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Public Act 096-1461
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| HB6080 Enrolled | LRB096 18717 AJO 36573 b |
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AN ACT concerning civil law.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The Adoption Act is amended by changing Section |
10 as follows:
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(750 ILCS 50/10) (from Ch. 40, par. 1512)
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Sec. 10. Forms of consent and surrender; execution and
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acknowledgment thereof. A. The form of consent required for |
the
adoption of a born child shall be substantially as follows:
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FINAL AND IRREVOCABLE CONSENT TO ADOPTION
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I, ...., (relationship, e.g., mother, father, relative, |
guardian)
of ...., a ..male child, state:
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That such child was born on .... at ....
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That I reside at ...., County of .... and State of ....
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That I am of the age of .... years.
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That I hereby enter my appearance in this proceeding and |
waive
service of summons on me.
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That I hereby acknowledge that I have been provided with a |
copy of the Birth Parent Rights and Responsibilities-Private |
Form before signing this Consent and that I have had time to |
read, or have had read to me, this Form. I understand that if I |
do not receive any of the rights as described in this Form, it |
shall not constitute a basis to revoke this Final and |
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Irrevocable Consent. |
That I do hereby consent and agree to the adoption of such |
child.
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That I wish to and understand that by signing this consent |
I do
irrevocably and permanently give up all custody and other |
parental
rights I have to such child.
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That I understand such child will be placed for adoption |
and that I
cannot under any circumstances, after signing this |
document, change my
mind and revoke or cancel this consent or |
obtain or recover custody or
any other rights over such child. |
That I have read and understand the
above and I am signing it |
as my free and voluntary act.
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Dated (insert date).
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.........................
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If under Section 8 the consent of more than one person is |
required,
then each such person shall execute a separate |
consent.
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A-1. (1) The form of the Final and Irrevocable Consent to |
Adoption by a Specified Person or Persons: Non-DCFS Case set |
forth in this subsection A-1 is to be used by legal parents |
only. This form is not to be used in cases in which there is a |
pending petition under Section 2-13 of the Juvenile Court Act |
of 1987. |
(2) The form of the Final and Irrevocable Consent to |
Adoption by a Specified Person or Persons in a non-DCFS case |
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shall have the caption of the proceeding in which it is to be |
filed and shall be substantially as follows: |
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY |
A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE |
I, ...., (relationship, e.g., mother, father) of ...., a |
..male child, state: |
1. That such child was born on ...., at ....., City of ... |
and State of .... |
2. That I reside at ...., County of .... and State of .... |
3. That I am of the age of .... years. |
4. That I hereby enter my appearance in this proceeding and |
waive service of summons on me. |
5. That I hereby acknowledge that I have been provided a |
copy of the Birth Parent Rights and Responsibilities-Private |
Form before signing this Consent and that I have had time to |
read, or have had read to me, this Form and that I understand |
the Rights and Responsibilities described in this Form. I |
understand that if I do not receive any of my rights as |
described in said Form, it shall not constitute a basis to |
revoke this Final and Irrevocable Consent to Adoption by a |
Specified Person. |
6. That I do hereby consent and agree to the adoption of |
such child by .... (specified persons) only. |
7. That I wish to and understand that upon signing this |
consent I do irrevocably and permanently give up all custody |
and other parental rights I have to such child if such child is |
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adopted by .... (specified person or persons). I hereby |
transfer all of my rights to the custody, care and control of |
such child to ............................. (specified person |
or persons). |
8. That I understand such child will be adopted by |
....................... (specified person or persons) and that |
I cannot under any circumstances, after signing this document, |
change my mind and revoke or cancel this consent or obtain or |
recover custody or any other rights over such child if |
............................ (specified person or persons) |
adopt(s) such child; PROVIDED that each specified person has |
filed or shall file, within 60 days from the date hereof, a |
petition for the adoption of such child. |
9. That if the specified person or persons designated |
herein do not file a petition for adoption within the |
time-frame specified above, or, if said petition for adoption |
is filed within the time-frame specified above but the adoption |
petition is dismissed with prejudice or the adoption proceeding |
is otherwise concluded without an order declaring the child to |
be the adopted child of the specified person or persons, then I |
understand that I will receive written notice of such |
circumstances within 10 business days of their occurrence. I |
understand that the notice will be directed to me using the |
contact information I have provided in this consent. I |
understand that I will have 10 business days from the date that |
the written notice is sent to me to respond, within which time |
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I may request the Court to declare this consent voidable and |
return the child to me. I further understand that the Court |
will make the final decision of whether or not the child will |
be returned to me. If I do not make such request within 10 |
business days of the date of the notice, then I expressly waive |
any other notice or service of process in any legal proceeding |
for the adoption of the child. |
10. That I expressly acknowledge that nothing in this |
Consent
impairs the validity and absolute finality of this
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Consent under any circumstance other than those described in
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paragraph 9 of this Consent. |
11. That I understand that I have a remaining duty and
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obligation to keep .............. (insert name and address of |
the attorney
for the specified person or persons) informed of |
my current
address or other preferred contact information until |
this adoption has been finalized. My failure to
do so may |
result in the termination of my parental rights and
the child |
being placed for adoption in another home. |
12. That I do expressly waive any other notice or service |
of process in any of the legal proceedings for the adoption of |
the child as long as the adoption proceeding by the specified |
person or persons is pending. |
13. That I have read and understand the above and I am |
signing it as my free and voluntary act. |
14. That I acknowledge that this consent is valid even if |
the specified person or persons separate or divorce or one of |
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the specified persons dies prior to the entry of the final |
judgment for adoption. |
Dated (insert date). |
............................................. |
Signature of parent. |
............................................. |
Address of parent. |
............................................. |
Phone number(s) of parent. |
............................................. |
Personal email(s) of parent. |
............................................. |
(3) The form of the certificate of acknowledgement for a |
Final and Irrevocable Consent for Adoption by a Specified |
Person or Persons: Non-DCFS Case shall be substantially as |
follows:
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STATE OF..............)
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) SS.
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COUNTY OF.............) |
I, .................... (Name of Judge or other person), |
..................... (official title, name, and address), |
certify that ............., personally known to me to be the |
same person whose name is subscribed to the foregoing Final and |
Irrevocable Consent for Adoption by a Specified Person or |
Persons; non-DCFS case, appeared before me this day in person |
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and acknowledged that (she)(he) signed and delivered the |
consent as (her)(his) free and voluntary act, for the specified |
purpose. I am further satisfied that, before signing this |
Consent, ........ has read, or has had read to him or her, the |
Birth Parent Rights and Responsibilities-Private Form. |
A-2. Birth Parent Rights and Responsibilities-Private |
Form. The Birth Parent Rights and Responsibilities-Private |
Form must be read by, or have been read to, any person |
executing a Final and Irrevocable Consent to Adoption under |
subsection A, a Final and Irrevocable Consent to Adoption by a |
Specified Person or Persons: Non-DCFS Case under subsection |
A-1, or a Consent to Adoption of Unborn Child under subsection |
B prior to the execution of said Consent. The form of the Birth |
Parent Rights and Responsibilities-Private Form shall be |
substantially as follows: |
Birth Parent Rights and Responsibilities-Private Form |
As a birth parent in the State of Illinois, you have the |
right: |
1. To have your own attorney represent you. The prospective |
adoptive parents may agree to pay for the cost of your attorney |
in a manner consistent with Illinois law, but they are not |
required to do so. |
2. To be treated with dignity and respect at all times and |
to make decisions free from coercion and pressure. |
3. To receive counseling before and after signing a Final |
and Irrevocable Consent to Adoption ("Consent"), a Final and |
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Irrevocable Consent to Adoption by a Specified Person or |
Persons: Non-DCFS Case ("Specified Consent"), or a Consent to |
Adoption of Unborn Child ("Unborn Consent"). The prospective |
adoptive parents may agree to pay for the cost of counseling in |
a manner consistent with Illinois law, but they are not |
required to do so. |
4. To ask to be involved in choosing your child's |
prospective adoptive parents and to ask to meet them. |
5. To ask your child's prospective adoptive parents any |
questions that pertain to your decision to place your child |
with them. |
6. To see your child before signing a Consent or Specified |
Consent. |
7. To request contact with your child and/or the child's |
prospective adoptive parents, with the understanding that any |
promises regarding contact with your child or receipt of |
information about the child after signing a Consent, Specified |
Consent, or Unborn Consent cannot be enforced under Illinois |
law. |
8. To receive copies of all documents that you sign and |
have those documents provided to you in your preferred |
language. |
9. To request that your identifying information remain |
confidential, unless required otherwise by Illinois law or |
court order, and to register with the Illinois Adoption |
Registry and Medical Information Exchange. |
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10. To work with an adoption agency or attorney of your |
choice, or change said agency or attorney, provided you |
promptly inform all of the parties currently involved. |
11. To receive, upon request, a written list of any |
promised support, financial or otherwise, from your attorney or |
the attorney for your child's prospective adoptive parents. |
12. To delay signing a Consent, Specified Consent, or |
Unborn Consent if you are not ready to do so. |
13. To decline to sign a Consent, Specified Consent, or |
