Request a Login – Adopt Kansas Kids

Tell Us About Yourself

Name *

Phone Number *

Email *

Agency *

Your Supervisor

Supervisor Name *

Supervisor Phone Number *

Supervisor Email *

Create Your Account

In an effort to promote better security, we recommend that you choose a password at least 10 characters long with a combination of letters and numbers. In the event the desired username or password is not available, one will be assigned to you.

Requested Username *

Requested Password *

Terms & Conditions

I hereby confirm that I am an employee of a child placing agency in Kansas who, as a result of work related duties, requires access to the Adoption Exchange (Adopt Kansas Kids) website.

I understand that my own username, password and IP (Internet Protocol) Address will be recorded in electronic form for the purpose of verifying the submission of this form. I understand that I am not anonymous, and that use of my assigned log-in information by any other parties will result in my employer being notified and my access to the Adoption Exchange (Adopt Kansas Kids) website permanently terminated.

I accept the terms & conditions. *

Exchange Contact Name *

Date *