Petition for Release of the Original Birth Certificate

* Required

In favor of an adult adoptee age 21 to obtaint their original birth certificate Yes    No    *

In Favor of adoptee age 18 to obtain background/health info? Yes    No     *
First Name
Last Name
Email Address
Re-type Email Address

Phone Number
Area Code: Phone:
I Am:
If you are an adoptee, adopted parent, birth parent or member of the adopted or birth family: did the adoption have a connection with S.C. (birth, adoption, termination, adopted/birth parent location) Yes    No

Which City & State Birth/Adoption

If Resident of SC - Are you a registered voter

Yes    No

Can we count on your support for law changes in S C for adoption reform? Yes    Not at this time   *
You will go to the confirmation page after you click submit button, please  check your info provided for all required areas indicated by *