HB6080 Engrossed

LRB096 18717 AJO 36573 b





  
1
    AN ACT concerning civil law.
  
 
2
    Be it enacted by the People of the State of Illinois,
 
3
represented in the General Assembly:
  



 
 
4
    Section 5. The Adoption Act is amended  by changing Section 
5
10 as follows:
 



6
    (750 ILCS 50/10)  (from Ch. 40, par. 1512)



7
    Sec. 10. Forms of consent and surrender; execution and

8
acknowledgment thereof.    A. The form of consent required for 
9
the
adoption of a born child shall be substantially as follows:

10

FINAL AND IRREVOCABLE CONSENT TO ADOPTION


11
    I, ...., (relationship, e.g., mother, father, relative, 
12
guardian)
of ...., a ..male child, state:

13
    That such child was born on .... at ....

14
    That I reside at ...., County of ....  and State of ....

15
    That I am of the age of .... years.

16
    That I hereby enter my appearance in this proceeding and 
17
waive
service of summons on me.

18
    That I hereby acknowledge that I have been provided with a 
19
copy of the Birth Parent Rights and Responsibilities-Private 
20
Form before signing this Consent and that I have had time to 
21
read, or have had read to me, this Form. I understand that if I 
22
do not receive any of the rights as described in this Form, it 
23
shall not constitute a basis to revoke this Final and 
 


 






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Irrevocable Consent. 
2
    That I do hereby consent and agree to the adoption of such 
3
child.

4
    That I wish to and understand that by signing this consent 
5
I do
irrevocably and permanently give up all custody and other 
6
parental
rights I have to such child.

7
    That I understand such child will be placed for adoption 
8
and that I
cannot under any circumstances, after signing this 
9
document, change my
mind and revoke or cancel this consent or 
10
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 
12
as my free and voluntary act.

13
    Dated (insert date).

14
.........................

 

15
    If under Section 8 the consent of more than one person is 
16
required,
then each such person shall execute a separate 
17
consent.

18
    A-1.  (1)   The form of the Final and Irrevocable Consent to 
19
Adoption by a Specified Person or Persons: Non-DCFS Case set 
20
forth in this subsection A-1 is to be used by legal parents 
21
only. This form is not to be used in cases in which there is a 
22
pending petition under Section 2-13 of the Juvenile Court Act 
23
of 1987.
24
    (2)   The form of the Final and Irrevocable Consent to 
25
Adoption by a Specified Person or Persons in a non-DCFS case 
 


 






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1
shall have the caption of the proceeding in which it is to be 
2
filed and shall be substantially as follows: 
3

FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY  
4

A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE  
5
    I, ...., (relationship, e.g., mother, father) of ...., a 
6
..male child, state:
7
    1. That such child was born on ...., at ....., City of ... 
8
and State of ....
9
    2. That I reside at ...., County of .... and State of ....
10
    3. That I am of the age of .... years.
11
    4. That I hereby enter my appearance in this proceeding and 
12
waive service of summons on me.
13
    5. That I hereby acknowledge that I have been provided a 
14
copy of the Birth Parent Rights and Responsibilities-Private 
15
Form before signing this Consent and that I have had time to 
16
read, or have had read to me, this Form and that I understand 
17
the Rights and Responsibilities described in this Form. I 
18
understand that if I do not receive any of my rights as 
19
described in said Form, it shall not constitute a basis to 
20
revoke this Final and Irrevocable Consent to Adoption by a 
21
Specified Person. 
22
    6. That I do hereby consent and agree to the adoption of 
23
such child by .... (specified persons) only.
24
    7. That I wish to and understand that upon signing this 
25
consent I do irrevocably and permanently give up all custody 
26
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 
2
transfer all of my rights to the custody, care and control of 
3
such child to ............................. (specified person 
4
or persons).
5
    8. That I understand such child will be adopted by 
6
....................... (specified person or persons) and that 
7
I cannot under any circumstances, after signing this document, 
8
change my mind and revoke or cancel this consent or obtain or 
9
recover custody or any other rights over such child if 
10
............................ (specified person or persons) 
11
adopt(s) such child; PROVIDED that each specified person has 
12
filed or shall file, within 60 days from the date hereof, a 
13
petition for the adoption of such child.
14
    9.  That if the specified person or persons designated 
15
herein do not file a petition for adoption within the 
16
time-frame specified above, or, if said petition for adoption 
17
is filed within the time-frame specified above but the adoption 
18
petition is dismissed with prejudice or the adoption proceeding 
19
is otherwise concluded without an order declaring the child to 
20
be the adopted child of the specified person or persons, then I 
21
understand that I may request the Court to declare this consent 
22
voidable and return the child to me. I further understand that 
23
the Court will make the final decision of whether or not the 
24
child will be returned to me.
25
    10. That I understand that I must request the return of the 
26
child to me  within 10 business days from the date that written 
 


 






