Consent Form

                        CONSENT TO BE INCLUDED IN THE
        NEW JERSEY ADOPTION RESOURCE CLEARING HOUSE
                                    (NJ ARCH) DIRECTORY

  _______________________________________, consents to having 
            (Name of Agency or Organization)           
information concerning the organization's services included in the New Jersey Adoption

Resource Clearing House (NJARCH) Directory.  We understand that the NJARCH

Directory will be available on the NJARCH Web Site and in print version.  We agree to

provide information to NJARCH and to periodically update the information provided.  We

understand that we may withdraw our name from the Directory, at any time by contacting

NJARCH.

 We understand that inclusion in the NJARCH Directory is not an endorsement of my

services by NJARCH, Children’s Aid and Family Services Inc., or the Division of Youth

and Family Services.

 We certify that the information provided to NJARCH is accurate. 

_________________________________                             _______________________
Name                                                                                      Agency or Organization

_________________________________                            _______________________ 
Signature                                                                                  Date

Phone/ Contact Number: ______________