Complete the Adoption Data Card (DSHS 10-114) on FormsPal in minutes. The form covers 4 pages of child information, birth parent details, and petitioner data. You must file the completed form with the court clerk when you submit your adoption petition in Washington State.
How to Fill Out the DSHS 10-114 Adoption Data Card
Before you start, gather these documents:
- The child's birth certificate
- Placement agreement from the adoption agency
- Special needs documentation (if applicable)
- Your attorney's contact information
Follow these steps to complete each section:
- Child Information (Part A): Enter the child's full legal name, date of birth, birthplace, sex, and race. Indicate whether the child has special needs and whether adoption assistance will be received.
- Birth Parent Information (Part B): Provide the birth mother's and birth father's date of birth, race, and marital status at the time of the child's birth. Leave fields blank only when the information is genuinely unavailable.
- Petitioner Information (Part C): Fill in the full name, date of birth, race, marital status, and prior adoption history for each adoptive parent. Include their relationship to the child.
- Placement and Court Information (Part D): Record the placement date, placing agency name, and the county where you file the adoption petition. Include the court case number and hearing date.
- Sign and date the form: The petitioner or their attorney must sign at the bottom. File the signed form with the court clerk along with the adoption petition under RCW 26.33.300.
Frequently Asked Questions About the Adoption Data Card
Who must complete the Adoption Data Card?
The petitioner (the adopting person or couple) or their attorney must complete and file the DSHS 10-114 in Washington State. It is required for all adoptions, including step-parent adoptions, foster care adoptions, and adoptions of children with special needs.
Where do I file the completed form?
File the Adoption Data Card with the court clerk in the county where you submit your adoption petition. The clerk forwards the form to the Washington Department of Social and Health Services for statewide adoption reporting under the AFCARS federal mandate.
Can I submit the form online?
Currently, the DSHS 10-114 must be filed in person with the court clerk as part of the adoption petition package. You can fill it out online using FormsPal and then print and sign the completed form before filing.
What if information about the birth parents is unavailable?
Birth parent fields may be left blank when the information is genuinely unknown. Complete all petitioner and child fields as fully as possible to avoid delays in your adoption hearing.
Is this form required for international adoptions?
The DSHS 10-114 applies to adoptions finalized in Washington State courts. For international adoptions that are re-domesticated in Washington, consult your attorney to confirm whether filing is required.
For related forms, see the Certificate of Adoption form, the New York Adoption Form, and the Georgia Adult Adoption Petition Form. You can also access the Alabama Adoption Report and the Kansas Report of Adoption in the FormsPal library.