Orphan Train Rider Form

Orphan Train Rider Form

Birth Name:

Adopted Name:

Was this person legally adopted?

Other surnames (such as married names) used:

Date of Birth:

Birth Place:

Sending Organization:

Date taken on train:

Railroad:

Agent in Charge:

Town and state taken to:

Family taking child:

Siblings (names if known):

Other Information:

Person submitting Information:

Name:

Relationship to Rider:

Address:

City:

Zip Code:

State:

Phone:

Email:

Yes or No

The information I submit may be placed in the OPEN RESEARCH FILES for gathering data and compiling reports
about the Orphan Train era.

The information I submit may be made available to media representatives

The information I submit may be make available to writers researching for books, articles, or productions.

My name and address may be given to anyone inquiring about the information I have submitted.

The information I submitted may be copied and included in educational packets.

The information I submitted may be printed in Crossroads.

The information I submitted may be used on the website to educate America about the Orphan Trains.

Are you submitting this information for research or to register a rider?
(please indicate which one)