You are on page 1of 2

This is to certify that

_________________________________________________
Name

Has Been Formally Adopted


Into _________________________ by _____________________
Family Name
Who adopted

And is Entitled to all the Rights and Privileges there to as One of the children.
ON THIS 21ST DAY OF SEPTEMBER 2012

________________________
Parent Signature over
printed name

________________________

Kahoy Dimaguiba
Administrator