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Welcome to the Putative Father Registry

Registration Form for Putative Fathers:

After you have completed this form, you must sign it electronically by typing your name in the certification box, and submit it to the Putative Father Registry by clicking on the "Submit" box. The Putative Father Registry must receive the registration before it will be considered filed and the Certification of Registration can be issued.
No one is allowed to register on behalf of a putative father!
Name
  First * Middle Last *
Other name/s by which you may be known:  
Address:*   Apt:   County:* 
City:*   State:*     Country:*   Zip Code: * 
Mailing Address (if different than residence)
Address:   Apt:   County: 
City: State:    Country:  Zip Code: 
Phone Number(s): (1)*  - - (2)  - -
Previous Address in last year
Address:   Apt:   County: 
City: State:    Country:  Zip Code: 
Employer's Information
Name Phone 
Address
City: State:    Country:  Zip Code: 
 
Social Security Number * - - Date of Birth * 
Physical Description
Race *     Height *  ft.  in.    Weight *  lbs.
Hair *         Eyes * 
 
Information About The Mother (Please complete as much as possible)
Name
  First Middle Last
Maiden Name    Other name/s by which the mother may be known: 
Address:   Apt:   County: 
City: State:    Country:  Zip Code: 
Mailing Address (if different than residence)
Address:   Apt:   County: 
City: State:    Country:  Zip Code: 
Phone Number(s): (1)  (2)   
Employer's Information
Name Phone 
Address
City: State:    Country:  Zip Code: 
 
Social Security Number     Date of Birth    Estimated Age 
Physical Description
Race     Height  ft.  in.    Weight  lbs.
Hair         Eyes 
 
Information About Child (Please complete as much as possible)
Name
  First Middle Last
Other Names: Nicknames: 
Sex:   DOB      Estimated Due Date of Mother 
Child's Place of Birth Hospital Name: 
City:   State:   County:   Country: 
  Has a court in Illinois or another state or territory of the United States ruled that you are the father of the child referenced here?    
If the answer to this question is yes, please attach a certified copy of the court order.

  • I understand that filing with the Putative Father Registry is only the first step in protecting my interests in being considered the legal father of the child and that I will have the right to object to an adoption only if I start legal proceedings to establish that I am the father. It is called a parentage action and must be completed with in 30 days of the date of my registration with the Putative Father Registry. For assistance with starting a parentage action, I must contact the Illinois Department of Public Aid. In Cook County contact the Division of Child Support Services at 36 S Wabash, 9th floor Chicago, IL 60603. For information to proceed in all counties, including Cook, I am to call 1-800-447-4278. There is a small fee that may be waived if I cannot afford it.
  • I understand that I must inform the Putative Father Registry if I change my address or if any other information changes on this form so that I can be located if the child I have identified becomes the subject of an adoption proceeding.
  • Attention! It is necessary to print this completed form and the Putative Father Registry Certification of Registration and keep for your records.
I have read, or someone has read to me, the information above before signing this form, and I understand that completing this form is not enough to protect my right to be the legal father of the child identified on this form.

Typing your name in the box below, is equivalent to signing the document.
Signature of Father: