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| | 103RD GENERAL ASSEMBLY
State of Illinois
2023 and 2024 HB3101 Introduced 2/17/2023, by Rep. Jennifer Gong-Gershowitz SYNOPSIS AS INTRODUCED: |
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Amends the Abandoned Newborn Infant Protection Act. Provides that there is a presumption that by relinquishing a newborn
infant in accordance with the Act, the infant's parent waives notice of any legal
proceeding to terminate his or her parental rights. Requires a hospital to complete and submit, on behalf of a relinquished newborn infant, an application for medical assistance benefits provided under the Illinois Public Aid Code and to provide all available medical information and records regarding the infant to the Department of Children and Family Services and to the child welfare agency (rather than child-placing agency) that has accepted the referral of the infant. Provides that if the person (rather than parent) who relinquished a newborn infant, or a person claiming to be the parent of the infant, returns to reclaim the infant within 30 days (rather than 72 hours) after the infant was relinquished to a police station, the police
station must inform such person of the name and
location of the hospital to which the infant was transported. Makes changes to provisions concerning information for a relinquishing person on the relinquishment process; a child welfare agency's authority to make medical
and health related decisions for a relinquished infant; notice to the infant's biological parents of legal proceedings to terminate their parental rights; the appointment of a guardian ad litem to represent the infant's interests; the alternative to relinquishment that results in the adoption of a relinquished infant under 30 (rather than 7) days of age; and other matters. Amends the Abandoned Newborn Infant Protection Act, the Immunization Data Registry Act, the Illinois Parentage Act of 2015, and the Adoption Act by replacing all references to "child placing agency" with "child welfare agency".
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| | A BILL FOR |
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1 | | AN ACT concerning children.
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2 | | Be it enacted by the People of the State of Illinois,
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3 | | represented in the General Assembly:
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4 | | Section 5. The Abandoned Newborn Infant Protection Act is |
5 | | amended by changing Sections 10, 15, 20, 22, 30, 35, 37, 40, |
6 | | 50, 55, 60, and 65, as follows: |
7 | | (325 ILCS 2/10)
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8 | | Sec. 10. Definitions. In this Act:
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9 | | "Abandon" has the same meaning as in the Abused and |
10 | | Neglected
Child Reporting Act.
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11 | | "Abused child" has the same meaning as in the Abused and |
12 | | Neglected
Child Reporting Act.
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13 | | " Child welfare Child-placing agency" means an Illinois a |
14 | | licensed public or private agency
that receives a child for |
15 | | the purpose of placing or arranging
for the placement of the |
16 | | child in a foster or pre-adoptive family home or
other |
17 | | facility for child care, apart from the custody of the child's
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18 | | parents.
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19 | | "Department" or "DCFS" means the Illinois Department of |
20 | | Children and
Family Services.
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21 | | "Emergency medical facility" means a freestanding |
22 | | emergency center or
trauma center, as defined in the Emergency |
23 | | Medical Services (EMS) Systems
Act.
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1 | | "Emergency medical professional" includes licensed |
2 | | physicians, and any
emergency medical technician, emergency |
3 | | medical
technician-intermediate, advanced emergency medical |
4 | | technician, paramedic,
trauma nurse specialist, and |
5 | | pre-hospital registered nurse, as defined in the
Emergency |
6 | | Medical Services (EMS) Systems Act.
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7 | | "Fire station" means a fire station within the State with |
8 | | at least one staff person.
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9 | | "Hospital" has the same meaning as in the Hospital |
10 | | Licensing Act.
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11 | | "Legal custody" means the relationship created by a court |
12 | | order in
the best interest of a newborn infant that imposes on |
13 | | the infant's custodian
the responsibility of physical |
14 | | possession of the infant, the duty to
protect, train, and |
15 | | discipline the infant, and the duty to provide the infant
with |
16 | | food,
shelter, education, and medical care, except as these |
17 | | are limited by
parental rights and responsibilities.
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18 | | "Neglected child" has the same meaning as in the Abused |
19 | | and
Neglected Child Reporting Act.
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20 | | "Newborn infant" means a child who a licensed physician |
21 | | reasonably
believes is 30 days old or less at the time the |
22 | | child is
initially relinquished to a hospital, police station, |
23 | | fire station, or
emergency
medical facility, and who is not an |
24 | | abused or a neglected child. |
25 | | "Parent" or "biological parent" means a person who has |
26 | | established maternity or paternity of the newborn infant |
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1 | | through genetic testing.
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2 | | "Police station" means a municipal police station, a |
3 | | county sheriff's
office, a campus police department located on |
4 | | any college or university owned or controlled by the State or |
5 | | any private college or private university that is not owned or |
6 | | controlled by the State when employees of the campus police |
7 | | department are present, or any of the district headquarters of |
8 | | the Illinois State Police.
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9 | | "Relinquish" means to bring a newborn infant, who a
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10 | | licensed physician reasonably believes is 30 days old or less,
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11 | | to a hospital, police station, fire station, or emergency |
12 | | medical facility
and
to leave the infant with personnel of the |
13 | | facility, if the person leaving the
infant does not express an |
14 | | intent to return for the
infant or states that he or she will |
15 | | not return for the infant.
In the case of a mother who gives |
16 | | birth to an infant in a hospital,
the mother's act of leaving |
17 | | that newborn infant at the
hospital (i) without expressing an |
18 | | intent to return for the infant or (ii)
stating that she will |
19 | | not return for the infant is not a "relinquishment" under
this |
20 | | Act.
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21 | | "Temporary protective custody" means the temporary |
22 | | placement of
a newborn infant within a hospital or other |
23 | | medical facility out of the
custody of the infant's parent.
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24 | | (Source: P.A. 97-293, eff. 8-11-11; 98-973, eff. 8-15-14.)
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25 | | (325 ILCS 2/15)
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1 | | Sec. 15. Presumptions.
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2 | | (a) There is a presumption that by relinquishing a newborn |
3 | | infant
in accordance with this Act, the infant's parent
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4 | | consents to the termination of his or her
parental rights with |
5 | | respect to the infant and therefore waives notice of any legal |
6 | | proceeding to terminate his or her parental rights .
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7 | | (b) There is a presumption that a person relinquishing a |
8 | | newborn
infant in accordance with this Act:
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9 | | (1) is the newborn infant's biological parent; and
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10 | | (2) either without expressing an intent to return for |
11 | | the
infant or expressing an intent not to return for the |
12 | | infant,
did intend to relinquish the infant to the |
13 | | hospital, police station, fire
station, or emergency |
14 | | medical facility to treat, care for, and
provide for the |
15 | | infant in accordance with this
Act.
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16 | | (c) A parent of a relinquished newborn infant
may rebut |
17 | | the presumption set forth in either subsection (a) or
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18 | | subsection (b) pursuant to Section 55, at any time before the |
19 | | termination of
the parent's
parental rights.
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20 | | (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01; |
21 | | 93-820, eff. 7-27-04 .)
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22 | | (325 ILCS 2/20)
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23 | | Sec. 20. Procedures with respect to relinquished newborn
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24 | | infants.
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25 | | (a) Hospitals. Every hospital must accept and
provide all |
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1 | | necessary emergency services and care to a relinquished
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2 | | newborn infant, in accordance with this Act.
The hospital |
3 | | shall examine a relinquished newborn infant and perform tests
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4 | | that, based on reasonable medical judgment, are appropriate in |
5 | | evaluating
whether the relinquished newborn infant was abused |
6 | | or neglected.
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7 | | The act of relinquishing a newborn infant serves as |
8 | | implied
consent for the hospital and its medical personnel and |
9 | | physicians on
staff to treat and provide care for the
infant.
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10 | | The hospital shall complete and submit an application for
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11 | | medical assistance provided under Article V of the Illinois |
12 | | Public Aid Code on behalf of the infant and shall provide all |
13 | | available medical information and records regarding the infant |
14 | | to the Department and the child welfare agency that has |
15 | | accepted the referral of the infant in accordance with Section |
16 | | 50. |
17 | | The hospital shall be deemed to have temporary protective |
18 | | custody of a
relinquished newborn
infant until the infant is |
19 | | discharged to the custody of a
child welfare child-placing |
20 | | agency or the Department.
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21 | | (b) Fire stations and emergency medical facilities. Every |
22 | | fire
station and emergency medical facility must accept and
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23 | | provide all necessary emergency services and care to a |
24 | | relinquished
newborn infant, in accordance with this Act.
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25 | | The act of relinquishing a newborn infant serves as |
26 | | implied
consent for the fire station or emergency medical |
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1 | | facility and
its emergency medical professionals to treat and |
2 | | provide care for the
infant, to the extent that those |
3 | | emergency medical professionals are trained
to
provide those |
4 | | services.
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5 | | After the relinquishment of a newborn infant to a fire |
6 | | station or
emergency medical facility, the fire station or |
7 | | emergency medical
facility's personnel must arrange for the |
8 | | transportation of the
infant to the nearest hospital as soon |
9 | | as
transportation can be arranged.
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10 | | If the person who relinquished parent of a newborn infant , |
11 | | or a person claiming to be the parent of the infant, returns to |
12 | | reclaim the
infant within 30 days child within 72 hours after |
13 | | the infant was relinquished relinquishing the child to a fire |
14 | | station or
emergency
medical facility, the fire station or |
15 | | emergency medical facility must inform
such person the parent |
16 | | of the name and location of the hospital to which the infant |
17 | | was
transported.
