WPCY L\p^b5(?O0+n#Wg"t(X~:>̟~9N FgV;j)WELy׮cZIҌ'Ûdu@~9 /Ε:A_w0%IS&jt{pp5x:{HNqqyYԌ_ ;^N Yd"ꯤ]R, S*<7Sy87Ɋ4kZ,-,;4dvPޥxȋ`2;ҝ7HlܮO` U ^ oW` c ЀRǦ#8 h(xYo%spg|w!cFL=ڣM(nժ.B:W) PJ|=ÕжK|4D-}/|\\$Yn&O^Y#2{W',dPG*:'Rq #zUN; % 0(w4 m 1 0Jc~ 0w 0X 0 0 06 0 0 1u 1< 1 1J UH 72NK^ MCanon PIXMA iP6000D0**00(9 Z6Times New Roman RegularX($ 1b#qCorel3|xU hCEIMQUY]aAutoList1""""""""i)1)a)(;3$2#  0  .3  0  (O;$0  2#  a  .3  0` (#(#(b$0  0` (#(#2#   .3  0 ` (#` (#(xir$0  0` (#(#0 ` (#` (#2#(  0  )3  0 (# (#($0  0` (#(#0 ` (#` (#0 (# (#2#(  a  )3  0h(#(#(F$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#2#(   )3  0h(#h(#($0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#2#  0  )3  0(#(#({$0  0` (#(#0 ` (#` (#0 (# (#0h(#(#0h(#h(#0(#(#2#  a  )3  0p(#(#3#37=CIQYag1.a.i.(1)(a)(i)1)a) hCEIMQUY]aAutoList2""""""""i)1)a) hCEIMQUY]aAutoList3""""""""i)1)a) hCEIMQUY]aAutoList4""""""""i)1)a)* 0Times New Roman Boldi) 2 !  _  gXXg8HXdd8LifeFocusCenter  2211SouthHaciendaBlvd.,Suite103C  HaciendaHeights,CA91745  Phone:6263307990  Fax:6268555476  #XX7#&Xs%XXDr.ElaineKindle,Ph.D.,_LCSW_,BoardCertifiedDiplomat   AdoptionServiceProvider#XX%&Xs#XX ~  #gV##XHXgv#+   `     h      p   gXXHgAdoptionServiceProviderFeeAgreement#g##XHXgn# . ~  bTotheAdoptiveParents: h  Pleasereadthefollowingfeeagreement.Ifyouhaveanyquestionsorcomments,pleasecontact @  meimmediately.Forfurtherinformation,pleaserefertotheAdoptiveParentletter. ,   BasicFee:   $700retainerfeetobepaidinfull prior totheAdvisementMeetingwiththebirthparent(s).Ifa  secondmeetingisnotscheduledbecauseabirthmotherchangeshermindpriortoplacement, | $100willberefunded,minussupplementalcharges. h  ExplanationofFee:  @ TheAdoptionServiceProviders(ASP)feeisfor services providedtothebirthparent(s)priorto h thebirthofthebaby,pursuanttosection88015oftheFamilyCode. X The feecovers boththeAdvisementmeeting(uptoonehour)andthePlacementmeeting(upto 0 onehalfhour).Thefeealsocoversusualandcustomarypaperwork,includingareportmailedto   theadoptionagency,andtheinitialphonecallmadetothebirthmotherandtheadoptiveparents   (excludinglongdistancecharges).Overtimefeesarebilledatproratedcounselingfeesas   outlinedelsewhereinthisagreement. ! Pleasenotethat InterstateCompacts(_ICPC_) and NativeAmerican adoptionsinandof l#! themselvesnecessitateextratime,work,andexpenses. Multiplebirthplacements andbirth \$" coupleshaveadditionalpaperworkcharges. L% #  Undernormalcircumstances ,theAdvisementmeetingoccursatleasttendayspriortothebirth $'t"% ofthebaby.ThePlacementmeetingissignedafterthebirthmotherisdischargedfromthe (d#& hospital.Attimes,thebabyalreadymayhavebeenbornbeforetheAdvisementmeeting,or )P$' beforethetendaywaitingperiodisover.Underthesecircumstances,thetwomeetingsdescribed )<%( abovestillapply.Forfurtherinformation,pleaserefertothelettermailedtoyouorthatyou *(&) obtainedonlinewiththisfeeagreement. +'* Ї AdditionalFees:   Alladditionalcostswillbebilledtotheprospectiveadoptiveparentsandaredueuponreceipt:    (x3" 3"   32"3  0    AttimesweareaskedimmediatelytodoanAdvisement(within24hours).This d necessitatesarushedAdvisement,whichinvolvesswitchingaroundschedules.A$75 P  rushfeeappliesunderthesecircumstances. 