Unborn Consent even if you have received financial support from |
the prospective adoptive parents. |
If you do not receive any of the rights described in this |
Form, it shall not be a basis to revoke a Consent, Specified |
Consent, or Unborn Consent. |
As a Birth Parent in the State of Illinois, you have the |
responsibility: |
1. To carefully consider your reasons for choosing |
adoption. |
2. To voluntarily provide all known medical, background, |
and family information about yourself and your immediate family |
to your child's prospective adoptive parents or their attorney. |
For the health of your child, you are strongly encouraged, but |
not required, to provide all known medical, background, and |
family history information about yourself and your family to |
your child's prospective adoptive parents or their attorney. |
3. (Birth mothers only) To accurately complete an Affidavit |
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of Identification, which identifies the father of the child |
when known, with the understanding that a birth mother has a |
right to decline to identify the birth father. |
4. To not accept financial support or reimbursement of |
pregnancy related expenses simultaneously from more than one |
source. |
B. The form of consent required for the adoption of an |
unborn child
shall be substantially as follows:
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CONSENT TO ADOPTION OF UNBORN CHILD
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I, ...., state:
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That I am the father of a child expected to be born on or |
about ....
to .... (name of mother).
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That I reside at .... County of ...., and State of .....
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That I am of the age of .... years.
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That I hereby enter my appearance in such adoption |
proceeding and
waive service of summons on me.
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That I hereby acknowledge that I have been provided with a |
copy of the Birth Parent Rights and Responsibilities-Private |
Form before signing this Consent, and that I have had time to |
read, or have had read to me, this Form. I understand that if I |
do not receive any of the rights as described in this Form, it |
shall not constitute a basis to revoke this Consent to Adoption |
of Unborn Child. |
That I do hereby consent and agree to the adoption of such |
child, and
that I have not previously executed a consent or |
surrender with respect
to such child.
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That I wish to and do understand that by signing this |
consent I do
irrevocably and permanently give up all custody |
and other parental
rights I have to such child, except that I |
have the right to revoke this
consent by giving written notice |
of my revocation not later than 72
hours after the birth of the |
child.
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That I understand such child will be placed for adoption |
and that,
except as hereinabove provided, I cannot under any |
circumstances, after
signing this document, change my mind and |
revoke or cancel this consent
or obtain or recover custody or |
any other rights over such child.
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That I have read and understand the above and I am signing |
it as my
free and voluntary act.
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Dated (insert date).
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........................
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B-5. (1) The parent of a child may execute a consent to |
standby
adoption by a specified person or persons. A consent |
under this subsection B-5
shall be acknowledged by a parent |
pursuant to subsection H and subsection K of
this Section.
The |
form of consent required for the standby adoption of a born |
child
effective at a future date when the consenting
parent of |
the child dies or
requests that a final judgment of adoption be |
entered shall be substantially as
follows:
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FINAL AND IRREVOCABLE CONSENT
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TO STANDBY ADOPTION
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I, ..., (relationship, e.g. mother or father)
of ...., a |
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..male child, state:
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That the child was born on .... at .....
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That I reside at ...., County of ...., and State of .....
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That I am of the age of .... years.
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That I hereby enter my appearance in this proceeding and |
waive service of
summons on me in this action only.
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That I do hereby consent and
agree to the standby adoption |
of the child, and that I have not previously
executed a consent |
or surrender with respect to the child.
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That I wish to and understand that by signing this consent |
I do irrevocably
and permanently give up all custody and other |
parental rights I have to the
child, effective upon
(my death) |
(the child's other parent's death) or upon (my) (the other
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parent's) request for the entry of a final judgment for |
adoption if .....
(specified person or persons) adopt my child.
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That I understand that until (I die) (the child's other |
parent dies), I
retain all legal rights and obligations |
concerning the child, but at that time,
I irrevocably give all |
custody and other parental rights to .... (specified
person or |
persons).
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I understand my child will be adopted by ....... (specified |
person or
persons) only and that I cannot, under any |
circumstances, after signing this
document, change my mind and |
revoke or cancel this consent or obtain or recover
custody or |
any other rights over my child if ..... (specified person or
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persons) adopt my child.