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notice is sent to me.  If I do not make such request within 10 
2
business days of the date of the notice, then I expressly waive 
3
any other notice or service of process in any legal proceeding 
4
for the adoption of the child. 
5
    11. That I expressly acknowledge that nothing in this 
6
Consent
impairs the validity and absolute finality of this

7
Consent under any circumstance other than those described in

8
paragraph 9 of this Consent.
9
    12. That I understand that I have a remaining duty and

10
obligation to keep .............. (insert name and address of 
11
the attorney
for the specified person or persons) informed of 
12
my current
address or other preferred contact information until 
13
this adoption has been finalized. My failure to
do so may 
14
result in the termination of my parental rights and
the child 
15
being placed for adoption in another home.
16
    13. That I do expressly waive any other notice or service 
17
of process in any of the legal proceedings for the adoption of 
18
the child as long as the adoption proceeding by the specified 
19
person or persons is pending.
20
    14. That I have read and understand the above and I am 
21
signing it as my free and voluntary act.
22
    15.  That I acknowledge that this consent is valid even if 
23
the specified person or persons separate or divorce or one of 
24
the specified persons dies prior to the entry of the final 
25
judgment for adoption. 
26
    Dated (insert date). 
 


 






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1
    ............................................. 
2
    Signature of parent. 
3
    .............................................
4
    Address of parent.
5
    .............................................
6
    Phone number(s) of parent.
7
    .............................................
8
    Personal email(s) of parent. 
9
    .............................................
10
    (3) The form of the certificate of acknowledgement for a 
11
Final and Irrevocable Consent for Adoption by a Specified 
12
Person or Persons: Non-DCFS Case shall be substantially as 
13
follows: 
 
14
STATE OF..............)

15
                      ) SS.

16
COUNTY OF.............)
17
    I, .................... (Name of Judge or other person), 
18
..................... (official title, name, and address), 
19
certify that ............., personally known to me to be the 
20
same person whose name is subscribed to the foregoing Final and 
21
Irrevocable Consent for Adoption by a Specified Person or 
22
Persons; non-DCFS case, appeared before me this day in person 
23
and acknowledged that (she)(he) signed and delivered the 
24
consent as (her)(his) free and voluntary act, for the specified 
25
purpose. I am further satisfied that, before signing this 
 


 






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Consent, ........ has read, or has had read to him or her, the 
2
Birth Parent Rights and Responsibilities-Private Form. 
3
    A-2. Birth Parent Rights and Responsibilities-Private 
4
Form. The Birth Parent Rights and Responsibilities-Private 
5
Form must be read by, or have been read to, any person 
6
executing a Final and Irrevocable Consent to Adoption under 
7
subsection A, a Final and Irrevocable Consent to Adoption by a 
8
Specified Person or Persons: Non-DCFS Case under subsection 
9
A-1, or a Consent to Adoption of Unborn Child under subsection 
10
B prior to the execution of said Consent. The form of the Birth 
11
Parent Rights and Responsibilities-Private Form shall be 
12
substantially as follows:
13

Birth Parent Rights and Responsibilities-Private Form  
14
    As a birth parent in the State of Illinois, you have the 
15
right:
16
    1. To have your own attorney represent you.  The prospective 
17
adoptive parents may agree to pay for the cost of your attorney 
18
in a manner consistent with Illinois law, but they are not 
19
required to do so.
20
    2. To be treated with dignity and respect at all times and 
21
to make decisions free from coercion and pressure.
22
    3. To receive counseling before and after signing a Final 
23
and Irrevocable Consent to Adoption ("Consent"), a Final and 
24
Irrevocable Consent to Adoption by a Specified Person or 
25
Persons: Non-DCFS Case ("Specified Consent"), or a Consent to 
26
Adoption of Unborn Child ("Unborn Consent").  The prospective 
 


 






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1
adoptive parents may agree to pay for the cost of counseling in 
2
a manner consistent with Illinois law, but they are not 
3
required to do so.
4
    4. To ask to be involved in choosing your child's 
5
prospective adoptive parents and to ask to meet them.
6
    5. To ask your child's prospective adoptive parents any 
7
questions that pertain to your decision to place your child 
8
with them.
9
    6. To see your child before signing a Consent or Specified 
10
Consent.
11
    7. To request contact with your child and/or the child's 
12
prospective adoptive parents, with the understanding that any 
13
promises regarding contact with your child or receipt of 
14
information about the child after signing a Consent, Specified 
15
Consent, or Unborn Consent cannot be enforced under Illinois 
16
law.
17
    8. To receive copies of all documents that you sign and 
18
have those documents provided to you in your preferred 
19
language.
20
    9. To request that your identifying information remain 
21
confidential, unless required otherwise by Illinois law or 
22
court order, and to register with the Illinois Adoption 
23
Registry and Medical Information Exchange.
24
    10. To work with an adoption agency or attorney of your 
25
choice, or change said agency or attorney, provided you 
26
promptly inform all of the parties currently involved.
 


