-mail)
Address in full: (apartment number) (street number)
(city, province) (postal code)
We are using a Co‑ordinator to assist us with preparation of our adoption documentation.
Yes If yes, (Co‑ordinator’s name/organization)
(Co‑ordinator’s telephone number)
No
2 To be completed and signed by Applicants
● We want to adopt one child or a sibling group from:
(country) .
● We are related (grandparents, aunts, uncles, great‑aunts/uncles)
or
not related
to the child we wish to adopt.
● We understand that a director may not accept an application involving a country that has been declared as being unacceptable for the purposes of international adoption.
● We understand that a director will not support the adoption placement of more than one child within a 12‑month period unless the children are siblings, or there are exceptional circumstances.
● We understand that a director must approve our completed home study report and any addendum to our home study report before we may proceed with our international adoption.
● We understand that we must complete training on preparation for international adoption before a director will approve our home study report.
● We understand that if a director refuses to approve our home study report or any addendum to our home study report, we may appeal that decision to an Appeal Panel.
● We will inform a director of any significant changes to our lives during the international adoption process (pregnancy, birth of a child, adoption, absence from Alberta, poor health, financial or marital or adult interdependent relationship changes). We understand that the adoption process may be placed “on hold” until the child’s country of origin confirms that we continue to be eligible for adoption.
● We understand that it is advisable to consult with a physician regarding the child’s health before accepting placement of the child.
● We understand that the Government of Alberta does not provide legal advice in the processing of our adoption.
● We understand that we are responsible for all costs of our adoption.
(applicant’s signature) (applicant’s signature) (year/month/day)
3 Authorization
Authorization is given to the Applicants to obtain a home study report from an Alberta Licensed Adoption Agency (List attached) for an international adoption of one child or a sibling group from:
(child’s country of origin)
(Adoption Services designate’s signature) (year/month/day)
PLEASE NOTE:
● Home study reports and home study report updates remain in effect for one year. Home study reports and addendums to home study reports are valid only when they have been approved by a director.
● A director will provide instructions that need to be followed to process an adoption from a specific country. If the instructions of the director are not followed, the child may not be permitted to enter Canada.
Form 9
Home Study Report
To prepare the Home Study Report, provide information under each heading below.
Part 1: Applicants’ Information
Provide information about each applicant
Name on birth certificate
Other names, if any
Address, street, city, province, postal code
Mailing address if different from above
Telephone, (residence, business, cellular), e-mail
Birthdate, (year, month and day), birthplace
Marital or adult interdependent relationship status
Racial Origin Ethnic Origin
Registered Indian Band Name
Metis Metis settlement name or
community
Health, as supported by
medical
Education Employment
Religion
Languages system
Brief family history (include parenting style, familial relationships, significant childhood experiences, views of extended family on this application)
Involvement with legal and child intervention systems (include criminal record checks, including vulnerable sector searches, and intervention record checks within the last 6 months for applicants and everyone aged 18 years or over living in the home)
Personality
Part 2: Family Dynamics
Describe the following:
Family composition
Relationship dynamics
Previous marriages or long‑term relationships
Communications patterns
Autonomy of individual family members
Ability to solve problems and handle crisis
Emotional interactions
Family traditions
Philosophy on child rearing
Modes of behaviour control
Interests and hobbies
Social support network
What arrangements have been made for alternative guardians for the child (include names, ages, education, occupation and income. Complete for international adoption only.)
Part 3: Home and Community
Describe the following:
Physical space
Safe environment assessment (include safe storage of medications and weapons, if any)
Availability of resources
Community involvement
Contact with professional agencies
Part 4: Child Desired
Is the home study for a specific child? If yes, describe relationship and involvement with child and birth family
Age
Male / Female
Racial origin
Sibling group
Acceptable background characteristics
Acceptable special needs
Acceptability of birth family contact
Acceptability of sibling contact
Acceptability of an abandoned child with no background information
Acceptability of a child who has lived in an institution
Acceptability of legal risk placements
Compatibility of applicants and child desired
Does the assessor completing the home study agree with applicants’ choices?