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I understand that this consent to standby adoption is valid |
only if the
petition for standby adoption is filed and that if |
....... (specified person or
persons), for any reason, cannot |
or will not file a petition for standby
adoption or if his, |
her, or their petition for standby adoption is denied, then
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this consent is void. I have the right to notice of any other |
proceeding that
could affect my parental rights.
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That I have read and understand the above and I am signing |
it as my free and
voluntary act.
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Dated (insert date).
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....................
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If under Section 8 the consent of more than one person is |
required, then each
such
person shall execute a separate |
consent. A separate consent shall be executed
for each
child.
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(2) If the parent consents to a standby adoption by 2 |
specified persons,
then the form shall contain 2 additional |
paragraphs in substantially the
following form:
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If .... (specified persons) obtain a judgment of
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dissolution of
marriage before the judgment for adoption is |
entered, then .....
(specified person) shall adopt my child. I |
understand that I cannot change my
mind and revoke this consent |
or obtain or recover custody of my child if .....
(specified |
persons) obtain a judgment of dissolution of marriage and .....
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(specified person) adopts my child. I understand that I cannot |
change my
mind and revoke this consent if ...... (specified |
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persons) obtain a
judgment of dissolution of marriage before |
the adoption is final. I
understand that this consent to |
adoption has no effect on who will get custody
of my child if |
..... (specified persons) obtain a judgment of dissolution
of |
marriage after the adoption is final. I understand that if |
either .....
(specified persons) dies before the petition to |
adopt my child is granted, then
the surviving person may adopt |
my child. I understand that I cannot change my
mind and revoke |
this consent or obtain or recover custody of my child if the
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surviving person adopts my child.
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A consent to standby adoption by specified persons on this |
form shall have no
effect on a court's determination of custody |
or visitation under the Illinois
Marriage and Dissolution
of |
Marriage Act if the marriage of the specified persons is |
dissolved before
the adoption is final.
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(3) The form of the certificate of acknowledgement for a |
Final and
Irrevocable Consent for Standby Adoption shall be |
substantially as follows:
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STATE OF .....)
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) SS.
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COUNTY OF ....)
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I, ....... (name of Judge or other person) ..... (official |
title,
name, and address), certify that ......., personally |
known to me to be
the same person whose name is subscribed to |
|
the foregoing Final and Irrevocable
Consent to Standby |
Adoption, appeared before me this day in person and
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acknowledged that (she) (he) signed and
delivered the consent |
as (her) (his) free and voluntary act, for the specified
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purpose.
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I have fully explained that this consent to adoption is |
valid only if the
petition to adopt is filed, and that if the |
specified person or persons, for
any reason, cannot or will not |
adopt the child or if the adoption petition is
denied, then |
this consent will be void. I have fully explained that if the
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specified person or persons adopt the child, by signing this |
consent (she) (he)
is irrevocably and permanently |
relinquishing all parental rights to the child,
and (she) (he) |
has stated that such is (her) (his) intention and desire.
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Dated (insert date).
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Signature..............................
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(4) If a consent to standby adoption is executed in this |
form,
the consent shall be valid only if the specified
person |
or persons adopt the child. The consent shall be void if:
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(a) the specified person or persons do not file a petition |
for standby
adoption of the child; or
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(b) a court denies the standby adoption petition.
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The parent shall not need to take further action to revoke |
the consent if the
standby adoption by the specified person or |
persons does not occur,
notwithstanding the provisions of |
Section 11 of this Act.
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C. The form of surrender to any agency given by a parent of |
a born
child who is to be subsequently placed for adoption |
shall be
substantially as follows and shall contain such other |
facts and
statements as the particular agency shall require.
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FINAL AND IRREVOCABLE SURRENDER
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FOR PURPOSES OF ADOPTION
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I, .... (relationship, e.g., mother, father, relative, |
guardian) of
...., a ..male child, state:
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That such child was born on ...., at .....
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That I reside at ...., County of ...., and State of .....
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That I am of the age of .... years.
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That I do hereby surrender and entrust the entire custody |
and control
of such child to the .... (the "Agency"), a |
(public) (licensed) child
welfare agency with its principal |
office in the City of ...., County of
.... and State of ...., |
for the purpose of enabling it to care for and
supervise the |
care of such child, to place such child for adoption and
to |
consent to the legal adoption of such child.
|
That I hereby grant to the Agency full power and authority |
to place
such child with any person or persons it may in its |
sole discretion
select to become the adopting parent or parents |
and to consent to the
legal adoption of such child by such |
person or persons; and to take any
and all measures which, in |
the judgment of the Agency, may be for the
best interests of |
such child, including authorizing medical, surgical
and dental |
care and treatment including inoculation and anaesthesia for
|
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such child.
|
That I wish to and understand that by signing this |
surrender I do
irrevocably and permanently give up all custody |
and other parental
rights I have to such child.
|
That I understand I cannot under any circumstances, after |
signing
this surrender, change my mind and revoke or cancel |
this surrender or
obtain or recover custody or any other rights |
over such child.
|
That I have read and understand the above and I am signing |
it as my
free and voluntary act.
|
Dated (insert date).
|
........................