 






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    11. To receive, upon request, a written list of any 
2
promised support, financial or otherwise, from your attorney or 
3
the attorney for your child's prospective adoptive parents.
4
    12. To delay signing a Consent, Specified Consent, or 
5
Unborn Consent if you are not ready to do so.
6
    13. To decline to sign a Consent, Specified Consent, or 
7
Unborn Consent even if you have received financial support from 
8
the prospective adoptive parents.
9
    If you do not receive any of the rights described in this 
10
Form, it shall not be a basis to revoke a Consent, Specified 
11
Consent, or Unborn Consent.
12
    As a Birth Parent in the State of Illinois, you have the 
13
responsibility:
14
    1. To carefully consider your reasons for choosing 
15
adoption.
16
    2. To provide all known medical background and family 
17
information about yourself and your immediate family to your 
18
child's prospective adoptive parents or their attorney. For the 
19
health of your child, you are strongly encouraged, but not 
20
required, to provide all known medical, background, and family 
21
history information about yourself and your family to your 
22
child's prospective adoptive parents or their attorney.
23
    3. (Birth mothers only) To accurately complete an Affidavit 
24
of Identification, which identifies the father of the child 
25
when known, with the understanding that a birth mother has a 
26
right to decline to identify the birth father.
 


 






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    4. To not accept financial support or reimbursement of 
2
pregnancy related expenses simultaneously from more than one 
3
source.
4
    B. The form of consent required for the adoption of an 
5
unborn child
shall be substantially as follows:

6

CONSENT TO ADOPTION OF UNBORN CHILD


7
    I, ...., state:

8
    That I am the father of a child expected to be born on or 
9
about ....
to .... (name of mother).

10
    That I reside at .... County of ...., and State of .....

11
    That I am of the age of .... years.

12
    That I hereby enter my appearance in such adoption 
13
proceeding and
waive service of summons on me.

14
    That I hereby acknowledge that I have been provided with a 
15
copy of the Birth Parent Rights and Responsibilities-Private 
16
Form before signing this Consent, and that I have had time to 
17
read, or have had read to me, this Form.  I understand that if I 
18
do not receive any of the rights as described in this Form, it 
19
shall not constitute a basis to revoke this Consent to Adoption 
20
of Unborn Child. 
21
    That I do hereby consent and agree to the adoption of such 
22
child, and
that I have not previously executed a consent or 
23
surrender with respect
to such child.

24
    That I wish to and do understand that by signing this 
25
consent I do
irrevocably and permanently give up all custody 
26
and other parental
rights I have to such child, except that I 
 


 






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have the right to revoke this
consent by giving written notice 
2
of my revocation not later than 72
hours after the birth of the 
3
child.

4
    That I understand such child will be placed for adoption 
5
and that,
except as hereinabove provided, I cannot under any 
6
circumstances, after
signing this document, change my mind and 
7
revoke or cancel this consent
or obtain or recover custody or 
8
any other rights over such child.

9
    That I have read and understand the above and I am signing 
10
it as my
free and voluntary act.

11
    Dated (insert date).

12
........................

13
    B-5. (1) The parent of a child may execute a consent to 
14
standby
adoption by a specified person or persons.  A consent 
15
under this subsection B-5
shall be acknowledged by a parent 
16
pursuant to subsection H and subsection K of
this Section.
The 
17
form of consent required for the standby adoption of a born 
18
child
effective at a future date when the consenting
 parent of 
19
the child dies or
requests that a final judgment of adoption be 
20
entered shall be substantially as
follows:

21

FINAL AND IRREVOCABLE CONSENT


22

TO STANDBY ADOPTION


23
    I, ..., (relationship, e.g. mother or father)
of ...., a 
24
..male child, state:

25
    That the child was born on .... at .....

26
    That I reside at ...., County of ...., and State of .....

 


 






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1
    That I am of the age of .... years.

2
    That I hereby enter my appearance in this proceeding and 
3
waive service of
summons on me in this action only.

4
    That I do hereby consent and
agree to the standby adoption 
5
of the child, and that I have not previously
executed a consent 
6
or surrender with respect to the child.

7
    That I wish to and understand that by signing this consent 
8
I do irrevocably
and permanently give up all custody and other 
9
parental rights I have to the
child, effective upon
(my death) 
10
(the child's other parent's death) or upon (my) (the other


11
parent's) request for the entry of a final judgment for 
12
adoption if .....
(specified person or persons) adopt my child.

13
    That I understand that until (I die) (the child's other 
14
parent dies), I
retain all legal rights and obligations 
15
concerning the child, but at that time,
I irrevocably give all 
16
custody and other parental rights to .... (specified
person or 
17
persons).

18
    I understand my child will be adopted by ....... (specified 
19
person or
persons) only and that I cannot, under any 
20
circumstances, after signing this
document, change my mind and 
21
revoke or cancel this consent or obtain or recover
custody or 
22
any other rights over my child if ..... (specified person or

23
persons) adopt my child.

24
    I understand that this consent to standby adoption is valid 
25
only if the
petition for standby adoption is filed and that if 
26
....... (specified person or
persons), for any reason, cannot 
 


 






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or will not file a petition for standby
adoption or if his, 
2
her, or their petition for standby adoption is denied, then

3
this consent is void.  I have the right to notice of any other 
4
proceeding that
could affect my parental rights.

