Birth Father's Register

Application to be entered on the Father or Relevant Non-Guardian Register
Name*

First NameLast Name
Address*

Address Line 1

Address Line 2

Address Line 3Address Line 4

Eircode/Zip code
Date of Birth

DayMonthYear
Child's Name*

First NameLast Name
Child's date of Birth or expected date of delivery*

DayMonthYear
Relationship to the Child
Name of Mother

First NameLast Name
Address of Mother

Address Line 1

Address Line 2

Address Line 3Address Line 4

Eircode/Zip code
Name of Child and Family Agency(CFA) or accredited body (if known)
Name and Address of Applicants if known, and relationship to the child
I, First Name* Last Name* of Address Line 1* Address Line 2* Address Line 3* Address Line 4* Eircode/Zip code* wish to be consulted in relations to
1. a proposal by the CFA/accredited body to place the child referred to above for adoption, or
2. an application by the mother, step-parent or a relative of the child for an Adoption Order relating to the child.
Please note that the CFA/accredited body may, in the future, request a copy of any notice the Adoption Authority of Ireland may have received from the father of relevant not-guardian of a child proposed for adoption. As such time, your contact details will be referred to the relevant body.
Please select the certified proof of identity that your are uploading*

Biographic page (Photo) from your passportFull or Provisional Driving LicencePublic Service Card
Upload a copy of your certified proof of identity here *

Cancelof
Signature*

Clear
Date*

DayMonthYear
Should be Empty:

Application to be entered on the Father or Relevant Non-Guardian Register