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C-5. The form of a Final and Irrevocable Designated |
Surrender for Purposes of Adoption to any agency given by a |
parent of a born child who is to be subsequently placed for |
adoption shall be substantially as follows and shall contain |
such other facts and statements as the particular agency shall |
require: |
FINAL AND IRREVOCABLE DESIGNATED SURRENDER |
FOR PURPOSES OF ADOPTION |
I, .... (relationship, e.g., mother, father, relative, |
guardian) of ...., a ..male child, state: |
1. That such child was born on ...., at ..... |
2. That I reside at ...., County of ...., and State of |
..... |
3. That I am of the age of .... years. |
|
4. That I do hereby surrender and entrust the entire |
custody and control of such child to the .... (the "Agency"), a |
(public) (licensed) child welfare agency with its principal |
office in the City of ...., County of .... and State of ...., |
for the purpose of enabling it to care for and supervise the |
care of such child, to place such child for adoption with |
............................. (specified person or persons) |
and to consent to the legal adoption of such child and to take |
any and all measures which, in the judgment of the Agency, may |
be for the best interests of such child, including authorizing |
medical, surgical and dental care and treatment including |
inoculation and anesthesia for such child. |
5. That I wish to and understand that by signing this |
surrender I do irrevocably and permanently give up all custody |
and other parental rights I have to such child. |
6. That if the petition for adoption is not filed by the
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specified person or persons designated herein or, if the
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petition for adoption is filed but the adoption petition is
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dismissed with prejudice or the adoption proceeding is
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otherwise concluded without an order declaring the child to be
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the adopted child of each specified person, then I understand |
that the Agency will provide notice to me within 10 business |
days and that such notice will be directed to me using the |
contact information I have provided to the Agency. I understand |
that I will have 10 business days from the date that the Agency |
sends me its notice to respond, within which time I may choose |
|
to designate other adoptive parent(s). However, I acknowledge |
that
the Agency has full power and authority to place the child |
for adoption with
any person or persons it may in its sole |
discretion select to
become the adopting parent or parents and |
to consent to the
legal adoption of the child by such person or |
persons. |
7. That I acknowledge that this surrender is valid even if |
the specified persons separate or divorce or one of the |
specified persons dies prior to the entry of the final judgment |
for adoption. |
8. That I expressly acknowledge that the above paragraphs 6 |
and 7 do not impair the validity and absolute finality of this |
surrender under any circumstance. |
9. That I understand that I have a remaining obligation to |
keep the Agency informed of my current contact information |
until the adoption of the child has been finalized if I wish to |
be notified in the event the adoption by the specified |
person(s) cannot proceed. |
10. That I understand I cannot under any circumstances, |
after signing this surrender, change my mind and revoke or |
cancel this surrender or obtain or recover custody or any other |
rights over such child. |
11. That I have read and understand the above and I am |
signing it as my free and voluntary act. |
Dated (insert date). |
.............................. |
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D. The form of surrender to an agency given by a parent of |
an unborn
child who is to be subsequently placed for adoption |
shall be
substantially as follows and shall contain such other |
facts and
statements as the particular agency shall require.
|
SURRENDER OF UNBORN CHILD FOR
|
PURPOSES OF ADOPTION
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I, .... (father), state:
|
That I am the father of a child expected to be born on or |
about ....
to .... (name of mother).
|
That I reside at ...., County of ...., and State of .....
|
That I am of the age of .... years.
|
That I do hereby surrender and entrust the entire custody |
and control
of such child to the .... (the "Agency"), a |
(public) (licensed) child
welfare agency with its principal |
office in the City of ...., County of
.... and State of ...., |
for the purpose of enabling it to care for and
supervise the |
care of such child, to place such child for adoption and
to |
consent to the legal adoption of such child, and that I have |
not
previously executed a consent or surrender with respect to |
such child.