5
    That I have read and understand the above and I am signing 
6
it as my free and
voluntary act.

7
    Dated (insert date).

8
....................

 

9
    If under Section 8 the consent of more than one person is 
10
required, then each
such
person shall execute a separate 
11
consent.  A separate consent shall be executed
for each
child.

12
    (2) If the parent consents to a standby adoption by 2 
13
specified persons,
then the form shall contain 2 additional 
14
paragraphs in substantially the
following form:

15
    If .... (specified persons) obtain a judgment of

16
dissolution of
marriage before the judgment for adoption is 
17
entered, then .....
(specified person) shall adopt my child.  I 
18
understand that I cannot change my
mind and revoke this consent 
19
or obtain or recover custody of my child if .....
(specified 
20
persons) obtain a judgment of dissolution of marriage and .....

21
(specified person) adopts my child.  I understand that I cannot 
22
change my
mind and revoke this consent if ...... (specified 
23
persons) obtain a
judgment of dissolution of marriage  before 
24
the adoption is final.  I
understand that this consent to 
25
adoption has no effect on who will get custody
of my child if 
 


 






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1
..... (specified persons) obtain a judgment of dissolution
of 
2
marriage after the adoption is final.  I understand that if 
3
either .....
(specified persons) dies before the petition to 
4
adopt my child is granted, then
the surviving person may adopt 
5
my child.  I understand that I cannot change my
mind and revoke 
6
this consent or obtain or recover custody of my child if the

7
surviving person adopts my child.

8
    A consent to standby adoption by specified persons on this 
9
form shall have no
effect on a court's determination of custody 
10
or visitation under the Illinois
Marriage and Dissolution
of 
11
Marriage Act if the marriage of the specified persons is 
12
dissolved before
the adoption is final.

13
    (3) The form of the certificate of acknowledgement for a 
14
Final and
Irrevocable Consent for Standby Adoption shall be 
15
substantially as follows:

 
16
STATE OF .....)

17
              ) SS.

18
COUNTY OF ....)

 

19
    I, ....... (name of Judge or other person) ..... (official 
20
title,
name, and address), certify that ......., personally 
21
known to me to be
the same person whose name is subscribed to 
22
the foregoing Final and Irrevocable
Consent to Standby 
23
Adoption, appeared before me this day in person and

24
acknowledged that (she) (he) signed and
delivered the consent 
 


 






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as (her) (his) free and voluntary act, for the specified

2
purpose.

3
    I have fully explained that this consent to adoption is 
4
valid only if the
petition to adopt is filed, and that if the 
5
specified person or persons, for
any reason, cannot or will not 
6
adopt the child or if the adoption petition is
denied, then 
7
this consent will be void.  I have fully explained that if the

8
specified person or persons adopt the child, by signing this 
9
consent (she) (he)
is irrevocably and permanently 
10
relinquishing all parental rights to the child,
and (she) (he) 
11
has stated that such is (her) (his) intention and desire.

12
    Dated (insert date).

13
    Signature..............................

14
    (4) If a consent to standby adoption is executed in this 
15
form,
the consent shall be valid only if the specified
person 
16
or persons adopt the child.  The consent shall be void if:

17
    (a) the specified person or persons do not file a petition 
18
for standby
adoption of the child; or

19
    (b) a court denies the standby adoption petition.

20
    The parent shall not need to take further action to revoke 
21
the consent if the
standby adoption by the specified person or 
22
persons does not occur,
notwithstanding the provisions of 
23
Section 11 of this Act.

24
    C. The form of surrender to any agency given by a parent of 
25
a born
child who is to be subsequently placed for adoption 
26
shall be
substantially as follows and shall contain such other 
 


 






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1
facts and
statements as the particular agency shall require.

2

FINAL AND IRREVOCABLE SURRENDER


3

FOR PURPOSES OF ADOPTION


4
    I, ....  (relationship, e.g., mother, father, relative, 
5
guardian) of
...., a ..male child, state:

6
    That such child was born on ...., at .....

7
    That I reside at ...., County of ...., and State of .....

8
    That I am of the age of .... years.

9
    That I do hereby surrender and entrust the entire custody 
10
and control
of such child to the ....  (the "Agency"), a 
11
(public) (licensed) child
welfare agency with its principal 
12
office in the City of ...., County of
.... and State of ...., 
13
for the purpose of enabling it to care for and
supervise the 
14
care of such child, to place such child for adoption and
to 
15
consent to the legal adoption of such child.

16
    That I hereby grant to the Agency full power and authority 
17
to place
such child with any person or persons it may in its 
18
sole discretion
select to become the adopting parent or parents 
19
and to consent to the
legal adoption of such child by such 
20
person or persons; and to take any
and all measures which, in 
21
the judgment of the Agency, may be for the
best interests of 
22
such child, including authorizing medical, surgical
and dental 
23
care and treatment including inoculation and anaesthesia for

24
such child.

