Hawaii International Child has received an application for adoption services from an applicant who has listed you as a reference. Your response is very important to this adoption. The information you provide may be shared with caseworkers, social workers, administrative staff and others involved in this adoption case and will be used to help determine whether a child placed for adoption with the applicants will be well cared for and protected. In some instances, because we are mandatory reporters, we may also be required to relay information we receive to child protective service agencies and/or to other appropriate authorities.

Your responses to the questions below will be kept confidential and will not be shared with the adoptive applicants unless:

We are required to do so by court order


Unless you give your written consent to release your completed reference form and the applicants can prove to our agency that completed reference forms are required for their adoption petition evidence. In these cases, we will send you a Consent to Release form along with a letter asking you to consider allowing us to release your completed reference form to the agency or government entity processing the adoption.

We ask that you respond to the questions on our reference form honestly and that you take no more than three days to complete it.. If you do not wish to act as a reference for the adoptive applicants, please indicate so by completing the contact information on the form and checking the applicable box at the top and submitting the form.

Thank you for your assistance in this matter.

The HIC Team

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