| Sample Home
is a sample of the components that will be included in your home study
January 1, 2010
the couple – January 1, 2010
John – January 1, 2010 & January 4, 2010
Debbie – January 1, 2010, January 4, 2010
T. Saunders, Ph.D., L.C.S.W.
Father: John William Davis
Date of Birth: January 1, 1980
Ethnic Background: Your ethnicity
Physical Description: Height 6’0” and 180 lbs. Blond hair and blue eyes.
Mother: Debbie Lois Davis
Date of Birth: January 1, 1980
Ethnic Background: Your ethnicity
Physical Description: Height 5’2” and 140 lbs. Brown hair and hazel eyes.
CURRENTLY LIVING IN THE HOME:
has one adopted child Billy who
was born on January 1, 2005. He
sing songs, eat fruit, play with his toys and he has a kitches set he
loves to "cook" in. He
has always been full of energy and is very inquisitive.
Billy is healthy,
happy and do very well in the Davis
Billy has been one of the
highlights in their lives. The family also has a dog.
There are no others living
in the home.
FOR HOME STUDY/ADOPTION:
have been married for 9 years and they are incapable of having children. Debbie has a medical
have had many treatments and have
utilized all medical advice for becoming pregnant including artificial
insemination and many other tests.
medical attempts have been unsuccessful.
The couple met in Home Town,
and they have lived in their
home for 2 years. After they married, they
wanted children. They
have successfully adopted one child and
have had such good experiences with Billy who is now 2 years old. They wish to adopt again
Billy has been so positive.
Davis was born on February 12, 1960, in Home Town, Utah
with birth certificate). He was the first of three children for Jim and
Davis. His father, age 65, was a successful stock broker and
is now retired. His father's
financial success allowed his mother, age 63, to stay home and raise
their children full
time. He has a sister Samantha and a brother Steve, 29 and 25
Samantha lives with her spouse Bobby Jones and their two children,
Spencer, in Their
Steve is obtaining a degree in Accounting
and is currently single. They
are all in excellent mental and physical health.
John grew up in a very family oriented environment. They all regularly
where they were actively
involved in both church and community functions. Being a close-knit
entire family would attend any activity involving another member. They
took vacations together, whether it was a long weekend to go camping or
weeks during the summer to see some part of the country. One of his
trips was to the Grand Canyon.
As a young man
he was encouraged to be involved with school clubs and sports, as a
had many friends. All his friends were always welcome in their home to
participate in the family's festivities.
As a child singing in the church choir, John, first realized his love
and has gone on to have several songs published. In addition to writing
he enjoys reading and landscaping their yard. He has planted several
flowerbeds while maintaining a flourishing garden. He still enjoys
sports and is involved along with Debbie in church volleyball and
leagues. Although you will hear John joke, "Debbie can't play! She runs
from the ball if it comes near her!" She really is a good ball player.
Occasionally he will play racquetball or basketball at the community
John says he grew up in a wonderful and loving environment and hopes to
the same for his children. He is still very close to his family and
normally get together every couple of weeks to have a bar-b-que. He
himself as an out-going, musically inclined, faithful, and caring man,
believes family is the most important thing in life.
John is a graduate of Pleasant
with a degree in Music Education in 1983. He graduated with honors. John is a music teacher
for a Pleasant
School. (Confirmed) He has been
with this school since his college graduation in 1983. In the summer,
as a part time salesman for Sears.
was born May 30, 1961 in Home Town, Utah.
She is thirty-one years old and the middle child of Lyle and Mary
After forty years as a manufacturer's representative for several
companies, her 64-year-old father plans to retire next year. Besides
pressure that is thought to be a result of being overweight, her father
good health. Debbie's mother is 62 years of age and also in good
health. She is
employed as a part time occupational therapist that plans to retire at
time as Lloyd. Regarding siblings, Debbie has a brother and a sister,
Curtis and Cathy. Curtis is thirty-five and married Joan. They have
lovely daughters. JoAnn is ten. Cindy is eight. Marci is four. They
Cathy is twenty-nine and married John Logan. They have one son, Ben who
three. They live in Anywhere, California.
While she was growing up, Debbie always felt special to her parents.
Debbie always felt loved and cared for. Religion
was important but not a dominant force in her upbringing. It was common
father to frequently travel because of his job. Lloyd despite his time
always seemed to find the time to take the family on an annual two-week
vacation. He also arranged for them to go on numerous business trips
over the summer. Even though Lloyd traveled and was often away from
still felt he greatly influenced her life. Debbie's mother always made
out of the worst situation. It was not uncommon for her mother to make
and Cathy's clothes.
