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Birthparent Services

Alliance Client Release Form

Birthparent Services

Authorization Form for Post-Placement Services

This form authorizes On Your Feet Foundation to contact you to offer post-placement services following placement of your child for adoption. Once this form is submitted, if you have indicated that you would like to be contacted, a member of On Your Feet Foundation's staff will reach out to you via the preferred method of communication selected below to tell you about the services you may access. Any of the services offered by On Your Feet Foundation may be accessed at any time following placement.

I,
authorize post-placement services to be provided by On Your Feet Foundation, 1555 Sherman Ave #173, Evanston, IL 60201.
I give permission for On Your Feet Foundation to contact me regarding their services/programs.
I would prefer to be contacted by:
I would like to be addressed as:
Pronouns
I give permission for On Your Feet Foundation and my agency/attorney to share information acknowledging my involvement in their services.
I acknowledge and agree to everything stated above.
I understand that information that has been released may be subject to re-disclosure by the recipient and is no longer protected by On Your Feet Foundation. I understand that this authorization may be revoked in writing at any time, prior to the specified expiration date. I understand that unless otherwise specified, this consent form will remain in effect for one year from the date of my signature. I understand and agree that a copy of this form shall be as valid as the original.
First Name *
Last Name *
Thank you for recognizing the importance of post-placement support: