IKB September 2026 Video ShootPlease complete this form in order to register a child on your caseload for our upcoming video shoot. Child Information Child's Name * Child's Age * Child's Gender * Female MaleRegion * Region 1 Region 2 Region 3 Region 4 Region 5Does the child go by a nickname or their middle name? * No YesYesIf "yes," please provide the nickname/middle name.Please note that Indiana code now requires us to utilize the child's name given at birth, as well as their biological gender. Exceptions may be granted for nicknames or middle names. There are no exceptions for gender identification at this time.Is the child part of a sibling group being recruited together? * No YesYesIf "yes," please provide the name(s) of the sibling(s). Note: all children must be registered separately.If a child is part of a sibling group that is being recruited together, the optimal scenario is to obtain video of the children together at the same time. We understand that this is not always possible, but highly recommend that every effort be made to have sibling groups participate together. Placement Location (City) * Placement Type * Foster Home Group Home Residential OtherOtherNeeds & Accommodations (select all that apply) * None Autism Non-verbal Physical limitations (wheelchair-bound, etc.) Food allergiesFood allergies OtherOtherTeam Information Adoption Consultant's Name * Email Address * Phone * Please provide a cell phone number, not an office number. FCM / OYCM's Name * Email Address * Phone * Please provide a cell phone number, not an office number.Transporter InformationDo you know who will be transporting the child? * Yes Not YetYou may register a child without having the complete transporter information. However, the child will not be assigned a video shoot time slot on the schedule until transporter information is provided and confirmed. Transporter's Name * Transporter's Title / Role in Child's Life * Transporter's Phone Number * Please provide a cell phone number, in case we need to reach the transporter while they are traveling to the shoot. Transporter's Email Address * Preferred Shoot Time * 8 AM - 12 Noon 12 Noon - 3 PM No preferencePlease note that we cannot guarantee specific time slots. We will do our best to accommodate transporter needs, and we appreciate your flexibility and understanding. Submit If you are human, leave this field blank.
