New Records System For Birth Parents

Create New Account

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:

Birth Mother Birth Father

Your Current First Name:

Your Current Middle Name:

Your Current Last Name:

Suffix:

Your Date of Birth:

Phone 1:

Type:

Phone 2:

Type:

Phone 3:

Type:

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.

Your Email:

Your Mailing Address:

Security Question 1:

Answer:

Security Question 2:

Answer:

Security Question 3:

Answer:

User Name:

Password Requirements:

between 8 to 20 characters required
at least one letter uppercase and lowercase , one number and one symbol !@#$%^&*()_+-=?;:,<.> is required

Password:

Confirm Password:

Verification:

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.

State of New Jersey
Department of Health

New Records System For Birth Parents

Department of Health, Office of Vital Statistics and Registry

State of New Jersey Department of Health

New Records System For Birth Parents

Department of Health, Office of Vital Statistics and Registry

State of New Jersey
Department of Health