Debbie was involved with numerous school activities while growing up.
active in a group called "Rainbow" girls. Debbie loved theater and
auditioned for all school theatrical productions. It was normal for
acquire the lead roles in most productions. Beyond theater, she enjoyed
singing, sewing, knitting, watching TV, and playing softball. Debbie
was a very
good athlete and she still boasts that she can catch a ball better than
Debbie's family was then and still is very close. She has fond memories
childhood. Debbie does not see her brother as much as she would like,
understands the chaos that managing three children can bring. Debbie is
generally closer now with her sister Cathy. They usually talk at least
two weeks. Debbie
graduated in 1984
with her bachelor's degree in elementary education from Pleasant
University. Debbie has been
employed since 1984 as a
third grade elementary teacher at Pleasant Elementary in Pleasant, Utah.
plans on quitting her job upon placement of a child. She plans to
teaching once her child is old enough to start school.
John has life insurance with Pleasant Mutual Life valued at
has life insurance with the same company valued at
HEALTH: They are covered with Pleasant Shield Major Medical. (Verified)
covers the baby from time of placement. They must wait twelve months
Debbie have completed a criminal background check with The State Utah
Criminal Identification. A
received for both Debbie and John.
of the reports is dated 1/03/2008 and contains the verbiage
“No Criminal Record
Debbie also completed a child abuse check with Utah Division of Child and Family Services. A
received for both Debbie and John.
The report is dated 1/03/2010 and contains the verbiage “there were no supported or substantiated
records found naming the above person(s) as perpetrator of child abuse,
neglect, or dependency.”
Neither John nor Debbie has been the perpetrator
of a crime and have not been arrested.
Neither has been a
perpetrator of physical, emotional, or sexual abuse
nor a victim of physical, emotional, or sexual abuse.
NEGLECT, DOMESTIC VIOLENCE, SUBSTANCE ABUSE:
Debbie spoke openly about their background, upbringing and their family. They have never
participated in drug and
alcohol use or abuse. They
strongly in abstaining from these substances are teaching their child
and have strong religious beliefs in this regard.
The matter of drugs and
alcohol was handled
in their family of origin by their parents teaching them to abstain
because of strong religious beliefs and they were encouraged to talk to
parents if there were any issues related to drugs or alcohol. In their families, they do
have a individuals
who have struggles with drugs and alcohol.
The family shields their
child from this and they do not have much
contact with them. If
they do visit,
they are respectful and do not use substances in front of them. They have specifically
talked with each other
about the issues relating to drug and alcohol abuse and have discussed
a problem developed in their family it would be handled utilizing
consequences including intervention, discussions and rational teachings
the detrimental effects of alcohol and drug use.
and Debbie denied that they have been the victims of child abuse. They denied that they had
ever committed or
been accused of an act of abuse on any child or ever committed or been
of an act of abuse or neglect on any disabled person or adult. They have not been the
victims of any type of
assault or domestic violence and have not been accused of an act of
violence. They have
never broken or been
accused of breaking the law. The criminal background reports received
The Davis's home is tucked away on a
residential street located in the town of Anywhere, Utah.
Their neighborhood is pleasantly
supported with good neighbors and children of all ages. Their church
are both within walking distance of their home.
Their home has approximately 3200 square feet and is two stories. The
floor contains a living room, dining room, kitchen, laundry room and
and a small room that can be used as a playroom. The second floor
three bedrooms with walk in closets and a full bath. The home is
furnished and housekeeping standards are good.
buying their home. They have lived at this address for the past three
They do not have any plans to move in the near future.
reference letters are positive and supportive of the Davis'
plans to adopt. One reference said,
"They are unique among our friends as responsible, kind and outgoing.
" Letters have been received from three friends, a family member and
their spiritual leader.
Letters were received from Todd Samuels of His Town, California; Mrs.
John (Brenda) Betty, Anywhere, Utah;
Mrs. Greg Carter, Anywhere, Utah;
(Shelly) Pinto, Anywhere, Utah
and Steven D.
