Portrait Request Form
In order to ensure that the child is shown in the best light possible, please be specific and include touching or compelling information if possible. 
Caseworker Name
Phone number Ext.
Cell phone
Email address
Agency name
Child’s name First Last
Adopt US Number
Best time(s) and day(s) for scheduling portrait







If child has siblings, please list all names and ages
Date of Birth mm/dd/year
Gender Male Female
How long has the child been in care?
Child’s favorite past time activities (please be specific)
Favorite food?
Favorite sport?
What grade are they in?
How are they doing in school?
What does the child want to do when he/she grows up? How does he/she intend to accomplish this?
What does the child excel in? (school subjects, math, science, sports, gardening, etc.)
Child’s personal characteristics (sweet, shy, intelligent, social, etc.)
Other things that make this child special
What type of family would the child like to be a part of?
Does the child have special needs? If so, please list.
What role, if any, do the current foster parents want to play in this child’s future?
Child needs to be included/listed: (Please check all that apply)

Heart Gallery



Has this child ever been involved with the media?
If siblings, should they be recruited for (photographed/interviewed) together?
AES Number
CAP Number

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