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The birth parent information requested below is for processing purposes and will not be released to a requester if you wish to retain your privacy at this time.

Relationship to Child:
Note: Either Email or Address 1 and Zip Code are required. This information will only be used by Vital Statistics staff for purposes of follow up with the birth parent.
Password Requirements:
  • between 8 to 20 characters required
  • at least one letter uppercase and lowercase , one number and one symbol !@#$%^&*()_+-=?;:,<.> is required
Please type the text you see in the box below. Kaptcha Verification

By submitting this form, I certify that I am the birth parent of the adoptee and, that, to the best of my knowledge, the information I am supplying is correct and accurate. I understand that if I falsely represent that I am the birth parent of the adoptee on this form, then I may be subject to penalties pursuant to N.J.S.A. 26:8-69.