Part 5: Income
Describe the following:
The source and level of income and expenditures (include T4 slips)
The effect of a placement on family’s finances
Part 6: Understanding and Motivation for Adoption
Describe the following:
Applicants’ understanding of the legal, social, inter‑racial and emotional aspects of adoption
Applicants’ plans to promote child’s cultural/racial/religious heritage and identity
Knowledge of the selected country (for international adoption only)
Applicants’ motivation for selecting the country (for international adoption only)
Part 7: References
References (3 references for each applicant, regarding suitability - including relationship to applicant, if any, on what basis judgment is made about applicant’s potential/actual parenting ability and summary of results of interview(s))
Part 8: Overview of Home Study Process
Date of personal visits (include amount of time spent at each interview and location of interview)
Persons interviewed (include confirmation that each person living in the home was interviewed separately and as a family)
Applicants’ training and activities in support of their application
Part 9: Summary of Outcome of Home Study
Report prepared by
Position
Date report prepared
Report reviewed by
Position
Date report reviewed
Report reviewed by applicants: signature and date
Part 10: Placement Supports
Needed supports and services
Arrangements for the provision of the identified supports/services
Part 11: Recommendation/Approval of Assessor
Assessor Recommendation
Approved
Not Approved (provide brief summary)
Approved by Director of Private Licensed Adoption Agency (for agency and international adoptions)/Supervisor
Approved by Director, Human Services (for international adoptions only)
Approved by Supervisor (for PGA/PGO adoptions)
Opinion of the child in respect of the application (if applicable)
Opinion of the child’s birth parents in respect of the application (if applicable)
This home study report is not valid until it is approved, under seal by Alberta Human Services (for international adoptions)
Form 10
Addendum to Home Study Report
Part 1:
Name
Address, street, city, province, postal code
Mailing address, if different from above
Telephone (residence, business, cellular), e‑mail
Part 2: Updated Information to the Home Study Report
(complete only those sections where changes have occurred)
Applicants Information
Health
Education
Source and level of income and expenditures (include T4 slips)
The effect of a placement on the adoptive family’s finances
Family Dynamics
Marital or adult interdependent relationship
Family composition
Arrangements for alternative guardian (international adoption only)
Social support network
Home and Community
Residence
Physical space
__ Safe environment assessment (include safe storage of medications and weapons, if any)
Availability of resources
Community involvement
Contact with professional agencies
Child Desired
Age
Male or Female
Racial origin
Sibling group (yes/no)
Acceptable background characteristics
Acceptable special needs
Acceptability of birth family contact
Acceptability of sibling contact
Acceptability of an abandoned child with no background information
Acceptability of a child who has lived in an institution
Acceptability of a legal risk placements
Compatibility of applicants and child desired
Does the assessor completing the home study agree with applicants’ choices?
Involvement with Legal and Child Intervention Systems
Applicants
Other residents in the home age 12 and over
Part 3: Other Significant Changes and Their Impact on Adoption
Part 4: Updated Documents (international adoption only)
Part 5: Overview of Addendum to Home Study Process
Date of personal visits
Persons interviewed
Part 6: Summary of Outcome of Home Study
Addendum prepared by (position/date)
Addendum reviewed by (position/date)
Addendum reviewed by applicants (signature and date)
Part 7: Recommendation/Approval of Assessor
Assessor Recommendation (Approved/Not Approved (provide brief summary))
Approved by Director of Private Licensed Adoption Agency (for agency and international adoptions)/Supervisor
Approved by Director, Human Services (for international adoptions only)
Approved by Supervisor (for PGA/PGO adoptions)
Opinion of the child in respect of the application (if applicable)
Opinion of the child’s birth parents in respect of the application (if applicable)
This Addendum is not valid until it is approved, under seal by Alberta Human Services (for international adoptions).
AR 187/2004 Forms;68/2008;117/2008;251/2009;31/2012