|
That I hereby grant to the Agency full power and authority |
to place
such child with any person or persons it may in its |
sole discretion
select to become the adopting parent or parents |
and to consent to the
legal adoption of such child by such |
person or persons; and to take any
and all measures which, in |
the judgment of the Agency, may be for the
best interests of |
|
such child, including authorizing medical, surgical
and dental |
care and treatment, including inoculation and anaesthesia for
|
such child.
|
That I wish to and understand that by signing this |
surrender I do
irrevocably and permanently give up all custody |
and other parental
rights I have to such child.
|
That I understand I cannot under any circumstances, after |
signing
this surrender, change my mind and revoke or cancel |
this surrender or
obtain or recover custody or any other rights |
over such child, except
that I have the right to revoke this |
surrender by giving written notice
of my revocation not later |
than 72 hours after the birth of such child.
|
That I have read and understand the above and I am signing |
it as my
free and voluntary act.
|
Dated (insert date).
|
........................
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E. The form of consent required from the parents for the |
adoption of
an adult, when such adult elects to obtain such |
consent, shall be
substantially as follows:
|
CONSENT
|
I, ...., (father) (mother) of ...., an adult, state:
|
That I reside at ...., County of .... and State of .....
|
That I do hereby consent and agree to the adoption of such |
adult by
.... and .....
|
Dated (insert date).
|
.........................
|
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F. The form of consent required for the adoption of a child |
of the
age of 14 years or upwards, or of an adult, to be given |
by such person,
shall be substantially as follows:
|
CONSENT
|
I, ...., state:
|
That I reside at ...., County of .... and State of ..... |
That I am
of the age of .... years. That I consent and agree to |
my adoption by
.... and .....
|
Dated (insert date).
|
........................
|
G. The form of consent given by an agency to the adoption |
by
specified persons of a child previously surrendered to it |
shall set
forth that the agency has the authority to execute |
such consent. The
form of consent given by a guardian of the |
person of a child sought to
be adopted, appointed by a court of |
competent jurisdiction, shall set
forth the facts of such |
appointment and the authority of the guardian to
execute such |
consent.
|
H. A consent (other than that given by an agency, or |
guardian of the
person of the child sought to be adopted who |
was appointed by a court of
competent jurisdiction) shall be |
acknowledged by a parent before a judge of a court of competent |
jurisdiction or, except as otherwise provided in
this Act, |
before a representative of an agency, or before a person, other |
than the attorney for the prospective adoptive parent or |
parents, designated by a court of competent
jurisdiction.
|
|
I. A surrender, or any other document equivalent to a |
surrender, by
which a child is surrendered to an agency shall |
be acknowledged by the
person signing such surrender, or other |
document, before a judge of a court of competent jurisdiction, |
or, except as otherwise provided in this Act, before a |
representative of an agency, or before a person designated by a |
court
of competent jurisdiction.
|
J. The form of the certificate of acknowledgment for a |
consent, a
surrender, or any other document equivalent to a |
surrender, shall be
substantially as follows:
|
STATE OF ....)
|
) SS.
|
COUNTY OF ...)
|
I, .... (Name of judge or other person), .... (official |
title, name and
location of court or status or position of |
other person),
certify that ...., personally known to me to be |
the same person whose
name is subscribed to the foregoing |
(consent) (surrender), appeared
before me this day in person |
and acknowledged that (she) (he) signed and
delivered such |
(consent) (surrender) as (her) (his) free and voluntary
act, |
for the specified purpose.
|
I have fully explained that by signing such (consent) |
(surrender)
(she) (he) is irrevocably relinquishing all |
parental rights to such
child or adult and (she) (he) has |
stated that such is (her) (his)
intention and desire. (Add if |
Consent only) I am further satisfied that, before signing this |
|
Consent, ........ has read, or has had read to him or her, the |
Birth Parent Rights and Responsibilities-Private Form.
|
Dated (insert date).
|
Signature ...............
|
K. When the execution of a consent or a surrender is |
acknowledged
before someone other than a judge,
such other |
person shall have his or her signature on the certificate
|
acknowledged before a notary public, in form substantially as |
follows:
|
STATE OF ....)
|
) SS.
|
COUNTY OF ...)
|
I, a Notary Public, in and for the County of ......, in the |
State of
......, certify that ...., personally known to me to |
be the
same person whose name is subscribed to the foregoing |
certificate of
acknowledgment, appeared before me in person and |
acknowledged that (she)
(he) signed such certificate as (her) |
(his) free and voluntary act and
that the statements made in |
the certificate are true.
|
Dated (insert date).