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18 | | (c) Police stations. Every police station must accept a |
19 | | relinquished
newborn
infant, in accordance with this Act. |
20 | | After the relinquishment of a newborn
infant to a
police |
21 | | station, the police station must arrange for the |
22 | | transportation of the
infant to the
nearest hospital as soon |
23 | | as transportation can be arranged.
The act of relinquishing a
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24 | | newborn infant serves as implied consent for the hospital to |
25 | | which the infant
is
transported and that hospital's medical |
26 | | personnel and physicians on staff to
treat and
provide care |
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1 | | for the infant.
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2 | | If the person who relinquished parent of a newborn infant , |
3 | | or a person claiming to be the parent of the infant, returns to |
4 | | reclaim the infant within 30 days 72
hours after
relinquishing |
5 | | the infant was relinquished to a police station,
the police |
6 | | station must inform such person the parent of the
name and |
7 | | location of the hospital to which the infant was transported.
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8 | | (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01; |
9 | | 93-820, eff. 7-27-04 .)
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10 | | (325 ILCS 2/22) |
11 | | Sec. 22. Signs. Every hospital, fire station, emergency |
12 | | medical facility, and police station that is required to |
13 | | accept a relinquished newborn infant in accordance with this |
14 | | Act must post, either by physical or electronic means, a sign |
15 | | in a conspicuous place on the exterior of the building housing |
16 | | the facility informing persons that a newborn infant may be |
17 | | relinquished at the facility in accordance with this Act. The |
18 | | Department shall prescribe specifications for the signs and |
19 | | for their placement that will ensure statewide uniformity. |
20 | | This Section does not apply to a hospital, fire station, |
21 | | emergency medical facility, or police station that has a sign |
22 | | that is consistent with the requirements of this Section that |
23 | | is posted on the effective date of this amendatory Act of the |
24 | | 95th General Assembly.
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25 | | (Source: P.A. 102-4, eff. 4-27-21.) |
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1 | | (325 ILCS 2/30)
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2 | | Sec. 30. Anonymity of relinquishing person.
If there is |
3 | | no evidence of abuse or neglect of a
relinquished newborn |
4 | | infant, the relinquishing person has the right to
remain |
5 | | anonymous and to leave the hospital, police station, fire |
6 | | station,
or emergency
medical facility at any time and not be |
7 | | pursued or followed. Before the
relinquishing person leaves |
8 | | the hospital, police station, fire station, or
emergency |
9 | | medical
facility, the hospital, police station, fire station, |
10 | | or emergency medical
facility personnel
shall (i) verbally |
11 | | inform the relinquishing person that by
relinquishing the
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12 | | child anonymously, he or she will have to petition the court if |
13 | | he or she
desires to prevent the termination of parental |
14 | | rights and regain custody of the
child and (ii) shall offer the |
15 | | relinquishing person the information
packet
described in |
16 | | Section 35 of this Act.
However, nothing in this Act shall be |
17 | | construed as precluding the
relinquishing person from |
18 | | providing his or her identity or completing the
application |
19 | | forms for the Illinois Adoption Registry and Medical |
20 | | Information
Exchange and requesting that the hospital, police |
21 | | station, fire station, or
emergency medical
facility forward |
22 | | those forms to the Illinois Adoption Registry and Medical
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23 | | Information Exchange.
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24 | | (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01; |
25 | | 93-820, eff. 7-27-04 .)
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1 | | (325 ILCS 2/35)
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2 | | Sec. 35. Information for relinquishing person. |
3 | | (a) The A hospital, police
station, fire station,
or |
4 | | emergency
medical facility that receives a newborn infant |
5 | | relinquished in accordance with
this
Act shall must offer |
6 | | information about the relinquishment process to an information |
7 | | packet to the relinquishing person and, if
possible, must |
8 | | clearly inform the relinquishing person either in writing or |
9 | | by referring said person to a website or other electronic |
10 | | resource. Such information shall clearly state that his or her
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11 | | acceptance of the
information is completely voluntary. The
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12 | | information packet must include all of
the following:
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13 | | (1) (Blank).
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14 | | (2) Written notice of the following:
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15 | | (A) No sooner than 60 days following the date of |
16 | | the
initial relinquishment of the infant to a |
17 | | hospital, police station,
fire station, or emergency |
18 | | medical facility, the court may enter an order |
19 | | terminating parental rights without notice to the |
20 | | parents of the infant child-placing agency or the
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21 | | Department will
commence proceedings for the |
22 | | termination of
parental rights and placement of the |
23 | | infant for
adoption .
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24 | | (B) Failure of a parent of the
infant to contact |
25 | | the Department and
petition for the return of custody |
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1 | | of the
infant before termination of parental rights
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2 | | bars any future action asserting legal rights
with |
3 | | respect to the infant.
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4 | | (3) A resource list of providers of counseling
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5 | | services including grief counseling, pregnancy counseling, |
6 | | and
counseling regarding adoption and other available |
7 | | options for placement of the
infant.
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8 | | Upon request of a parent, the Department of Public Health |
9 | | shall provide the
application forms for the Illinois Adoption |
10 | | Registry and Medical Information
Exchange.
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11 | | (b) The information offered packet given to a |
12 | | relinquishing person parent in accordance with this Act shall |
13 | | include, in addition to other information required under this |
14 | | Act, the following: |
15 | | (1) Information A brochure (with a self-mailer |
16 | | attached) that describes this Act and the rights of birth |
17 | | parents, including an option optional section for the |
18 | | parent to complete and mail to the Department of Children |
19 | | and Family Services a form , that shall ask for basic |
20 | | anonymous background information about the relinquished |
21 | | child. This form brochure shall be maintained by the |
22 | | Department on its website. |
23 | | (2) Information about A brochure that describes the |
24 | | Illinois Adoption Registry, including a toll-free number |
25 | | and website information. This brochure shall be maintained |
26 | | on the Office of Vital Records website. |
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1 | | (3) Information about a mother's postpartum health A |
2 | | brochure describing postpartum health information for the |
3 | | mother . |
4 | | The information provided in writing or through electronic |
5 | | means packet shall be designed in coordination between the |
6 | | Office of Vital Records and the Department of Children and |
7 | | Family Services . The failure to provide such information under |
8 | | this Section, or the failure of the relinquishing person to |
9 | | accept such information, shall not invalidate the |
10 | | relinquishment under this Act. , with the exception of the |
11 | | resource list of providers of counseling services and adoption |
12 | | agencies, which shall be provided by the hospital, fire |
13 | | station, police station, sheriff's office, or emergency |
14 | | medical facility. |
15 | | (Source: P.A. 96-1114, eff. 7-20-10; 97-333, eff. 8-12-11.)
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16 | | (325 ILCS 2/37) |
17 | | Sec. 37. Public disclosure of information prohibited. |
18 | | Emergency medical professionals, employees, or other persons |
19 | | engaged in the administration or operation of a fire station, |
20 | | police station, hospital, emergency medical facility, child |
21 | | welfare placing agency, or the Department where a newborn |
22 | | infant baby has been relinquished or transferred under this |
23 | | Act, are prohibited from publicly disclosing any information |
24 | | concerning the relinquishment of the infant and the |
25 | | individuals involved, except as otherwise provided by law.
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1 | | (Source: P.A. 95-549, eff. 6-1-08 .) |
2 | | (325 ILCS 2/40)
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3 | | Sec. 40. Reporting requirements.
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4 | | (a) Within 12 hours after accepting a newborn infant
from |
5 | | a relinquishing person or from a police station, fire station, |
6 | | or
emergency medical
facility in accordance with this Act, a |
7 | | hospital must report to the
Department's State Central |
8 | | Registry for the purpose of transferring
physical custody of |
9 | | the infant from the hospital to either a
child welfare |
10 | | child-placing agency or the Department.
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11 | | (b) Within 24 hours after receiving a report under |
12 | | subsection (a), the
Department must request assistance from |
13 | | law enforcement
officials to investigate the matter using the |
14 | | National Crime Information Center
to ensure that the |
15 | | relinquished newborn infant is not a missing
child.
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16 | | (c) Once a hospital has made a report to the Department
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17 | | under subsection (a), the
Department must
arrange for
a |
18 | | licensed child welfare child-placing agency to accept physical |
19 | | custody of the relinquished
newborn infant.
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20 | | (d) If a relinquished child is not a newborn infant as |
21 | | defined
in this Act, the hospital and the Department must |
22 | | proceed as if the child is an
abused or neglected child.
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23 | | (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01; |
24 | | 93-820, eff. 7-27-04 .)
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1 | | (325 ILCS 2/50)
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2 | | Sec. 50. Child welfare Child-placing agency procedures.
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3 | | (a) The Department's
State Central Registry must maintain |
4 | | a list of licensed child welfare child-placing
agencies |
5 | | willing to take legal custody of newborn infants relinquished
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6 | | in accordance with this Act. The
child welfare child-placing |
7 | | agencies on the list must be contacted by the
Department on a |
8 | | rotating basis upon notice from a hospital
that a newborn |
9 | | infant has been
relinquished in accordance with this Act.