THE PREPARATION FOR ADOPTION:
loving parents. Billy receives appropriate suggestions for his age as
proper punishment by way of time out. Talking and explanations are ways
and Debbie help Billy to learn right from wrong. They generally enjoy
outings and often involve Billy in the planning's of such outings.
repeatedly suggests the park. Two
week, the Davis'
send Billy to a day care. The other three days a week he stays with a
day care provider while the Davis'
are teaching. During the summer, he stays at home with his mother.
are willing to
meet with the birth parent if that is their desire. They wish to be
only on first name basis. They are willing to send pictures and letters
birth parent(s) as well as receive letters from the birth parent(s) via
adoption agency. They feel comfortable sending letters and pictures
months for a year. At the end of that year, they will then decide if
Debbie met while attending the University. After only a few dates, they
to date exclusively. Debbie states it was "love at first sight" for
her. For John, the love grew greater with each date and their
together. John has been so pleased that his feelings for Debbie have
graduation, he married
Debbie. They were
married March 4, 1983
at the local Church, in Home Town, Utah.
(Confirmed by marriage
Debbie and John family backgrounds were very similar. John and Debbie
similar hobbies. When either is involved in separate activities the
very supportive. Debbie and John both feel that they can discuss
naturally share their most intimate feelings. They feel they are "best
and Debbie have been very specific about educating Billy and
teaching him values including the importance of work by providing
for him to do small jobs and have responsibilities in their home. Debbie supports John in
his employment and
John supports Debbie in hers. They
established a good balance between work and fun.
Debbie has been the primary
care giver of Billy. They
also have good family support including
parents, siblings, aunts and uncles and a very supportive neighborhood. They do not perceive any
their work schedule and the time required to care for another child.
is tremendous positive support that can and has been
rendered by their extended family to the family and to Billy and any
children. They have discussed adoption extensively with the extended
members and they are very supportive of this decision.
They have discussed and
considered with their
family how the family members will feel, think, and act about a child
different race and/or culture than some family members.
Debbie’s family is
of mixed heritage, John’s
is Caucasian only. The issue of the family treating an adopted child
than a biological child has been discussed and addressed. There are specific family
celebrations throughout the year including every holiday, family
family vacations that the adoptive children will benefit from by
and Debbie are members of the local Church.
They are active in their
church and community
with much involvement and a great deal of their time is volunteered. Religion has played a
significant role in
their moral/personal growth and development by providing them stability
firm beliefs in God and that there is a specific purpose for their
and for their adherence to eternal principles.
The church does have
extensive family services and support that is
offered to families including issues related to adoption.
have a gross combined annual income of $84,000 with a net income of
(Verified by IRS statements) John has an annual gross income of
has an annual gross income of $42,000 as well.
They have approximately $100,000 in assets. This consists of $10,000 in
savings and checking accounts, $20,000 in stocks and bonds, $30,000
vested in a
retirement plan through both of their employers. Their home is valued
$200,000 and they have a thirty-year mortgage with a balance of
pay $1100 a month on the mortgage and that includes insurance. Together
car payment, house payment, utilities, food, insurance, etc. they pay
approximately $4000 per month. They have enough left over that they can
afford a child into their family.
in good health. He had the usual childhood illnesses. He has
surgery or serious illness. He sees Dr. Good and was last seen on
11/1/08. Debbie is in good health. She had the usual
She has had extensive treatment for her infertility. She is physically
of parenting a child. Her doctor is Dr. Sullivan and she was last seen
11/1/08. The family pediatrician is Dr. Butler who recently evaluated
found him to be in good health.
In case of
untimely deaths, the Davis'
John's sister and brother-in-law, Samantha and Bobby Jones of Their
Town, Utah to be the legal
guardians of their children. They feel Mr. and Mrs. Jones would be
parents because they currently have two lovely children. They
financially secure as Danny has a career as an attorney. The Davis’
currently are in the process of making
a will. They have a verbal agreement in place regarding this
will consider a boy or girl from a newborn to a toddler. They will
only a Caucasian child. It is possible Debbie and John will accept a
mild handicaps such as clubfeet, cleft palate, etc. They, however, will
accept a child with any neurological or mental handicaps. It was
them that it is often impossible to determine such neurological and
handicaps at birth. They will consider twins or a sibling group with
child not exceeding age 4 years.
I feel the Davis'
are sincerely motivated in their desire to adopt a child. After my
with John and Debbie, I find them to be mature, well-adjusted couple
strong desire to parent. It is my recommendation that an adopted child
greatly benefit the Davis'.
It is easy to conclude that a child would be welcomed into a loving,
family and would be given every opportunity to grow into his/her own
person. Without reservation, I
do not hesitate to recommend John and Debbie Davis as good prospective
Dated, and Notarized
ME, the undersigned authority on this day personally appeared
introduced to me by original documentation to be the person whose name
subscribed to the foregoing instrument, and acknowledged to me that
executed the same for the purposed and consideration therein expressed.
GIVEN UNDER MY HAND and seat
this ____day of__________, 2010