3݌< (#(# Ќ  " 3"   3m2"3  0    Ifatherapyclientneedstobetakenoffsessiontoaccommodatetherushedadoption  d (whichshouldbearareeventsincetheschedulehasbeendesignedtoleavesufficient  P  timeforadoptionwork)theadoptiveparentsbecomeresponsibleforthecostofthat  <  session. 3m݌( (#(# Ќ  " 3"   3i2"3  0    Attimesweneedtomeetwithbirthparent(s)onSundaysorholidaystoexpeditethe   process.A$75feeappliesunderthesecircumstances. 3i݌ (#(# Ќ  " 3"   32"3  0    Travelingfeesforallmeetingsarebilledat$60anhourbytheASP;$25bythedriver 3݌t(#(# Ќ    whomakestworoundtripstobringthebirthparent(s)totheoffice=samefeeoutcome. `   Thereisa$20feeforgaspereachninetyminutesdrivetime. L " 3"   32"3  0    Parkingexpensesrelatedtotheadoption. 3݌$t(#(# Ќ  " 3"   32"3  0    Telephonecallstoorfromanypartyinvolvedintheadoptionprocessareconsidered L counselingandwillbechargedtimeandtoll.Timeiscumulative(example:tencallsat 8 tenminuteseachequals100minutes,or1hour40minutes).Initialphonecallare $ includedintheBasicFee. 3݌(#(# Ќ  " 3"   32"3  0    Faxingdocumentstoanypartyinvolvedintheadoptionischarged.50perpagetocover  operationcosts(e.g._IAPA_ԀandDeclarationofBirthMothertypicallygetsfaxedtothe  attorneytohelpexpeditethefilingprocess).Ahardcopyfollowsandisincludedinthe p BasicFee. 3݌\ (#(# Ќ   (xx " 3"   3:2"3  0    FederalExpress/OvernightmailtoanyagencyinvolvedintheAdoptionPlacement 4"  processat$25each. 3:g݌ #p!(#(# Ќ  " 3"   3i2"3  0    Iftheadoptiveparent,foranyreason,needsaseparatemeetingwiththeAdoptionService $H # ProvidertosigntheIndependentAdoptionPlacementAgreement(_IAPA_),_aka_,the %4!$ consent,_aka_,theplacementagreement,proratedcounselingfeesanddrivingfeeswillbe & "% chargedasdefinedelsewhereinthisagreement. 3i݌' #&(#(# Ќ  " 3 "   32"3  0    Thereisa$75peradditionalchildfeeformultipleadoptions(e.g.twoormorechildren) )$( beingplacedatthesametime. 3݌*%)(#(# Ќ   l+&* Ї" 3 "   3G 2"3  0    IfacaseisclosedpriortotheAdvisementMeeting,a$100feewillbechargedfor  preliminaryphonecallsandinitialpreparationwork. 3G t ݌(#(# Ќ  " 3 "   3!2"3  0    Ifanappointmentisscheduledandbirthparent(s)misstheappointment,counselingfees t willbecharged.Counselingfeesare$125per45minutes. 3!!݌`(#(# Ќ  " 3 "   3"2"3  0    Ifathirdmeetingisrequestedbythebirthmotherwithintendaysofsigningthe_IAPA_, 8  whichisoneofherrightsaccordingtotheFamilyCode,counselingfeeswillbecharged, $ t andmileage,ifitapplies. 3"%#݌ `(#(# Ќ  " 3 "   3$2"3  0    A$20filingfeeischargedforcompliancewithNativeAmericanIndianslawre:Tribal  8  clearance.Feesforadditionalserviceswillbebilledatproratedcounselingcharges. 