THE COUNT 2024: SURVEY FOR NATIVE ADOPTEES

GOOGLE DRIVE PDF - take your cellphone to a printer like Staples or CVS to print out. Make copies for yourself, too.

PRINT THIS PAGE  (on computer: hit Ctrl/p buttons) (or copy and paste into new document) or request this survey using contact form

 

THE COUNT 2024 – SURVEY of NATIVE AMERICAN FIRST NATIONS ADOPTEES

FILL OUT WHAT YOU KNOW AS BEST YOU CAN. (Adoptees may not have all this information. ) If you are born in the US or Canada and were adopted, PLEASE PRINT and FILL out THIS SURVEY.  Make copies.  SAVE this paperwork in a safe place. (USE INK PEN)

TRIBALLY ENROLLED? Yes or No or Unsure. (circle one)

USA or CANADA?

 

IN REUNION? Yes or No.

YOUR BIRTH NAME:

YOUR ADOPTED NAME:

BIRTHDATE: (if known)

Where were you born?

CITY:

STATE/PROVINCE:

RESERVATION:

HOSPITAL:

BIRTH PARENTS NAMES:

 

ADOPTIVE PARENTS NAMES:

 

Original Birth Certificate : do you have a copy? Yes or No.

Fake Birth Certificate : do you have a copy? Yes or No.

MOST IMPORTANT: YOUR CONTACT INFORMATION:

HOME PHONE: (     )

MESSAGE PHONE: (a friend or relative) (     )

CELLPHONE: (      )

EMAIL: 

 

YOUR MAILING ADDRESS:

 

Did you have ADOPTEE SIBLINGS:  NAME, BIRTH DATES

100% CONFIDENTIAL

THIS PRIVATE INFORMATION will be used later to create a class action lawsuit.  Adoptees will be required to file an AFFIDAVIT with the court system at a later date.  This form and copies of your original adoption documents will be needed.

The count is to determine how many children were adopted through state and federal programs.

No accurate account has ever been published before.

It could be millions.

SHARE THIS SURVEY WITH OTHER ADOPTEES.

 

EACH MEMBER OF YOUR FAMILY WHO IS AN ADOPTEE NEEDS A FORM COMPLETED IN HIS OR HER NAME.

If you are born in the US or Canada, please complete this survey and print, store a copy in a safe place. 

If you are an adoptive parent or the birth parent of Native children (living or dead), fill out this form for each child.

If you know an adoptee who is incarcerated, fill out this form for them or mail them a copy of this survey. (LET US KNOW VIA EMAIL THEIR NAME AND PRISON AND PRISON NUMBER)

If you know an adoptee who committed suicide, fill out this survey form for them.

If you are the child of an adoptee who is deceased, fill out this form with your information.

QUESTIONS:

 

EMAIL: tracelara@pm.me to request a COPY OF THIS FORM.

Later, you will be given an address to mail COPIES of your adoption documents. 

KEEP THE ORIGINAL ADOPTION DOCUMENTS in a safe secure place.

MAIL SURVEY TO:

Trace Hentz

General Delivery

Greenfield, MA 01301