|
Signature ...................... Notary Public
|
(official seal)
|
There shall be attached a certificate of magistracy, or |
other
comparable proof of office of the notary public |
satisfactory to the
court, to a consent signed and acknowledged |
|
in another state.
|
L. A surrender or consent executed and acknowledged outside |
of this
State, either in accordance with the law of this State |
or in accordance
with the law of the place where executed, is |
valid.
|
M. Where a consent or a surrender is signed in a foreign |
country,
the execution of such consent shall be acknowledged or |
affirmed in a
manner conformable to the law and procedure of |
such country.
|
N. If the person signing a consent or surrender is in the |
military
service of the United States, the execution of such |
consent or surrender
may be acknowledged before a commissioned |
officer and the signature of
such officer on such certificate |
shall be verified or acknowledged
before a notary public or by |
such other procedure as is then in effect
for such division or |
branch of the armed forces.
|
O. (1) The parent or parents of a child in whose interests |
a petition
under Section 2-13 of the Juvenile Court Act of 1987 |
is pending may, with the
approval of the designated |
representative of the Department of Children and
Family |
Services, execute a consent to adoption by a specified person |
or
persons:
|
(a) in whose physical custody the child has resided for |
at least 6
months;
or
|
(b) in whose physical custody at least one sibling of |
the child who is the
subject of this consent has resided |
|
for at least 6 months, and
the child who is
the subject of |
this consent is currently residing in this foster home; or
|
(c) in whose physical custody a child under one year of |
age has resided
for at least 3 months.
|
A consent under this subsection O shall be acknowledged by a |
parent pursuant to
subsection H and subsection K of this |
Section.
|
(2) The consent to adoption by a specified person or |
persons shall have the
caption of the proceeding in which it is |
to be filed and shall be substantially
as follows:
|
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
|
A SPECIFIED PERSON OR PERSONS : DCFS CASE
|
I, ......................................, the |
.................. (mother or
father) of a ....male child, |
state:
|
1. My child ............................ (name of |
child) was born on
(insert date) at .................... |
Hospital in
................ County, State of |
...............
|
2. I reside at ......................, County of |
............. and
State of ..............
|
3. I, ..........................., am .... years old.
|
4. I enter my appearance in this action to adopt my |
child by the
person or persons specified herein by me and |
waive service of
summons on me in this action only.
|
5. I consent to the adoption of my child by
|
|
.............................
(specified person or |
persons) only.
|
6. I wish to sign this consent and I understand that by |
signing this
consent I irrevocably and permanently give up |
all parental rights I have to my
child if my child is |
adopted by ............................. (specified person
|
or persons).
|
7. I understand my child will be adopted by |
.............................
(specified person or |
persons) only and that I cannot under any circumstances,
|
after signing this document, change my mind and revoke or |
cancel this consent
or obtain or recover custody or any |
other rights over my child if
............................ |
(specified person or persons) adopt my child.
|
8. I understand that this consent to adoption is valid |
only if the
petition to adopt is filed within one year from |
the date that I sign it and
that if ....................... |
(specified person or persons), for any reason,
cannot or |
will not file a petition to adopt my child within that one |
year
period or if their adoption petition is denied, then |
this consent will be
voidable after one year upon the |
timely filing of my motion. If I file this
motion before |
the filing of the petition for adoption, I understand that |
the
court shall revoke this specific consent.
I have the |
right to notice of any other proceeding that could affect |
my
parental rights, except for the proceeding for |
|
............. (specified person
or persons) to adopt my |
child.
|
9. I have read and understand the above and I am |
signing it as my free
and voluntary act.
|
Dated (insert date).
|
.............................................
|
Signature of parent
|
(3) If the parent consents to an adoption by 2 specified |
persons, then the
form shall contain 2 additional paragraphs in |
substantially the following form:
|
10. If ............... (specified persons) get a |
divorce
before the petition to adopt my child is granted, |
then ..........
(specified person) shall adopt my child. I |
understand that I
cannot change my mind and revoke this |
consent or obtain or
recover custody over my child if |
............. (specified persons)
divorce and |
............. (specified person) adopts my
child. I |
understand that I cannot change my mind and revoke
this |
consent or obtain or recover custody over my child if
|
................. (specified persons) divorce after the
|
adoption is final. I understand that this consent to |
adoption
has no effect on who will get custody of my child |
if they
divorce after the adoption is final.
|
11. I understand that if either ...............
|
(specified persons) dies before the petition to adopt
my |
child is granted, then the surviving person can adopt my |
|
child. I
understand that I cannot change my mind and revoke |
this consent
or obtain or recover custody over my child if |
the surviving
person adopts my child.