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10 | | (b) Upon notice from the Department that a newborn infant |
11 | | has
been relinquished in accordance with this Act, a child |
12 | | welfare child-placing
agency must accept the newborn infant if |
13 | | the agency has the accommodations to
do
so. The
child welfare |
14 | | child-placing agency must seek an order for legal custody of |
15 | | the
infant upon its acceptance of the infant.
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16 | | (c) Within 3 business days after accepting the referral |
17 | | from the Department, assuming physical custody of the infant,
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18 | | the child welfare child-placing agency shall file a
petition
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19 | | for custody in the division of the
circuit court in which |
20 | | petitions for adoption would normally be
heard. The infant |
21 | | shall be referred to as "Baby Girl Doe" or "Baby Boy Doe" in |
22 | | all pleadings, notwithstanding actual knowledge of the |
23 | | infant's name or of the names of the infant's alleged parents, |
24 | | in order to preserve the confidentiality of the relinquishing |
25 | | parent or parents and the expectation of anonymity consistent |
26 | | with the purposes of this Act. The petition for custody shall |
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1 | | allege that the newborn infant has been relinquished
in |
2 | | accordance with this Act and shall request state that the |
3 | | child welfare child-placing agency
be given the authority |
4 | | intends to place the infant in an adoptive home , foster home, |
5 | | child care facility, or other facility appropriate for the |
6 | | needs of the infant. No filing or appearance fees shall be |
7 | | charged to any petitioner .
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8 | | (d) If no licensed child welfare child-placing agency is |
9 | | able to accept the
relinquished newborn infant, then the |
10 | | Department must assume
responsibility for the infant as soon |
11 | | as practicable.
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12 | | (e) A custody order issued under subsection (b) shall |
13 | | grant the child welfare agency the authority to make medical |
14 | | and health related decisions for the infant. Said order shall |
15 | | remain in
effect until a final adoption order based on the |
16 | | relinquished newborn
infant's best interests is issued in |
17 | | accordance with this Act and the Adoption
Act.
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18 | | (f) When possible, the child welfare child-placing agency |
19 | | must place a
relinquished newborn infant in a prospective |
20 | | adoptive home.
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21 | | (g) An order terminating the parental rights of the |
22 | | biological parents of the infant and appointing a guardian of |
23 | | the infant with authority to consent to the adoption may be |
24 | | entered The Department or child-placing agency must initiate |
25 | | proceedings to (i)
terminate the parental rights of the |
26 | | relinquished newborn infant's
known or unknown parents, (ii) |
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1 | | appoint a guardian for the infant, and
(iii) obtain consent to |
2 | | the infant's adoption in accordance with this
Act no sooner |
3 | | than 60 days following the date of the initial
relinquishment |
4 | | of the infant to the hospital, police station, fire station,
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5 | | or
emergency medical facility. |
6 | | (g-1) Notice to the infant's biological parents of the |
7 | | legal proceedings under this Act shall be given by publication |
8 | | of a notice in a newspaper published in the county in which the |
9 | | action is pending, or if there is no newspaper published in |
10 | | that county, then in a newspaper published in an adjoining |
11 | | county having a circulation in the county in which the action |
12 | | is pending. The form to be used for publication shall be |
13 | | substantially as follows: |
14 | | "ABANDONED NEWBORN NOTICE – STATE OF ILLINOIS, County of |
15 | | ...., ss,--Circuit Court of ...... County, In the matter of |
16 | | the Abandonment of BABY (GIRL/BOY) DOE, a newborn infant, Case |
17 | | Number .......... To THE UNKNOWN MOTHER, UNKNOWN FATHER and |
18 | | ALL WHOM IT MAY CONCERN: Take notice that a Petition was filed |
19 | | in the Circuit Court of ........ County, Illinois, for an |
20 | | unnamed child, referred to as BABY (GIRL/BOY) DOE, born on or |
21 | | about ......, and relinquished to ............. on or about |
22 | | ..........., pursuant to the Abandoned Newborn Infant |
23 | | Protection Act. Now therefore, unless you UNKNOWN MOTHER, |
24 | | UNKNOWN FATHER and ALL WHOM IT MAY CONCERN, file your petition |
25 | | for return of custody in the said Circuit Court of .... County, |
26 | | ..............., in the city of .........., Illinois, on or |
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1 | | before .........., an order terminating your parental rights |
2 | | may be entered against you any time after that day and a |
3 | | judgment may be entered in accordance with the Petition. |
4 | | (E-filing instructions, Contact information for the attorney |
5 | | for the petition)" |
6 | | Notwithstanding actual knowledge, the name of the |
7 | | relinquishing parent, alleged parent, or infant shall not be |
8 | | included in the publication notice in order to preserve |
9 | | confidentiality and anonymity consistent with the purpose of |
10 | | this Act. No further notice is required unless a person |
11 | | claiming to be the infant's parent files a petition in |
12 | | accordance with Section 55 of this Act, or a possible parent is |
13 | | discovered as a result of the required procedures in |
14 | | subsection (h).
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15 | | (h) Before requesting an order filing a petition for |
16 | | termination of parental
rights, the Department or child |
17 | | welfare child-placing agency must do the following:
|
18 | | (1) If the name of either biological parent or alleged |
19 | | parent is known, search the Illinois Search its Putative |
20 | | Father Registry for the purpose of
determining the |
21 | | identity and location of the putative father of
the |
22 | | relinquished newborn infant who is, or is expected to be, |
23 | | the
subject of an adoption proceeding, in order to provide |
24 | | notice of
the proceeding to the putative father. At least |
25 | | one search of the
Registry must be conducted, at least 30 |
26 | | days after the
relinquished newborn infant's estimated |
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1 | | date of birth; earlier
searches may be conducted, however. |
2 | | Notice to any potential
putative father discovered in a |
3 | | search of the Registry according
to the estimated age of |
4 | | the relinquished newborn infant must be
in accordance with |
5 | | the Code of Civil Procedure or Section 12a of the Adoption |
6 | | Act.
If the names of all alleged parents are unknown, then |
7 | | a search is not required under this Section.
|
8 | | (2) Verify with the Department that, in accordance |
9 | | with subsection (b) of Section 40, that law enforcement |
10 | | officials, using the National Crime
Information Center,
|
11 | | that the relinquished newborn infant is not a missing |
12 | | child. |
13 | | (3) Publish notice in accordance with subsection |
14 | | (g-1).
|
15 | | (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01; |
16 | | 93-820, eff. 7-27-04 .)
|
17 | | (325 ILCS 2/55)
|
18 | | Sec. 55. Petition for return of custody.
|
19 | | (a) A parent or person claiming to be a parent of a newborn |
20 | | infant relinquished
in accordance with this Act may petition |
21 | | for the return of custody of
the infant before the termination |
22 | | of parental
rights with respect to the infant.
|
23 | | (b) A parent of a newborn infant relinquished
in |
24 | | accordance with this Act may petition for the return of |
25 | | custody of
the infant by contacting the Department
for the |
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1 | | purpose of obtaining the name of the child welfare -placing |
2 | | agency with custody of the infant and the appropriate court in |
3 | | which the petition of return of custody of the infant must be |
4 | | filed and then
filing
a petition for return of custody in the |
5 | | circuit court in which the
proceeding for the termination of |
6 | | parental rights is pending. No filing or appearance fees shall |
7 | | be charged to any petitioner.
|
8 | | (c) (Blank). If a petition for the termination of parental |
9 | | rights has not
been filed by the Department or the |
10 | | child-placing agency, the parent of the
relinquished newborn |
11 | | infant must contact the Department, which must
notify the |
12 | | parent of the appropriate court in which
the petition for |
13 | | return of custody must be filed.
|
14 | | (d) The circuit court may hold the proceeding for the |
15 | | termination of
parental rights in abeyance for a period not to |
16 | | exceed 60 days from the date
that the petition for return of |
17 | | custody was filed without a
showing of good cause. During that |
18 | | period:
|
19 | | (1) The court shall order genetic testing to establish |
20 | | maternity
or
paternity, or both.
|
21 | | (2) The Department shall conduct a child protective |
22 | | investigation and home
study to develop recommendations to |
23 | | the court.
|
24 | | (3) When indicated as a result of the Department's |
25 | | investigation and home
study, further proceedings under |
26 | | the Juvenile Court Act of 1987 as the court
determines |
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1 | | appropriate, may be conducted. However,
relinquishment of
|
2 | | a newborn infant
in accordance with this Act does not |
3 | | render the infant abused,
neglected, or abandoned solely |
4 | | because the newborn infant was relinquished to a
hospital, |
5 | | police station, fire station, or emergency medical |
6 | | facility in
accordance with this
Act. |
7 | | (4) The court shall appoint a guardian ad litem to |
8 | | represent the interests of the newborn infant.
|
9 | | (e) Failure to file a petition for the return of custody of |
10 | | a
relinquished newborn infant before the termination
of |
11 | | parental rights
bars any future action asserting legal rights |
12 | | with respect to the
infant unless the parent's act
of |
13 | | relinquishment that led to the termination of parental rights
|
14 | | involved fraud perpetrated against and not stemming from or |
15 | | involving
the parent of the newborn infant . No
action to void |
16 | | or revoke the termination of parental rights of a parent
of a |
17 | | newborn infant relinquished in accordance with
this Act, |
18 | | including an action based on fraud, may be commenced after 12
|
19 | | months after the date that the newborn infant was initially
|
20 | | relinquished to a hospital, police station, fire station, or |
21 | | emergency
medical
facility.
