• Contact Preference Register (CPR) - Form A

    Application Form A: For people looking to contact or share information with their relatives
    • Section 1: About this form 

    • Please read the CPR information leaflet before you complete this form

      We encourage you to give us as much information as possible. The more information we have to work with, the greater are the chances that we will help you make a match with relatives.

       

      What is the Contact Preference Register (CPR)?

      The main function of the Contact Preference Register is for people who have been affected by adoption to register their contact preferences and it can assist in facilitating contact between people who have been affected by adoption. If two applicants have joined the register and have registered that they would like contact with each other, this would be considered a possible match. 

      The register is also a way to lodge an item. Applicants can lodge an item like a letter or photograph for a specified person. The item will be given to the specified person if:

      • the specified person is matched with the person who lodged the item on the register and the specified person agrees to accept the item or
      • the specified person is an adopted person who has applied to the Adoption Authority of Ireland under BITA 2022 for their birth information and has chosen the option to accept provided items that may be on file for them. 

      About the words we used in this form

      We have tried to use terms (words) that would suit everyone involved in adoption. For ease of use, the terms ‘mother’ and ‘father’ refer to the ‘natural birth’ mother and ‘natural birth’ father. We use the term ‘applicants’ for people who register with the CPR.

       Personal identification (ID)

      You will need to include a copy of your personal identification with this form.

      The types of personal identification we accept are:

      • Passport
      • Driving Licence (including provisional licence)
      • Garda Age Card

       Nominating a friend or family member to complete this form on your behalf

      You can nominate a friend or family member to complete this form for you. What you have to do is:

      1. Sign or make your mark at the end of the application form.
      2. In a separate letter of consent, give the name of the friend or family member who is going to help you. Tell us if you are happy to allow them to act and be contacted on your behalf. All correspondence will still be addressed to you. 
      3. Date and sign or make your mark on your letter of consent. 
      4. Send us in the following:
      • Your signed application form
      • Your signed and dated letter of consent
      • A copy of your ID, valid and in date
      • A copy of ID for your friend or family member

      What happens after I send in my application form?

      When we receive this application form, we will write to you to let you know your details have been added to the Contact Preference Register (CPR).

      If we find a possible match for you on the CPR, you will be contacted by a member of our Social Work Team who will advise you of what the next steps are. This will depend on the contact preferences you and the person you are matched with have chosen, and may include the following:

      1. The sharing or requesting of information.
      2. The opportunity of contacting the applicant with whom you are matched.
      3. The opportunity to use the Adoption Authority’s mediation service.
      4. Access to any specific items that may have been lodged.

       

      For more information, please read our CPR information leaflet.

      If you wish to know about how we use and store your personal data, please read our BITA privacy statement.

       

    • Section 2: Your current personal details 

    • Section 2: Your current personal details

      Please provide your personal email address, postal address or phone number, so we can contact you to confirm that we have received your application form.
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    • Section 3: Details of the relative you would like to contact, share information with or express a contact preference for 

    • Section 3: Details of the relative you would like to contact, share information with or express a contact preference for

      Please do not use the form to ask for information. If you have questions, please send them to records@aai.gov.ie.

    • Relative 1

      If you are searching for, or seeking to share information with, more than one birth relative, then please give the details for each one.

    • Please give as much information as you can below. If you don’t have this information, just leave it blank.

      If you are unsure of this information, please give a rough idea of the date of birth or age and say that you are unsure.
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    • Relative 2

    • Please give as much information as you can below. If you don’t have this information, just leave it blank.

      If you are unsure of this information, please give a rough idea of the date of birth or age and say that you are unsure.
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    • Relative 3

    • Please give as much information as you can below. If you don’t have this information, just leave it blank.

      If you are unsure of this information, please give a rough idea of the date of birth or age and say that you are unsure.
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    • Relative 4

    • Please give as much information as you can below. If you don’t have this information, just leave it blank.

      If you are unsure of this information, please give a rough idea of the date of birth or age and say that you are unsure.
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    • Section 4: What level of contact do you want to have with this person? 

    • Section 4: What level of contact do you want to have with this person?

      You can choose more than one of these options. Please tick the boxes to show your preference
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    • Sharing or looking for information

      Please choose the relevant categories and use this space to share or request any medical or background information. If you need more space, please write on a separate page and upload it with your ID.
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    • Section 5: Other contact options 

    • Section 5: Other contact options

      Someone other than the specific person(s) you have named in Section 3 may join the register looking for you.
    • Section 6: Lodging an item of interest  

    • Section 6: Lodging an item of interest

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    • If you would like to send original letters, photographs or momentos (present, family heirloom etc.) for the person(s) named on your CPR application form, please package securely, include your name and contact details and send to the following address:

      Information and Records Unit
      Adoption Authority of Ireland
      Shelbourne House
      Shelbourne Road
      Dublin 4
      D04 H6F6

    • Section 7: Identification and signature 

    • Section 7: Identification and signature

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    •  

      By signing this form:

      • I acknowledge that to the best of my knowledge, all information given by me is true and accurate.
      • I consent to my scanned written signature or my electronic signature or my typed signature being used to authorise the processing and storing of my data on the Register.
      • I understand that I may withdraw my consent at any point by advising the Adoption Authority I wish to be removed from the Register.
      • I confirm that the personal identification provided by me is true and accurate.
    • Clear
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    • Note: This is an extremely serious and sensitive matter for those involved. The Adoption Authority will report any person who misuses this form to An Garda Síochána.

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