3$$݌$ (#(# Ќ  " 3"   3=&2"3  0    IftheASPisrequestedtohelpcomplete_ICPC_Ԁdocuments,theextratimeisbilledat$200   perhour.Ifweareaskedtocompletetheentire_ICPC_Ԁdocuments,thefeeis$1,000. 3=&j&݌ (#(# Ќ  " 3"   3'2"3  0    Notaryservices,ifprovidedbytheASP,arethecustomary$10persignature.Ifdriving p timeisnecessary,drivingcharges,asoutlinedelsewhere,apply. 3'#(݌\(#(# Ќ  " 3"   3\)2"3  0    Ifadditionalreportsarerequiredforspecialcircumstances(e.g.varyingoutofstate 4 adoptioncodes)theseextrareportwritingfeeswillbebillat$125perhour. 3\))݌ p(#(# Ќ  " 3"   3*2"3  0    IfabirthmotherwishestheassistanceoftheASPtosignthewaiver(e.g.,drivingherto H theagencyandwaitingforhertomeetwiththesocialworker)alltimeinvolvedisbilled 4 at$125perhour. 3**݌ (#(# Ќ  " 3"   3t,2"3  0    Ifareportandpaperworkneedstobeforwardedimmediatelytotheadoptionagencyto  helpexpeditethesigningofthewaiveror_ICPC_Ԁclearance,apriorityfeeof$75willbe  charged. 3t,,݌(#(# Ќ  " 3"   3*.2"3  0    Intheunfortunatecasethatareclaimisnecessary,alloutstandingfeesowedtothe X  AdoptionServiceProviderneedtobepaid.IfthebirthmotherrequeststheAdoption D! ServiceProvidersassistance,theFamilyCodestatesthattheASPmustcomplywithin 0"  reasonandwithoutpersonalexpense. 3*.W.݌#l!(#(# Ќ  " 3"   3F02"3  0    Miscellaneousexpenseswillbedelineatedandchargedaccordingtocost(e.g.,birth $D # parentmealsiftheAdvisementoccursinaneutralsetting,suchasacoffeeshop). 3F0s0݌%0!$(#(# Ќ    (xx " 3"   3:22"3  0    Attimesweareaskedtoprovidebirthparentcounseling.TheFamilyCodestatesthat '#& birthparentsareallowedaminimumofthreeseparatecounselingsessionswiththeir (#' AdoptionServiceProvideroranylicensedtherapistoftheirchoice.Theadoptivefamily )$( paystheexpensesforcounseling.CounselingfeesatLifeFocusCenterare$125per45 |*%) minutehourtobepaidwhenservicesarerendered. 3:2g2݌h+&*(#(# Ќ    XXH˵FeeAgreementSignaturePage#˵4##XHX4# t 4PleasemakeyourcheckfortheBasicFeepayabletoDr.ElaineKindle,Ph.D.,ASP.Pleaseremit `  yourcheckwiththeattachedformandmailimmediatelytotheaddressabove.Keeptherestof L  thisFeeAgreementforyourreference.Thankyou. 8   XXHԀr#XHX6# 0  I/WehavereadandunderstandtheFeeAgreementandagreetothetermstherein.I/We L  understandthattheBasicFeeisduepriortotheAdvisementmeeting(unlessspecial `  circumstancesapply).L (#(#  XXHԀr#XHX<8# 0  TheBasicFeeisenclosed.(#(#  XXHԀr#XHX8# 0  I/WeunderstandthatundernormalcircumstancestheSupplementalFeemustbepaid  beforethepaperworkissenttotheCounty.(#(#  XXHԀr#XHX9# 0  IntheeventthatDr.Kindlerushesthepaperworkandreporttotheagencytohelp  facilitatethesigningofthewaiver,or_ICPC_Ԁclearance,I/weagreetoimmediatelypaythe  supplementalfeeinfulluponreceipt.(#(# __________________________________________________________________________ "H  ProspectiveAdoptiveParent0  0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#Date#4!(#(# __________________________________________________________________________ '"% ProspectiveAdoptiveParent0  0h(#(#0h(#h(#0(#(#0p(#(#0p(#p(#Date(#&(#(# 5/05 0,'* Ї