25
    That I wish to and understand that by signing this 
26
surrender I do
irrevocably and permanently give up all custody 
 


 






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and other parental
rights I have to such child.

2
    That I understand I cannot under any circumstances, after 
3
signing
this surrender, change my mind and revoke or cancel 
4
this surrender or
obtain or recover custody or any other rights 
5
over such child.

6
    That I have read and understand the above and I am signing 
7
it as my
free and voluntary act.

8
    Dated (insert date).

9
........................

10
    C-5. The form of a Final and Irrevocable Designated 
11
Surrender for Purposes of Adoption to any agency given by a 
12
parent of a born child who is to be subsequently placed for 
13
adoption shall be substantially as follows and shall contain 
14
such other facts and statements as the particular agency shall 
15
require: 
16

FINAL AND IRREVOCABLE DESIGNATED SURRENDER  
17

FOR PURPOSES OF ADOPTION  
18
    I, .... (relationship, e.g., mother, father, relative, 
19
guardian) of ...., a ..male child, state:
20
    1.    That such child was born on ...., at .....
21
    2.    That I reside at ...., County of ...., and State of 
22
.....
23
    3.    That I am of the age of .... years.
24
    4.    That I do hereby surrender and entrust the entire 
25
custody and control of such child to the .... (the "Agency"), a 
26
(public) (licensed) child welfare agency with its principal 
 


 






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office in the City of ...., County of .... and State of ...., 
2
for the purpose of enabling it to care for and supervise the 
3
care of such child, to place such child for adoption with 
4
............................. (specified person or persons) 
5
and to consent to the legal adoption of such child and to take 
6
any and all measures which, in the judgment of the Agency, may 
7
be for the best interests of such child, including authorizing 
8
medical, surgical and dental care and treatment including 
9
inoculation and anesthesia for such child.
10
    5.   That I wish to and understand that by signing this 
11
surrender I do irrevocably and permanently give up all custody 
12
and other parental rights I have to such child.
13
    6. That if the petition for adoption is not filed by the

14
specified person or persons designated herein or, if the

15
petition for adoption is filed but the adoption petition is

16
dismissed with prejudice or the adoption proceeding is

17
otherwise concluded without an order declaring the child to be

18
the adopted child of each specified person, then I understand 
19
that the Agency will provide notice to me within 10 business 
20
days and that such notice will be directed to me using the 
21
contact information I have provided to the Agency. I understand 
22
that I will have 10 business days from the date that the Agency 
23
sends me its notice to respond, within which time I may choose 
24
to designate other adoptive parent(s). However, I acknowledge 
25
that
the Agency has full power and authority to place the child 
26
for adoption with
any person or persons it may in its sole 
 


 






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1
discretion select to
become the adopting parent or parents and 
2
to consent to the
legal adoption of the child by such person or 
3
persons.
4
    7.    That I acknowledge that this surrender is valid even if 
5
the specified persons separate or divorce or one of the 
6
specified persons dies prior to the entry of the final judgment 
7
for adoption.
8
    8.    That I expressly acknowledge that the above paragraphs 6 
9
and 7 do not impair the validity and absolute finality of this 
10
surrender under any circumstance.
11
    9. That I understand that I have a remaining obligation to 
12
keep the Agency informed of my current contact information 
13
until the adoption of the child has been finalized if I wish to 
14
be notified in the event the adoption by the specified 
15
person(s) cannot proceed. 
16
    10.   That I understand I cannot under any circumstances, 
17
after signing this surrender, change my mind and revoke or 
18
cancel this surrender or obtain or recover custody or any other 
19
rights over such child.
20
    11.   That I have read and understand the above and I am 
21
signing it as my free and voluntary act. 
22
    Dated (insert date). 
23
.............................. 
24
    D. The form of surrender to an agency given by a parent of 
25
an unborn
child who is to be subsequently placed for adoption 
26
shall be
substantially as follows and shall contain such other 
 


 






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1
facts and
statements as the particular agency shall require.

2

SURRENDER OF UNBORN CHILD FOR


3

PURPOSES OF ADOPTION


4
    I, .... (father), state:

5
    That I am the father of a child expected to be born on or 
6
about ....
to .... (name of mother).

7
    That I reside at ...., County of ...., and State of .....

8
    That I am of the age of .... years.

9
    That I do hereby surrender and entrust the entire custody 
10
and control
of such child to the .... (the "Agency"), a 
11
(public) (licensed) child
welfare agency with its principal 
12
office in the City of ...., County of
.... and State of ...., 
13
for the purpose of enabling it to care for and
supervise the 
14
care of such child, to place such child for adoption and
to 
15
consent to the legal adoption of such child, and that I have 
16
not
previously executed a consent or surrender with respect to 
17
such child.

18
    That I hereby grant to the Agency full power and authority 
19
to place
such child with any person or persons it may in its 
20
sole discretion
select to become the adopting parent or parents 
21
and to consent to the
legal adoption of such child by such 
22
person or persons; and to take any
and all measures which, in 
23
the judgment of the Agency, may be for the
best interests of 
24
such child, including authorizing medical, surgical
and dental 
25
care and treatment, including inoculation and anaesthesia for

26
such child.