|
22 | | (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01; |
23 | | 93-820, eff. 7-27-04 .)
|
24 | | (325 ILCS 2/60)
|
25 | | Sec. 60. Department's duties. The Department must |
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1 | | implement a
public information program to promote safe |
2 | | placement alternatives for newborn
infants. The public |
3 | | information program must inform the public of the
following:
|
4 | | (1) The relinquishment alternative provided for in |
5 | | this
Act, which results in the adoption of a newborn |
6 | | infant relinquished under 30 7 days of age
and which
|
7 | | provides for the parent's
anonymity, if the parent so |
8 | | chooses.
|
9 | | (2) The alternative of adoption
through a public or |
10 | | private agency, in which the parent's identity may or may
|
11 | | not be known to the agency, but is kept anonymous from the |
12 | | adoptive parents, if
the birth parent so desires, and |
13 | | which allows the parent to be actively
involved in the |
14 | | child's adoption plan.
|
15 | | The public information program may include, but
need
not |
16 | | be limited to, the
following elements:
|
17 | | (i) Educational and informational materials in print, |
18 | | audio, video,
electronic or other media.
|
19 | | (ii) Establishment of a web site.
|
20 | | (iii) Public service announcements and advertisements.
|
21 | | (iv) Establishment of toll-free
telephone
hotlines to |
22 | | provide information.
|
23 | | (Source: P.A. 94-941, eff. 6-26-06.)
|
24 | | (325 ILCS 2/65)
|
25 | | Sec. 65. Evaluation.
|
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1 | | (a) The Department shall collect and analyze
information |
2 | | regarding the relinquishment of newborn infants and placement |
3 | | of
children under this Act. Police stations, fire stations, |
4 | | emergency medical
facilities, and
medical professionals |
5 | | accepting and providing services to a newborn infant
under |
6 | | this Act shall report to the Department data necessary for the |
7 | | Department
to evaluate and determine the effect of this Act in |
8 | | the prevention of injury
or death of newborn infants. Child |
9 | | welfare Child-placing agencies shall report to the
Department |
10 | | data necessary to evaluate and determine the effectiveness of |
11 | | these
agencies in providing child protective and child welfare |
12 | | services to newborn
infants relinquished under this Act.
|
13 | | (b) The information collected shall include,
but need not |
14 | | be limited to: the number of newborn infants relinquished; the |
15 | | category of the place of relinquishment (hospital, police |
16 | | station, fire station, or emergency medical facility); the
|
17 | | services provided to relinquished newborn infants; the outcome
|
18 | | of care for the relinquished newborn infants; the number and |
19 | | disposition of
cases of relinquished newborn infants subject |
20 | | to placement; the number of
children accepted and served by |
21 | | child welfare child-placing agencies; and the services
|
22 | | provided by child welfare child-placing agencies and the |
23 | | disposition of the cases of the
children placed under this |
24 | | Act.
|
25 | | (c) The Department shall submit a report by
January 1, |
26 | | 2002, and on January 1 of each
year thereafter, to the Governor |
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1 | | and General Assembly regarding the prevention
of injury or |
2 | | death of newborn infants and the effect of placements of |
3 | | children
under this Act. The report shall include, but need |
4 | | not be limited to, a
summary of
collected data, an analysis of |
5 | | the data and conclusions regarding the Act's
effectiveness, a |
6 | | determination whether the purposes of the Act are being
|
7 | | achieved,
and recommendations for changes that may be |
8 | | considered necessary to improve the
administration and |
9 | | enforcement of this Act.
|
10 | | (Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01; |
11 | | 93-820, eff. 7-27-04 .)
|
12 | | Section 10. The Immunization Data Registry Act is amended |
13 | | by changing Section 20 as follows: |
14 | | (410 ILCS 527/20)
|
15 | | Sec. 20. Confidentiality of information; release of |
16 | | information; statistics;
panel on expanding access.
|
17 | | (a) Records maintained as part of the immunization data
|
18 | | registry are confidential.
|
19 | | (b) The Department may release an individual's |
20 | | confidential
information to the individual or to the |
21 | | individual's parent or guardian
if the individual is less than |
22 | | 18 years of age.
|
23 | | (c) Subject to subsection (d) of this Section, the |
24 | | Department may release
information in the immunization data |
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1 | | registry concerning an
individual to the following entities:
|
2 | | (1) The immunization data registry of another state.
|
3 | | (2) A health care provider or a health care provider's |
4 | | designee.
|
5 | | (3) A local health department.
|
6 | | (4) An elementary or secondary school that is attended |
7 | | by the
individual.
|
8 | | (5) A licensed child care center in
which the |
9 | | individual is enrolled.
|
10 | | (6) A licensed child welfare child-placing agency.
|
11 | | (7) A college or university that is
attended by the |
12 | | individual.
|
13 | | (8) The Department of Healthcare and Family Services |
14 | | or a managed care entity contracted with the Department of |
15 | | Healthcare and Family Services to coordinate the provision |
16 | | of medical care to enrollees of the medical assistance |
17 | | program. |
18 | | (d) Before immunization data may be released to an entity, |
19 | | the
entity must enter into an agreement with the Department |
20 | | that
provides that information that identifies a patient will |
21 | | not be released
to any other person without the written |
22 | | consent of the patient.
|
23 | | (e) The Department may release summary statistics |
24 | | regarding
information in the immunization data registry if the |
25 | | summary
statistics do not reveal the identity of an |
26 | | individual.
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1 | | (Source: P.A. 97-117, eff. 7-14-11; 98-651, eff. 6-16-14.) |
2 | | Section 15. The Illinois Parentage Act of 2015 is amended |
3 | | by changing Section 602 as follows: |
4 | | (750 ILCS 46/602) |
5 | | Sec. 602. Standing. A complaint to adjudicate parentage |
6 | | shall be verified, shall be designated a petition, and shall |
7 | | name the person or persons alleged to be the parent of the |
8 | | child. Subject to Article 3 and Sections 607, 608, and 609 of |
9 | | this Act, a proceeding to adjudicate parentage may be |
10 | | maintained by: |
11 | | (a) the child;
|
12 | | (b) the mother of the child;
|
13 | | (c) a pregnant woman; |
14 | | (d) a man presumed or alleging himself to be the |
15 | | parent of the child; |
16 | | (e) a woman presumed or alleging herself to be the |
17 | | parent of the child; |
18 | | (f) the support-enforcement agency or other |
19 | | governmental agency authorized by other law;
|
20 | | (g) any person or public agency that has physical |
21 | | possession of or has custody of or has been allocated |
22 | | parental responsibilities for, is providing financial |
23 | | support to, or has provided financial support to the |
24 | | child; |
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1 | | (h) the Department of Healthcare and Family Services |
2 | | if it is providing, or has provided, financial support to |
3 | | the child or if it is assisting with child support |
4 | | collections services; |
5 | | (i) an authorized adoption agency or licensed child |
6 | | welfare child-placing agency; |
7 | | (j) a representative authorized by law to act for an |
8 | | individual who would otherwise be entitled to maintain a |
9 | | proceeding but who is deceased, incapacitated, or a minor; |
10 | | or |
11 | | (k) an intended parent.
|
12 | | (Source: P.A. 99-85, eff. 1-1-16; 99-769, eff. 1-1-17 .) |
13 | | Section 20. The Adoption Act is amended by changing |
14 | | Sections 4.1 and 10 as follows:
|
15 | | (750 ILCS 50/4.1) (from Ch. 40, par. 1506)
|
16 | | Sec. 4.1. Adoption between multiple jurisdictions. It is |
17 | | the public policy of this State to promote child welfare in |
18 | | adoption between multiple jurisdictions by implementing |
19 | | standards that foster permanency for children in an |
20 | | expeditious manner while considering the best interests of the |
21 | | child as paramount. Ensuring that standards for |
22 | | interjurisdictional adoption are clear and applied |
23 | | consistently, efficiently, and reasonably will promote the |
24 | | best interests of the child in finding a permanent home. |
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1 | | (a) The Department of Children and Family Services shall |
2 | | promulgate rules regarding the approval and regulation of |
3 | | agencies providing, in this State, adoption services, as |
4 | | defined in Section 2.24 of the Child Care Act of 1969, which |
5 | | shall include, but not be limited to, a requirement that any |
6 | | agency shall be licensed in this State as a child welfare |
7 | | agency as defined in Section 2.08 of the Child Care Act of |
8 | | 1969. Any out-of-state agency, if not licensed in this State |
9 | | as a child welfare agency, must obtain the approval of the |
10 | | Department in order to act as a sending agency, as defined in |
11 | | Section 1 of the Interstate Compact on Placement of Children |
12 | | Act, seeking to place a child into this State through a |
13 | | placement subject to the Interstate Compact on the Placement |
14 | | of Children. An out-of-state agency, if not licensed in this |
15 | | State as a child welfare agency, is prohibited from providing |
16 | | in this State adoption services, as defined by Section 2.24 of |
17 | | the Child Care Act of 1969; shall comply with Section 12C-70 of |
18 | | the Criminal Code of 2012; and shall provide all of the |
19 | | following to the Department: |
20 | | (1) A copy of the agency's current license or other |
21 | | form of authorization from the approving authority in the |
22 | | agency's state. If no license or authorization is issued, |
23 | | the agency must provide a reference statement, from the |
24 | | approving authority, stating that the agency is authorized |
25 | | to place children in foster care or adoption or both in its |
26 | | jurisdiction. |
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1 | | (2) A description of the program, including home |
2 | | studies, placements, and supervisions, that the child |
3 | | welfare child placing agency conducts within its |
4 | | geographical area, and, if applicable, adoptive placements |
5 | | and the finalization of adoptions. The child welfare child |
6 | | placing agency must accept continued responsibility for |
7 | | placement planning and replacement if the placement fails. |
8 | | (3) Notification to the Department of any significant |
9 | | child welfare child placing agency changes after approval. |
10 | | (4) Any other information the Department may require. |
11 | | The rules shall also provide that any agency that places |
12 | | children for
adoption in this State may not, in any policy or |
13 | | practice relating to the
placement of children for adoption, |
14 | | discriminate against any child or
prospective adoptive parent |
15 | | on the basis of race.