|
A consent to adoption by specified persons on this form |
shall
have no effect on a court's determination of custody or |
visitation
under the Illinois Marriage and Dissolution of |
Marriage Act if the
marriage of the
specified persons is |
dissolved after the adoption is final.
|
(4) The form of the certificate of acknowledgement for a |
Final and
Irrevocable Consent for Adoption by a Specified |
Person or Persons: DCFS Case shall be
substantially as follows:
|
STATE OF..............)
|
) SS.
|
COUNTY OF.............)
|
I, .................... (Name of Judge or other person),
|
..................... (official title, name, and address),
|
certify that ............., personally known to me to be the |
same person whose
name is subscribed to the foregoing Final and |
Irrevocable Consent for Adoption
by a Specified Person or |
Persons, appeared before me this day
in person and acknowledged |
that (she)(he) signed and delivered the consent as
(her)(his) |
free and voluntary act, for the specified purpose.
|
I have fully explained that this consent to adoption is |
valid only if the
petition to adopt is filed within one year |
|
from the date that it is signed, and
that if the specified |
person or persons, for any reason, cannot or will not
adopt the |
child or if the adoption petition is denied, then this consent |
will
be voidable after one year upon the timely filing of a |
motion by the parent
to revoke the consent. I explained that if |
this motion is filed before the
filing of the petition for |
adoption, the court shall revoke this specific
consent. I have |
fully explained that if the specified person or
persons adopt
|
the child, by signing this consent this parent is irrevocably
|
and permanently
relinquishing all parental rights to the child, |
and this parent has stated that
such is (her)(his) intention |
and desire.
|
Dated (insert date).
|
...............................
|
Signature
|
(5) If a consent to adoption by a specified person or |
persons is executed in
this form, the following provisions |
shall apply. The consent shall be valid
only if that specified |
person or persons adopt the child. The consent shall be
|
voidable after one year if:
|
(a) the specified person or persons do not file a |
petition to adopt the
child within one year after the |
consent is signed and the parent files a
timely motion to |
revoke this consent. If this motion is filed before the
|
filing of the petition for adoption the court shall revoke |
this consent; or
|
|
(b) a court denies the adoption petition; or
|
(c) the Department of Children and Family Services |
Guardianship
Administrator determines that the specified |
person or persons will not or
cannot complete the adoption, |
or in the best interests of the child should not
adopt the |
child.
|
Within 30 days of the consent becoming void, the Department |
of Children and
Family Services Guardianship Administrator |
shall make good faith attempts to
notify the parent in writing |
and shall give written notice to the court and all
additional |
parties in writing that the adoption has not occurred or will |
not
occur and that the consent is void. If the adoption by a |
specified person or
persons does not occur, no proceeding for |
termination of parental rights shall
be brought unless the |
biological parent who executed the consent to adoption by
a |
specified person or persons has been notified of the proceeding |
pursuant to
Section 7 of this Act or subsection (4) of Section |
2-13 of the Juvenile Court
Act of 1987. The parent shall not |
need to take further action to revoke the
consent if the |
specified adoption does not occur, notwithstanding the
|
provisions of Section 11 of this Act.
|
(6) The Department of Children and Family Services is |
authorized
to promulgate rules necessary to implement this |
subsection O.
|
(7) The Department shall collect and maintain data |
concerning the efficacy
of specific consents. This data shall |
|
include the number of specific consents
executed and their |
outcomes, including but not limited to the number of
children |
adopted pursuant to the consents, the number of children for |
whom
adoptions are not completed, and the reason or reasons why |
the adoptions are
not completed.
|
P. If the person signing a consent is incarcerated or |
detained in a correctional facility, prison, jail, detention |
center, or other comparable institution, either in this State |
or any other jurisdiction, the execution of such consent may be |
acknowledged before social service personnel of such |
institution, or before a person designated by a court of |
competent jurisdiction. |
Q. A consent may be acknowledged telephonically, via |
audiovisual connection, or other electronic means, provided |
that a court of competent jurisdiction has entered an order |
approving the execution of the consent in such manner and has |
designated an individual to be physically present with the |
parent executing such consent in order to verify the identity |
of the parent. |
R. An agency whose representative is acknowledging a |
consent pursuant to this Section shall be a public child |
welfare agency, or a child welfare agency, or a child placing |
agency that is authorized or licensed in the State or |
jurisdiction in which the consent is signed. |
(Source: P.A. 96-601, eff. 8-21-09.)
|
Section 99. Effective date. This Act takes effect January |