 


 






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1
    That I wish to and understand that by signing this 
2
surrender I do
irrevocably and permanently give up all custody 
3
and other parental
rights I have to such child.

4
    That I understand I cannot under any circumstances, after 
5
signing
this surrender, change my mind and revoke or cancel 
6
this surrender or
obtain or recover custody or any other rights 
7
over such child, except
that I have the right to revoke this 
8
surrender by giving written notice
of my revocation not later 
9
than 72 hours after the birth of such child.

10
    That I have read and understand the above and I am signing 
11
it as my
free and voluntary act.

12
    Dated (insert date).

13
........................

14
    E. The form of consent required from the parents for the 
15
adoption of
an adult, when such adult elects to obtain such 
16
consent, shall be
substantially as follows:

17

CONSENT


18
    I, ...., (father) (mother) of ...., an adult, state:

19
    That I reside at ...., County of .... and State of .....

20
    That I do hereby consent and agree to the adoption of such 
21
adult by
.... and .....

22
    Dated (insert date).

23
.........................

24
    F. The form of consent required for the adoption of a child 
25
of the
age of 14 years or upwards, or of an adult, to be given 
26
by such person,
shall be substantially as follows:

 


 






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1

CONSENT


2
    I, ...., state:

3
    That I reside at ...., County of .... and State of .....  
4
That I am
of the age of .... years.  That I consent and agree to 
5
my adoption by
.... and .....

6
    Dated (insert date).

7
........................

8
    G. The form of consent given by an agency to the adoption 
9
by
specified persons of a child previously surrendered to it 
10
shall set
forth that the agency has the authority to execute 
11
such consent.  The
form of consent given by a guardian of the 
12
person of a child sought to
be adopted, appointed by a court of 
13
competent jurisdiction, shall set
forth the facts of such 
14
appointment and the authority of the guardian to
execute such 
15
consent.

16
    H. A consent (other than that given by an agency, or 
17
guardian of the
person of the child sought to be adopted who 
18
was appointed by a court of
competent jurisdiction) shall be 
19
acknowledged by a parent before a  judge of a  court of competent 
20
jurisdiction  or, except as otherwise provided in
this Act, 
21
before a representative of an  agency, or before a person, other 
22
than the attorney for the prospective adoptive parent or 
23
parents, designated by  a court of competent
jurisdiction.

24
    I. A surrender, or any other document equivalent to a 
25
surrender, by
which a child is surrendered to an agency shall 
26
be acknowledged by the
person signing such surrender, or other 
 


 






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1
document, before a judge of a court of competent jurisdiction, 
2
or, except as otherwise provided in this Act, before a 
3
representative of an agency, or before a  person designated  by a  
4
court
of competent jurisdiction.

5
    J. The form of the certificate of acknowledgment for a 
6
consent, a
surrender, or any other document equivalent to a 
7
surrender, shall be
substantially as follows:

8
STATE OF ....)

9
             ) SS.

10
COUNTY OF ...)

11
    I, .... (Name of judge or other person), .... (official 
12
title, name and
location of court or status or position of 
13
other person),
certify that ...., personally known to me to be 
14
the same person whose
name is subscribed to the foregoing 
15
(consent) (surrender), appeared
before me this day in person 
16
and acknowledged that (she) (he) signed and
delivered such 
17
(consent) (surrender) as (her) (his) free and voluntary
act, 
18
for the specified purpose.

19
    I have fully explained that by signing such (consent) 
20
(surrender)
(she) (he) is irrevocably relinquishing all 
21
parental rights to such
child or adult and (she) (he) has 
22
stated that such is (her) (his)
intention and desire. (Add if 
23
Consent only) I am further satisfied that, before signing this 
24
Consent, ........ has read, or has had read to him or her, the 
25
Birth Parent Rights and Responsibilities-Private Form.

26
    Dated (insert date).

 


 






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1
    Signature ...............

2
    K. When the execution of a consent or a surrender is 
3
acknowledged
before someone other than a judge,
such other 
4
person shall have his or her signature on the certificate

5
acknowledged before a notary public, in form substantially as 
6
follows:

7
STATE OF ....)

8
             ) SS.

9
COUNTY OF ...)

10
    I, a Notary Public, in and for the County of ......, in the 
11
State of
......, certify that ...., personally known to me to 
12
be the
same person whose name is subscribed to the foregoing 
13
certificate of
acknowledgment, appeared before me in person and 
14
acknowledged that (she)
(he) signed such certificate as (her) 
15
(his) free and voluntary act and
that the statements made in 
16
the certificate are true.

17
    Dated (insert date).

18
    
Signature ...................... Notary Public


19

(official seal)


 

20
    There shall be attached a certificate of magistracy, or 
21
other
comparable proof of office of the notary public 
22
satisfactory to the
court, to a consent signed and acknowledged 
23
in another state.