|
16 | | (a-5) (Blank). |
17 | | (b) Interstate adoptions. |
18 | | (1) All interstate adoption placements under this Act |
19 | | shall comply with the Child Care Act of 1969 and the |
20 | | Interstate Compact on
the Placement of Children. The |
21 | | placement of children with relatives by the Department of |
22 | | Children and Family Services shall also comply with |
23 | | subsection (b) of Section 7 of the Children and Family |
24 | | Services Act. The Department may promulgate rules to |
25 | | implement interstate adoption placements, including those |
26 | | requirements set forth in this Section. |
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1 | | (2) If an adoption is finalized prior to bringing or |
2 | | sending a child to this State, compliance with the |
3 | | Interstate Compact on the Placement of Children is not |
4 | | required. |
5 | | (3) Approval requirements. The Department shall |
6 | | promulgate procedures for interstate adoption placements |
7 | | of children under this Act. No later than September 24, |
8 | | 2017 (30 days after the effective date of Public Act |
9 | | 100-344), the Department shall distribute a written list |
10 | | of all preadoption approval requirements to all Illinois |
11 | | licensed child welfare agencies performing adoption |
12 | | services, and all out-of-state agencies approved under |
13 | | this Section, and shall post the requirements on the |
14 | | Department's website. The Department may not require any |
15 | | further preadoption requirements other than those set |
16 | | forth in the procedures required under this paragraph. The |
17 | | procedures shall reflect the standard of review as stated |
18 | | in the Interstate Compact on the Placement of Children and |
19 | | approval shall be given by the Department if the placement |
20 | | appears not to be contrary to the best interests of the |
21 | | child.
|
22 | | (4) Time for review and decision. In all cases where |
23 | | the child to be placed is not a youth in care in Illinois |
24 | | or any other state, a provisional or final approval for |
25 | | placement shall be provided in writing from the Department |
26 | | in accordance with the Interstate Compact on the Placement |
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1 | | of Children. Approval or denial of the placement must be |
2 | | given by the Department as soon as practicable, but in no |
3 | | event more than 3 business days of the receipt of the |
4 | | completed referral packet by the Department's Interstate |
5 | | Compact Administrator. Receipt of the packet shall be |
6 | | evidenced by the packet's arrival at the address |
7 | | designated by the Department to receive such referrals. |
8 | | The written decision to approve or deny the placement |
9 | | shall be communicated in an expeditious manner, including, |
10 | | but not limited to, electronic means referenced in |
11 | | paragraph (b)(7) of this Section, and shall be provided to |
12 | | all Illinois licensed child welfare agencies involved in |
13 | | the placement, all out-of-state child placing agencies |
14 | | involved in the placement, and all attorneys representing |
15 | | the prospective adoptive parent or biological parent. If, |
16 | | during its initial review of the packet, the Department |
17 | | believes there are any incomplete or missing documents, or |
18 | | missing information, as required in paragraph (b)(3), the |
19 | | Department shall, as soon as practicable, but in no event |
20 | | more than 2 business days of receipt of the packet, |
21 | | communicate a list of any incomplete or missing documents |
22 | | and information to all Illinois licensed child welfare |
23 | | agencies involved in the placement, all out-of-state child |
24 | | placing agencies involved in the placement, and all |
25 | | attorneys representing the adoptive parent or biological |
26 | | parent. This list shall be communicated in an expeditious |
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1 | | manner, including, but not limited to, electronic means |
2 | | referenced in paragraph (b)(7) of this Section. |
3 | | (5) Denial of approval. In all cases where the child |
4 | | to be placed is not a youth in the care of any state, if |
5 | | the Department denies approval of an interstate placement, |
6 | | the written decision referenced in paragraph (b)(4) of |
7 | | this Section shall set forth the reason or reasons why the |
8 | | placement was not approved and shall reference which |
9 | | requirements under paragraph (b)(3) of this Section were |
10 | | not met. The written decision shall be communicated in an |
11 | | expeditious manner, including, but not limited to, |
12 | | electronic means referenced in paragraph (b)(7) of this |
13 | | Section, to all Illinois licensed child welfare agencies |
14 | | involved in the placement, all out-of-state child placing |
15 | | agencies involved in the placement, and all attorneys |
16 | | representing the prospective adoptive parent or biological |
17 | | parent. |
18 | | (6) Provisional approval. Nothing in paragraphs (b)(3) |
19 | | through (b)(5) of this Section shall preclude the |
20 | | Department from issuing provisional approval of the |
21 | | placement pending receipt of any missing or incomplete |
22 | | documents or information. |
23 | | (7) Electronic communication. All communications |
24 | | concerning an interstate placement made between the |
25 | | Department and an Illinois licensed child welfare agency, |
26 | | an out-of-state child placing agency, and attorneys |
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1 | | representing the prospective adoptive parent or biological |
2 | | parent, including the written communications referenced in |
3 | | this Section, may be made through any type of electronic |
4 | | means, including, but not limited to, electronic mail. |
5 | | (c) Intercountry adoptions. The adoption of a child, if |
6 | | the child is a habitual resident of a country other than the |
7 | | United States and the petitioner is a habitual resident of the |
8 | | United States, or, if the child is a habitual resident of the |
9 | | United States and the petitioner is a habitual resident of a |
10 | | country other than the United States, shall comply with the |
11 | | Intercountry Adoption Act of 2000, as amended, and the |
12 | | Immigration and Nationality Act, as amended. In the case of an |
13 | | intercountry adoption that requires oversight by the adoption |
14 | | services governed by the Intercountry Adoption Universal |
15 | | Accreditation Act of 2012, this State shall not impose any |
16 | | additional preadoption requirements.
|
17 | | (d) (Blank).
|
18 | | (e) Re-adoption after an intercountry adoption. |
19 | | (1) Any time after a minor child has been adopted in a |
20 | | foreign country and has immigrated to the United States, |
21 | | the adoptive parent or parents of the child may petition |
22 | | the court for a judgment of adoption to re-adopt the child |
23 | | and confirm the foreign adoption decree. |
24 | | (2) The petitioner must submit to the court one or |
25 | | more of the following to verify the foreign adoption: |
26 | | (i) an immigrant visa for the child issued by |
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1 | | United States Citizenship and Immigration Services of |
2 | | the U.S. Department of Homeland Security that was |
3 | | valid at the time of the child's immigration; |
4 | | (ii) a decree, judgment, certificate of adoption, |
5 | | adoption registration, or equivalent court order, |
6 | | entered or issued by a court of competent jurisdiction |
7 | | or administrative body outside the United States, |
8 | | establishing the relationship of parent and child by |
9 | | adoption; or |
10 | | (iii) such other evidence deemed satisfactory by |
11 | | the court. |
12 | | (3) The child's immigrant visa shall be prima facie |
13 | | proof that the adoption was established in accordance with |
14 | | the laws of the foreign jurisdiction and met United States |
15 | | requirements for immigration. |
16 | | (4) If the petitioner submits documentation that |
17 | | satisfies the requirements of paragraph (2), the court |
18 | | shall not appoint a guardian ad litem for the minor who is |
19 | | the subject of the proceeding, shall not require any |
20 | | further termination of parental rights of the child's |
21 | | biological parents, nor shall it require any home study, |
22 | | investigation, post-placement visit, or background check |
23 | | of the petitioner. |
24 | | (5) The petition may include a request for change of |
25 | | the child's name and any other request for specific relief |
26 | | that is in the best interests of the child. The relief may |
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1 | | include a request for a revised birth date for the child if |
2 | | supported by evidence from a medical or dental |
3 | | professional attesting to the appropriate age of the child |
4 | | or other collateral evidence. |
5 | | (6) Two adoptive parents who adopted a minor child |
6 | | together in a foreign country while married to one another |
7 | | may file a petition for adoption to re-adopt the child |
8 | | jointly, regardless of whether their marriage has been |
9 | | dissolved. If either parent whose marriage was dissolved |
10 | | has subsequently remarried or entered into a civil union |
11 | | with another person, the new spouse or civil union partner |
12 | | shall not join in the petition to re-adopt the child, |
13 | | unless the new spouse or civil union partner is seeking to |
14 | | adopt the child. If either adoptive parent does not join |
15 | | in the petition, he or she must be joined as a party |
16 | | defendant. The defendant parent's failure to participate |
17 | | in the re-adoption proceeding shall not affect the |
18 | | existing parental rights or obligations of the parent as |
19 | | they relate to the minor child, and the parent's name |
20 | | shall be placed on any subsequent birth record issued for |
21 | | the child as a result of the re-adoption proceeding. |
22 | | (7) An adoptive parent who adopted a minor child in a |
23 | | foreign country as an unmarried person may file a petition |
24 | | for adoption to re-adopt the child as a sole petitioner, |
25 | | even if the adoptive parent has subsequently married or |
26 | | entered into a civil union. |
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1 | | (8) If one of the adoptive parents who adopted a minor |
2 | | child dies prior to a re-adoption proceeding, the deceased |
3 | | parent's name shall be placed on any subsequent birth |
4 | | record issued for the child as a result of the re-adoption |
5 | | proceeding. |
6 | | (Source: P.A. 99-49, eff. 7-15-15; 100-344, eff. 8-25-17; |
7 | | 100-863, eff. 8-14-18.)
