Pennsylvania Adoption Information Registry Birth Parent Authorization and Registration Form (CY 910)
Pennsylvania Department of Human ServicesAdoptionForm CY 910Free downloadLast verified November 10, 2026
Lets a birth parent or birth parent survivor register family history and contact preferences with the Pennsylvania Adoption Information Registry, and choose whether identifying information may be released. It goes to the registry at the Department of Human Services, not the vital records office.
Who can use this form
- A birth mother
- A birth father
- A birth parent survivor, such as the spouse, parent, sibling or child of a deceased birth parent
What to send with it
- Completed and signed form, typed or printed in black or blue ink
- A separate form for each child placed for adoption
- If you are also asking the Department of Health to redact your name: complete at least Sections I, IIa or IIIa, and VI
Where to send it
- Mail to
- Pennsylvania Adoption Information Registry P.O. Box 959 Camp Hill, PA 17001-0959
- State fee
- Not provided
- Typical processing
- Not provided
- Issued by
- Pennsylvania Department of Human Services
- Form revision
- 4/24
- Source
- Official government page