24
    L. A surrender or consent executed and acknowledged outside 
25
of this
State, either in accordance with the law of this State 
 


 






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1
or in accordance
with the law of the place where executed, is 
2
valid.

3
    M. Where a consent or a surrender is signed in a foreign 
4
country,
the execution of such consent shall be acknowledged or 
5
affirmed in a
manner conformable to the law and procedure of 
6
such country.

7
    N. If the person signing a consent or surrender is in the 
8
military
service of the United States, the execution of such 
9
consent or surrender
may be acknowledged before a commissioned 
10
officer and the signature of
such officer on such certificate 
11
shall be verified or acknowledged
before a notary public or by 
12
such other procedure as is then in effect
for such division or 
13
branch of the armed forces.

14
    O. (1) The parent or parents of a child in whose interests 
15
a petition
under Section 2-13 of the Juvenile Court Act of 1987 
16
is pending may, with the
approval of the designated 
17
representative of the Department of Children and
Family 
18
Services, execute a consent to adoption by a specified person 
19
or
persons:


20
        (a) in whose physical custody the child has resided for 
21
    at least 6
months;
or


22
        (b) in whose physical custody at least one sibling of 
23
    the child who is the
subject of this consent has resided 
24
    for at least 6 months, and
the child who is
the subject of 
25
    this consent is currently residing in this foster home; or


26
        (c) in whose physical custody a child under one year of 
 


 






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1
    age has resided
for at least 3 months.

2
A consent under this subsection O shall be acknowledged by a 
3
parent pursuant to
subsection H and subsection K of this 
4
Section.

5
    (2) The consent to adoption by a specified person or 
6
persons shall have the
caption of the proceeding in which it is 
7
to be filed and shall be substantially
as follows:

8

FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY


9

A SPECIFIED PERSON OR PERSONS : DCFS CASE  


10
    I, ......................................, the 
11
.................. (mother or
father) of a ....male child, 
12
state:


13
        1. My child ............................ (name of 
14
    child) was born on
(insert date) at .................... 
15
    Hospital in
................ County, State of 
16
    ...............


17
        2. I reside at ......................, County of 
18
    ............. and
State of ..............


19
        3. I, ..........................., am .... years old.


20
        4. I enter my appearance in this action to adopt my 
21
    child by the
person or persons specified herein by me and 
22
    waive service of
summons on me in this action only.


23
        5. I consent to the adoption of my child by

24
    .............................
(specified person or 
25
    persons) only.


26
        6. I wish to sign this consent and I understand that by 
 


 






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1
    signing this
consent I irrevocably and permanently give up 
2
    all parental rights I have to my
child if my child is 
3
    adopted by ............................. (specified person

4
    or persons).


5
        7. I understand my child will be adopted by 
6
    .............................
(specified person or 
7
    persons) only and that I cannot under any circumstances,

8
    after signing this document, change my mind and revoke or 
9
    cancel this consent
or obtain or recover custody or any 
10
    other rights over my child if
............................ 
11
    (specified person or persons) adopt my child.


12
        8. I understand that this consent to adoption is valid 
13
    only if the
petition to adopt is filed within one year from 
14
    the date that I sign it and
that if ....................... 
15
    (specified person or persons), for any reason,
cannot or 
16
    will not file a petition to adopt my child within that one 
17
    year
period or if their adoption petition is denied, then 
18
    this consent will be
voidable after one year upon the 
19
    timely filing of my motion.  If I file this
motion before 
20
    the filing of the petition for adoption, I understand that 
21
    the
court shall revoke this specific consent.
I have the 
22
    right to notice of any other proceeding that could affect 
23
    my
parental rights, except for the proceeding for 
24
    ............. (specified person
or persons) to adopt my 
25
    child.


26
        9. I have read and understand the above and I am 
 


 






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1
    signing it as my free
and voluntary act.

2
        Dated (insert date).

3
        .............................................

4
        Signature of parent

5
    (3) If the parent consents to an adoption by 2 specified 
6
persons, then the
form shall contain 2 additional paragraphs in 
7
substantially the following form:


8
        10. If ............... (specified persons) get a 
9
    divorce
before the petition to adopt my child is granted, 
10
    then ..........
(specified person) shall adopt my child.  I 
11
    understand that I
cannot change my mind and revoke this 
12
    consent or obtain or
recover custody over my child if 
13
    ............. (specified persons)
divorce and 
14
    ............. (specified person) adopts my
child.  I 
15
    understand that I cannot change my mind and revoke
this 
16
    consent or obtain or recover custody over my child if

17
    ................. (specified persons) divorce after the

18
    adoption is final.  I understand that this consent to 
19
    adoption
has no effect on who will get custody of my child 
20
    if they
divorce after the adoption is final.


21
        11. I understand that if either ...............

22
    (specified persons) dies before the petition to adopt
my 
23
    child is granted, then the surviving person can adopt my 
24
    child.  I
understand that I cannot change my mind and revoke 
25
    this consent
or obtain or recover custody over my child if 
26
    the surviving
person adopts my child.