|
8 | | (750 ILCS 50/10) (from Ch. 40, par. 1512)
|
9 | | Sec. 10. Forms of consent and surrender; execution and
|
10 | | acknowledgment thereof. |
11 | | A. The form of consent required for the
adoption of a born |
12 | | child shall be substantially as follows:
|
13 | | FINAL AND IRREVOCABLE CONSENT TO ADOPTION
|
14 | | I, ...., (relationship, e.g., mother, father, relative, |
15 | | guardian)
of ...., a male or female (circle one) child, state:
|
16 | | That such child was born on .... at ....
|
17 | | That I reside at ...., County of .... and State of ....
|
18 | | That I am of the age of .... years.
|
19 | | That I hereby enter my appearance in this proceeding and |
20 | | waive
service of summons on me.
|
21 | | That I hereby acknowledge that I have been provided with a |
22 | | copy of the Birth Parent Rights and Responsibilities-Private |
23 | | Form before signing this Consent and that I have had time to |
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1 | | read, or have had read to me, this Form. I understand that if I |
2 | | do not receive any of the rights as described in this Form, it |
3 | | shall not constitute a basis to revoke this Final and |
4 | | Irrevocable Consent. |
5 | | That I do hereby consent and agree to the adoption of such |
6 | | 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 such child.
|
10 | | That I understand such child will be placed for adoption |
11 | | and that I
cannot under any circumstances, after signing this |
12 | | document, change my
mind and revoke or cancel this consent or |
13 | | obtain or recover custody or
any other rights over such child. |
14 | | That I have read and understand the
above and I am signing it |
15 | | as my free and voluntary act.
|
16 | | Dated (insert date).
|
17 | | .........................
|
18 | | If under Section 8 the consent of more than one person is |
19 | | required,
then each such person shall execute a separate |
20 | | consent.
|
21 | | A-1. (1) The form of the Final and Irrevocable Consent to |
22 | | Adoption by a Specified Person or Persons: Non-DCFS Case set |
23 | | forth in this subsection A-1 is to be used by legal parents |
24 | | only. This form is not to be used in cases in which there is a |
25 | | pending petition under Section 2-13 of the Juvenile Court Act |
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1 | | of 1987. |
2 | | (2) The form of the Final and Irrevocable Consent to |
3 | | Adoption by a Specified Person or Persons in a non-DCFS case |
4 | | shall have the caption of the proceeding in which it is to be |
5 | | filed and shall be substantially as follows: |
6 | | FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY |
7 | | A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE |
8 | | I, ...., (relationship, e.g., mother, father) of ...., a |
9 | | male or female (circle one) child, state: |
10 | | 1. That such child was born on ...., at ....., in the |
11 | | City/Town of ... and State of .... |
12 | | 2. That I reside at ...., County of .... and State of ...., |
13 | | my email address (if I have one) is .... my cell phone number |
14 | | where I can receive text messages (if I have one) is .... and |
15 | | my land line phone number (if I have one) is ...., and any |
16 | | other contact information is .... |
17 | | 3. That I am of the age of .... years. |
18 | | 4. That I hereby enter my appearance in this proceeding |
19 | | and waive service of summons on me. |
20 | | 5. That I hereby acknowledge that I have been provided a |
21 | | copy of the Birth Parent Rights and Responsibilities-Private |
22 | | Form before signing this Consent and that I have had time to |
23 | | read, or have had read to me, this Form and that I understand |
24 | | the Rights and Responsibilities described in this Form. I |
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1 | | understand that if I do not receive any of my rights as |
2 | | described in said Form, it shall not constitute a basis to |
3 | | revoke this Final and Irrevocable Consent to Adoption by a |
4 | | Specified Person. |
5 | | 6. That I do hereby consent and agree to the adoption of |
6 | | such child by .... (specified person or persons) only. If only |
7 | | first names are used for the specified person or persons, I |
8 | | voluntarily sign this specified consent form without |
9 | | disclosure to me of the last name of the specified person or |
10 | | persons. However, I understand that if I wish to know the last |
11 | | name of the specified person or persons, I may request it |
12 | | before signing the form. If I do not receive the last name, I |
13 | | may choose not to sign the specified consent form. |
14 | | 7. That I wish to and understand that upon signing this |
15 | | consent I do irrevocably and permanently give up all custody |
16 | | and other parental rights I have to such child if such child is |
17 | | adopted by .... (specified person or persons). I hereby |
18 | | transfer all of my rights to the custody, care and control of |
19 | | such child to ............................. (specified person |
20 | | or persons). |
21 | | 8. That I understand such child will be adopted by |
22 | | ....................... (specified person or persons) and that |
23 | | I cannot under any circumstances, after signing this document, |
24 | | change my mind and revoke or cancel this consent or obtain or |
25 | | recover custody or any other rights over such child if |
26 | | ............................ (specified person or persons) |
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1 | | adopt(s) such child; PROVIDED that each specified person has |
2 | | filed or shall file, within 60 days from the date hereof, a |
3 | | petition for the adoption of such child. |
4 | | 9. That if the specified person or persons designated |
5 | | herein do not file a petition for adoption within the |
6 | | time-frame specified above, or, if said petition for adoption |
7 | | is filed within the time-frame specified above but the |
8 | | adoption petition is dismissed with prejudice or the adoption |
9 | | proceeding is otherwise concluded without an order declaring |
10 | | the child to be the adopted child of the specified person or |
11 | | persons, then I understand that I will be sent written notice |
12 | | of such circumstances at the mailing address, at the email |
13 | | address, through a text message to my cell phone number, and to |
14 | | any other contact information I have provided in paragraph 2 |
15 | | within 5 business days of this occurrence. I understand that |
16 | | the notice will be directed to me using the contact |
17 | | information I have provided in this consent. I understand that |
18 | | I will have 15 business days from the date that the written |
19 | | notice is sent to me to respond in the manner described in the |
20 | | notice, within which time I may request the Court to declare |
21 | | this consent voidable and return the child to me. I further |
22 | | understand that the Court will make the final decision of |
23 | | whether or not the child will be returned to me. If I do not |
24 | | make such request within 15 business days of the date the |
25 | | notice was sent, then I expressly waive any other notice or |
26 | | service of process in any legal proceeding regarding the |
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1 | | child, including a legal proceeding for someone other than |
2 | | ..... (specified person or persons) to adopt the child, and |
3 | | that I will have no parental rights as to the child. The person |
4 | | sending the notice shall file an affidavit of notice as proof |
5 | | of the date sent. |
6 | | 10. That I expressly acknowledge that nothing in this |
7 | | Consent
impairs the validity and absolute finality of this
|
8 | | Consent under any circumstance other than those described in
|
9 | | paragraph 9 of this Consent. |
10 | | 11. That I understand that I have a remaining duty and
|
11 | | obligation to keep .............. (insert name and address of |
12 | | the attorney
for the specified person or persons) informed of |
13 | | my current
address or other preferred contact information |
14 | | until this adoption has been finalized. My failure to
do so may |
15 | | result in the termination of my parental rights and
the child |
16 | | being placed for adoption in another home. |
17 | | 12. That I do expressly waive any other notice or service |
18 | | of process in any of the legal proceedings for the adoption of |
19 | | the child as long as the adoption proceeding by the specified |
20 | | person or persons is pending. |
21 | | 13. That I have read and understand the above and I am |
22 | | signing it as my free and voluntary act. |
23 | | 14. That I acknowledge that this consent is valid even if |
24 | | the specified person or persons separate or divorce or one of |
25 | | the specified persons dies prior to the entry of the final |
26 | | judgment for adoption. |
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1 | | Dated (insert date). |
2 | | ............................................. |
3 | | Signature of parent. |
4 | | ............................................. |
5 | | Address of parent. |
6 | | ............................................. |
7 | | Phone number(s) of parent. |
8 | | ............................................. |
9 | | Personal email(s) of parent. |
10 | | ............................................. |
11 | | (3) The form of the certificate of acknowledgement for a |
12 | | Final and Irrevocable Consent for Adoption by a Specified |
13 | | Person or Persons: Non-DCFS Case shall be substantially as |
14 | | follows: |
15 | | STATE OF ..............)
|
16 | | ) SS.
