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This is all made up (the family part); hope that's okay.

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LN: Harper
H: Oliver John
W: Julia Rose (well, that's correct)
Any other children?: Adriana Sofia (5)

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# of children to adopt (as many as you like): 5
Any preferred countries: Israel, Russia, Spain/Mexico
Any preferred gender: girl
Any preferred ages: 0-5

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Would you be willing to adopt...
Sibsets: yes
Sibsets?: B
If yes, a) a sibset plus other children or b) one sibset altogether?:
eg. a) a brother and sister, and also 2 more children or b) two brothers and a sister

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Multiples:
Twins?: yes
Triplets?: yes
More?: no

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Disabilities:
Physical disabilities (eg. Deformities): yes
Emotional disabilities: no
Mental disabilities (eg. Down Syndrome): no
Long Term Illness (eg. Cancer): yes

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Travelling
Would you be prepared to travel...
--abroad to visit family (eg. Africa): yes
--to far away hospitals (eg. 5 hours away in the same country): yes
--a long way to family: yes

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Pets
Would you be prepared to look after the child's pet? yes
If so, are there any pets you wouldn't look after? (eg. snakes, spiders, or anything you are allergic to): snakes
Any preferred pets? cat/dog