 


 






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1
    A consent to adoption by specified persons on this form 
2
shall
have no effect on a court's determination of custody or 
3
visitation
under the Illinois Marriage and Dissolution of 
4
Marriage Act if the
marriage of the
specified persons is 
5
dissolved after the adoption is final.

6
    (4) The form of the certificate of acknowledgement for a 
7
Final and
Irrevocable Consent for Adoption by a Specified 
8
Person or Persons: DCFS Case shall be
substantially as follows:

 
9
STATE OF..............)

10
                      ) SS.

11
COUNTY OF.............)

 

12
    I, .................... (Name of Judge or other person),

13
..................... (official title, name, and address),

14
certify that ............., personally known to me to be the 
15
same person whose
name is subscribed to the foregoing Final and 
16
Irrevocable Consent for Adoption
by a Specified Person or 
17
Persons, appeared before me this day
in person and acknowledged 
18
that (she)(he) signed and delivered the consent as
(her)(his) 
19
free and voluntary act, for the specified purpose.

20
    I have fully explained that this consent to adoption is 
21
valid only if the
petition to adopt is filed within one year 
22
from the date that it is signed, and
that if the specified 
23
person or persons, for any reason, cannot or will not
adopt the 
24
child or if the adoption petition is denied, then this consent 
 


 






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1
will
be voidable after one year upon the timely filing of a 
2
motion by the parent
to revoke the consent. I explained that if 
3
this motion is filed before the
filing of the petition for 
4
adoption, the court shall revoke this specific
consent.  I have 
5
fully explained that if the specified person or
persons adopt

6
the child, by signing this consent this parent is irrevocably

7
and permanently
relinquishing all parental rights to the child, 
8
and this parent has stated that
such is (her)(his) intention 
9
and desire.

10
    Dated (insert date).

11
    ...............................

12
    Signature

13
    (5) If a consent to adoption by a specified person or 
14
persons is executed in
this form, the following provisions 
15
shall apply.  The consent shall be valid
only if that specified 
16
person or persons adopt the child.  The consent shall be

17
voidable after one year if:


18
        (a) the specified person or persons do not file a 
19
    petition to adopt the
child within one year after the 
20
    consent is signed and the parent files a
timely motion to 
21
    revoke this consent.  If this motion is filed before the

22
    filing of the petition for adoption the court shall revoke 
23
    this consent; or


24
        (b) a court denies the adoption petition; or


25
        (c) the Department of Children and Family Services 
26
    Guardianship
Administrator determines that the specified 
 


 






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1
    person or persons will not or
cannot complete the adoption, 
2
    or in the best interests of the child should not
adopt the 
3
    child.

4
    Within 30 days of the consent becoming void, the Department 
5
of Children and
Family Services Guardianship Administrator 
6
shall make good faith attempts to
notify the parent in writing 
7
and shall give written notice to the court and all
additional 
8
parties in writing that the adoption has not occurred or will 
9
not
occur and that the consent is void.  If the adoption by a 
10
specified person or
persons does not occur, no proceeding for 
11
termination of parental rights shall
be brought unless the 
12
biological parent who executed the consent to adoption by
a 
13
specified person or persons has been notified of the proceeding 
14
pursuant to
Section 7 of this Act or subsection (4) of Section 
15
2-13 of the Juvenile Court
Act of 1987.  The parent shall not 
16
need to take further action to revoke the
consent if the 
17
specified adoption does not occur, notwithstanding the

18
provisions of Section 11 of this Act.

19
    (6) The Department of Children and Family Services is 
20
authorized
to promulgate rules necessary to implement this 
21
subsection O.

22
    (7) The Department shall collect and maintain data 
23
concerning the efficacy
of specific consents.  This data shall 
24
include the number of specific consents
executed and their 
25
outcomes, including but not limited to the number of
children 
26
adopted pursuant to the consents, the number of children for 
 


 






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1
whom
adoptions are not completed, and the reason or reasons why 
2
the adoptions are
not completed.

3
    P. If the person signing a consent is incarcerated or 
4
detained in a correctional facility, prison, jail, detention 
5
center, or other comparable institution, either in this State 
6
or any other jurisdiction, the execution of such consent may be 
7
acknowledged before social service personnel of such 
8
institution, or before a person designated by a court of 
9
competent jurisdiction.
10
    Q. A consent may be acknowledged telephonically, via 
11
audiovisual connection, or other electronic means, provided 
12
that a court of competent jurisdiction has entered an order 
13
approving the execution of the consent in such manner and has 
14
designated an individual to be physically present with the 
15
parent executing such consent in order to verify the identity 
16
of the parent.
17
    R. An agency whose representative is acknowledging a 
18
consent pursuant to this Section shall be a public child 
19
welfare agency, or a child welfare agency, or a child placing 
20
agency that is authorized or licensed in the State or 
21
jurisdiction in which the consent is signed. 
22
(Source: P.A. 96-601, eff. 8-21-09.)

 
23
    Section 99. Effective date. This Act takes effect January 
24
1, 2011.