|
17 | | COUNTY OF .............) |
18 | | I, .................... (Name of Judge or other person), |
19 | | ..................... (official title, name, and address), |
20 | | certify that ............., personally known to me to be the |
21 | | same person whose name is subscribed to the foregoing Final |
22 | | and Irrevocable Consent for Adoption by a Specified Person or |
23 | | Persons; non-DCFS case, appeared before me this day in person |
24 | | and acknowledged that (she)(he) signed and delivered the |
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1 | | consent as (her)(his) free and voluntary act, for the |
2 | | specified purpose. I am further satisfied that, before signing |
3 | | this Consent, ........ has read, or has had read to him or her, |
4 | | the Birth Parent Rights and Responsibilities-Private Form. |
5 | | A-2. Birth Parent Rights and Responsibilities-Private |
6 | | Form. The Birth Parent Rights and Responsibilities-Private |
7 | | Form must be read by, or have been read to, any person |
8 | | executing a Final and Irrevocable Consent to Adoption under |
9 | | subsection A, a Final and Irrevocable Consent to Adoption by a |
10 | | Specified Person or Persons: Non-DCFS Case under subsection |
11 | | A-1, or a Consent to Adoption of Unborn Child under subsection |
12 | | B prior to the execution of said Consent. The form of the Birth |
13 | | Parent Rights and Responsibilities-Private Form shall be |
14 | | substantially as follows: |
15 | | Birth Parent Rights and Responsibilities-Private Form |
16 | | THIS FORM DOES NOT CONSTITUTE LEGAL ADVICE. LEGAL ADVICE IS |
17 | | DEPENDENT ON THE SPECIFIC CIRCUMSTANCES OF EACH SITUATION AND |
18 | | JURISDICTION. THE INFORMATION IN THIS FORM CANNOT REPLACE THE |
19 | | ADVICE OF AN ATTORNEY LICENSED IN YOUR STATE. |
20 | | As a birth parent in the State of Illinois, you have the |
21 | | right: |
22 | | 1. To have your own attorney represent you. The |
23 | | prospective adoptive parents may agree to pay for the cost of |
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1 | | your attorney in a manner consistent with Illinois law, but |
2 | | they are not required to do so. |
3 | | 2. To be treated with dignity and respect at all times and |
4 | | to make decisions free from coercion and pressure. |
5 | | 3. To request to receive counseling before and after |
6 | | signing a Final and Irrevocable Consent to Adoption |
7 | | ("Consent"), a Final and Irrevocable Consent to Adoption by a |
8 | | Specified Person or Persons: Non-DCFS Case ("Specified |
9 | | Consent"), or a Consent to Adoption of Unborn Child ("Unborn |
10 | | Consent"). The prospective adoptive parents may agree to pay |
11 | | for the cost of counseling in a manner consistent with |
12 | | Illinois law, but they are not required to do so. |
13 | | 4. To ask to be involved in choosing your child's |
14 | | prospective adoptive parents and to ask to meet them. |
15 | | 5. To ask your child's prospective adoptive parents any |
16 | | questions that pertain to your decision to place your child |
17 | | with them. |
18 | | 6. To see your child before signing a Consent or Specified |
19 | | Consent if you are the custodial parent, and to request to see |
20 | | your child if you are not the custodial parent. |
21 | | 7. To request contact with your child and/or the child's |
22 | | prospective adoptive parents, with the understanding that any |
23 | | promises regarding contact with your child or receipt of |
24 | | information about the child after signing a Consent, Specified |
25 | | Consent, or Unborn Consent cannot be enforced under Illinois |
26 | | law. |
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1 | | 8. To receive copies of all documents that you sign and |
2 | | have those documents provided to you in your preferred |
3 | | language. |
4 | | 9. To request that your identifying information remain |
5 | | confidential, unless required otherwise by Illinois law or |
6 | | court order, and to voluntarily share your medical, |
7 | | background, and identifying information, including information |
8 | | on the original birth certificate of your child. This can be |
9 | | done through the Illinois Adoption Registry and Medical |
10 | | Information Exchange or through completing the Birth Parent |
11 | | Preference Form. Please visit http://dph.illinois.gov or |
12 | | www.newillinoisadoptionlaw.com. |
13 | | 10. To access the Confidential Intermediary Program which |
14 | | provides a way for a court appointed person to connect and/or |
15 | | exchange information between adoptees, adoptive parents and |
16 | | birth parents, and other biological family members, provided |
17 | | in most cases that mutual consent is given. Please visit |
18 | | www.ci-illinois.org or call (800) 526-9022(x29). |
19 | | 11. To work with an adoption agency or attorney of your |
20 | | choice, or change said agency or attorney, provided you |
21 | | promptly inform all of the parties currently involved. |
22 | | 12. To receive, upon request, a written list of any |
23 | | promised support, financial or otherwise, from your attorney |
24 | | or the attorney for your child's prospective adoptive parents. |
25 | | 13. To delay signing a Consent, Specified Consent, or |
26 | | Unborn Consent if you are not ready to do so. |
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1 | | 14. To decline to sign a Consent, Specified Consent, or |
2 | | Unborn Consent even if you have received financial support |
3 | | from the prospective adoptive parents. |
4 | | If you do not receive any of the rights described in this |
5 | | Form, it shall not be a basis to revoke a Consent, Specified |
6 | | Consent, or Unborn Consent. |
7 | | As a Birth Parent in the State of Illinois, you have the |
8 | | responsibility: |
9 | | 1. To carefully consider your reasons for choosing |
10 | | adoption. |
11 | | 2. (Birth mothers only) To accurately complete an |
12 | | Affidavit of Identification, which identifies the father of |
13 | | the child when known, with the understanding that a birth |
14 | | mother has a right to decline to identify the birth father. |
15 | | 3. To provide the necessary documentation regarding |
16 | | financial need to make an appropriate determination of |
17 | | reasonable pregnancy-related expenses. |
18 | | 4. To not accept financial support or reimbursement of |
19 | | pregnancy related expenses simultaneously from more than one |
20 | | source or if you are not pregnant, as doing so is a crime. |
21 | | 5. To voluntarily provide all known medical, background, |
22 | | and family information about yourself and your immediate |
23 | | family to your child's prospective adoptive parents or their |
24 | | attorney. For the health of your child, you are strongly |
25 | | encouraged, but not required, to do so as set forth on the |
26 | | following form: |
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1 | | Birth Parent Medical Information |
2 | | The purpose of this form is to gather your health history, |
3 | | genetic history, and social background information to share |
4 | | with the adoptive parents. It is important the adoptive family |
5 | | provide this information to the child's physician. It will |
6 | | become a part of the child's medical and family history. This |
7 | | form, in its entirety, will be given to the adoptive |
8 | | parent(s). |
9 | | The following information is true and complete to the best |
10 | | of my knowledge and belief. |
11 | | Birth parent name: |
12 | | ...................................... |
13 | | Signature: |
14 | | .............................................. |
15 | | Date: .................................................... |
16 | | YES or NO (circle one) I agree to release my full name on |
17 | | this form to the adoptive family. If NO is circled then the |
18 | | birth parent's name shall be redacted on this form. |
19 | | MOTHER'S PHYSICAL CHARACTERISTICS: |
20 | | Eyes: ... Hair: .... Complexion: .... Height: .... |
21 | | Weight: .... Body build: .....
Race: ..... |
22 | | Nationality/Descent: ....... Blood type: .... Rh factor: .... |
23 | | Eye glasses or contact lenses? Yes /.../ No /.../ |
24 | | Right /.../ Left /.../ handed |
25 | | Age: .... or Date of birth: ..... Religion: ................. |
26 | | Please list your highest education level, occupation, |
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1 | | hobbies, interests, and talents: |
2 | | ............................ |
3 | | Existence of any disabilities? Yes /.../ No /.../ |
4 | | If yes, explain: ............................................. |
5 | | If you have other children, list them below. Include any |
6 | | children previously placed for adoption. |
7 | | .................... |
8 | | Describe your relationship with the birth father: ....... |
9 | | FATHER'S PHYSICAL CHARACTERISTICS: |
10 | | Eyes: ... Hair: .... Complexion: .... Height: .... |
11 | | Weight: .... Body build: .....
Race: ..... |
12 | | Nationality/Descent: ....... Blood type: .... Rh factor: .... |
13 | | Eye glasses or contact lenses? Yes /.../ No /.../ |
14 | | Right /.../ Left /.../ handed |
15 | | Age: .... or Date of birth: ..... Religion: ................. |
16 | | Please list your highest education level, occupation, |
17 | | hobbies, interests, and talents: |
18 | | ............................ |
19 | | Existence of any disabilities? Yes /.../ No /.../ |
20 | | If yes, explain: ............................................. |
21 | | If you have other children, list them below. Include any |
22 | | children previously placed for adoption. |
23 | | .................... |
24 | | PREGNANCY HISTORY INVOLVING THIS CHILD |
25 | | Month prenatal care began during this pregnancy: ......... |
26 | | Complications during pregnancy: Yes ... No ... If yes, |
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1 | | explain: .................................................... |
2 | | ............................................................. |
3 | | MEDICATION AND OTHER SUBSTANCES USED DURING |
4 | | PREGNANCY OR YEAR PRIOR TO PREGNANCY |
|
5 | | | | | FREQUENCY/ | FREQUENCY/ | |
6 | | | | | AMOUNT | AMOUNT | |
7 | | | | | DURING | PRIOR TO | |
8 | | | YES | NO | PREGNANCY | PREGNANCY | |
9 | | Alcohol | /../ | /../ | ................. | ............... | |
10 | | Amphetamines | /../ | /../ | ................. | ............... | |
11 | | Barbiturates | /../ | /../ | ................. | ............... | |
12 | | Cocaine | /../ | /../ | ................. | ............... | |
13 | | Heroin | /../ | /../ | ................. | ............... | |
14 | | LSD | /../ | /../ | ................. | ............... | |
15 | | Marijuana | /../ | /../ | ................. | ............... | |
16 | | Caffeine | | | | | |
17 | | (Coffee, | | | | | |
18 | | tea, etc) | /../ | /../ | ................. | ............... | |
19 | | Prescription | | | | | |
20 | | drugs | /../ | /../ | ................. | ............... | |
21 | | Non- | | | | | |
22 | | prescription | | | | | |
23 | | drugs | /../ | /../ | ................. | ............... | |
24 | | Other | /../ | /../ | ................. | ............... |
|
25 | | In addition to this form, a birth parent shall also be |
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1 | | provided the forms for the Illinois Adoption Registry and |
2 | | Medical Information Exchange. |
3 | | B. The form of consent required for the adoption of an |
4 | | unborn child
shall be substantially as follows:
|
5 | | CONSENT TO ADOPTION OF UNBORN CHILD
|
6 | | I, ...., state:
|
7 | | That I am the father of a child expected to be born on or |
8 | | about ....
to .... (name of mother).
|
9 | | That I reside at .... County of ...., and State of .....
|
10 | | That I am of the age of .... years.
|
11 | | That I hereby enter my appearance in such adoption |
12 | | proceeding and
waive service of summons on me.
|
13 | | That I hereby acknowledge that I have been provided with 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. I understand that if I |
17 | | do not receive any of the rights as described in this Form, it |
18 | | shall not constitute a basis to revoke this Consent to |
19 | | Adoption of Unborn Child. |
20 | | That I do hereby consent and agree to the adoption of such |
21 | | child, and
that I have not previously executed a consent or |
22 | | surrender with respect
to such child.
|
23 | | That I wish to and do understand that by signing this |
24 | | consent I do
irrevocably and permanently give up all custody |
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1 | | and other parental
rights I have to such child, except that I |
2 | | have the right to revoke this
consent by giving written notice |
3 | | of my revocation not later than 72
hours after the birth of the |
4 | | child.
|
5 | | That I understand such child will be placed for adoption |
6 | | and that,
except as hereinabove provided, I cannot under any |
7 | | circumstances, after
signing this document, change my mind and |
8 | | revoke or cancel this consent
or obtain or recover custody or |
9 | | any other rights over 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 | | B-5. (1) The parent of a child may execute a consent to |
15 | | standby
adoption by a specified person or persons. A consent |
16 | | under this subsection B-5
shall be acknowledged by a parent |
17 | | pursuant to subsection H and subsection K of
this Section.
The |
18 | | form of consent required for the standby adoption of a born |
19 | | child
effective at a future date when the consenting
parent of |
20 | | the child dies or
requests that a final judgment of adoption be |
21 | | entered shall be substantially as
follows:
|
22 | | FINAL AND IRREVOCABLE CONSENT
|
23 | | TO STANDBY ADOPTION
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1 | | I, ..., (relationship, e.g. mother or father)
of ...., a |
2 | | male or female (circle one) child, state:
|
3 | | That the child was born on .... at .....
|
4 | | That I reside at ...., County of ...., and State of .....
|
5 | | That I am of the age of .... years.
|
6 | | That I hereby enter my appearance in this proceeding and |
7 | | waive service of
summons on me in this action only.
|
8 | | That I do hereby consent and
agree to the standby adoption |
9 | | of the child, and that I have not previously
executed a consent |
10 | | or surrender with respect to the child.
|
11 | | That I wish to and understand that by signing this consent |
12 | | I do irrevocably
and permanently give up all custody and other |
13 | | parental rights I have to the
child, effective upon
(my death) |
14 | | (the child's other parent's death) or upon (my) (the other
|
15 | | parent's) request for the entry of a final judgment for |
16 | | adoption if .....
(specified person or persons) adopt my |
17 | | child.
|
18 | | That I understand that until (I die) (the child's other |
19 | | parent dies), I
retain all legal rights and obligations |
20 | | concerning the child, but at that time,
I irrevocably give all |
21 | | custody and other parental rights to .... (specified
person or |
22 | | persons).
|
23 | | I understand my child will be adopted by ....... |
24 | | (specified person or
persons) only and that I cannot, under |
25 | | any circumstances, after signing this
document, change my mind |
26 | | and revoke or cancel this consent or obtain or recover
custody |
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1 | | or any other rights over my child if ..... (specified person or
|
2 | | persons) adopt my child.
|
3 | | I understand that this consent to standby adoption is |
4 | | valid only if the
petition for standby adoption is filed and |
5 | | that if ....... (specified person or
persons), for any reason, |
6 | | cannot or will not file a petition for standby
adoption or if |
7 | | his, her, or their petition for standby adoption is denied, |
8 | | then
this consent is void. I have the right to notice of any |
9 | | other proceeding that
could affect my parental rights.
|
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 | | If under Section 8 the consent of more than one person is |
15 | | required, then each
such
person shall execute a separate |
16 | | consent. A separate consent shall be executed
for each
child.
|
17 | | (2) If the parent consents to a standby adoption by 2 |
18 | | specified persons,
then the form shall contain 2 additional |
19 | | paragraphs in substantially the
following form:
|
20 | | If .... (specified persons) obtain a judgment of
|
21 | | dissolution of
marriage before the judgment for adoption is |
22 | | entered, then .....
(specified person) shall adopt my child. I |
23 | | understand that I cannot change my
mind and revoke this |
24 | | consent or obtain or recover custody of my child if .....
|
25 | | (specified persons) obtain a judgment of dissolution of |
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1 | | marriage and .....
(specified person) adopts my child. I |
2 | | understand that I cannot change my
mind and revoke this |
3 | | consent if ...... (specified persons) obtain a
judgment of |
4 | | dissolution of marriage before the adoption is final. I
|
5 | | understand that this consent to adoption has no effect on who |
6 | | will get custody
of my child if ..... (specified persons) |
7 | | obtain a judgment of dissolution
of marriage after the |
8 | | adoption is final. I understand that if either .....
|
9 | | (specified persons) dies before the petition to adopt my child |
10 | | is granted, then
the surviving person may adopt my child. I |
11 | | understand that I cannot change my
mind and revoke this |
12 | | consent or obtain or recover custody of my child if the
|
13 | | surviving person adopts my child.
|
14 | | A consent to standby adoption by specified persons on this |
15 | | form shall have no
effect on a court's determination of |
16 | | custody or visitation under the Illinois
Marriage and |
17 | | Dissolution
of Marriage Act if the marriage of the specified |
18 | | persons is dissolved before
the adoption is final.
|
19 | | (3) The form of the certificate of acknowledgement for a |
20 | | Final and
Irrevocable Consent for Standby Adoption shall be |
21 | | substantially as follows:
|
22 | | STATE OF .....)
|
23 | | ) SS.
|
24 | | COUNTY OF ....)
|
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1 | | I, ....... (name of Judge or other person) ..... (official |
2 | | title,
name, and address), certify that ......., personally |
3 | | known to me to be
the same person whose name is subscribed to |
4 | | the foregoing Final and Irrevocable
Consent to Standby |
5 | | Adoption, appeared before me this day in person and
|
6 | | acknowledged that (she) (he) signed and
delivered the consent |
7 | | as (her) (his) free and voluntary act, for the specified
|
8 | | purpose.
|
9 | | I have fully explained that this consent to adoption is |
10 | | valid only if the
petition to adopt is filed, and that if the |
11 | | specified person or persons, for
any reason, cannot or will |
12 | | not adopt the child or if the adoption petition is
denied, then |
13 | | this consent will be void. I have fully explained that if the
|
14 | | specified person or persons adopt the child, by signing this |
15 | | consent (she) (he)
is irrevocably and permanently |
16 | | relinquishing all parental rights to the child,
and (she) (he) |
17 | | has stated that such is (her) (his) intention and desire.
|
18 | | Dated (insert date).
|
19 | | Signature ..............................
|
20 | | (4) If a consent to standby adoption is executed in this |
21 | | form,
the consent shall be valid only if the specified
person |
22 | | or persons adopt the child. The consent shall be void if:
|
23 | | (a) the specified person or persons do not file a |
24 | | petition for standby
adoption of the child; or
|
25 | | (b) a court denies the standby adoption petition.
|
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1 | | The parent shall not need to take further action to revoke |
2 | | the consent if the
standby adoption by the specified person or |
3 | | persons does not occur,
notwithstanding the provisions of |
4 | | Section 11 of this Act.
|
5 | | C. The form of surrender to any agency given by a parent of |
6 | | a born
child who is to be subsequently placed for adoption |
7 | | shall be
substantially as follows and shall contain such other |
8 | | facts and
statements as the particular agency shall require.
|
9 | | FINAL AND IRREVOCABLE SURRENDER
|
10 | | FOR PURPOSES OF ADOPTION
|
11 | | I, .... (relationship, e.g., mother, father, relative, |
12 | | guardian) of
...., a male or female (circle one) 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 do hereby surrender and entrust the entire custody |
17 | | and control
of such child to the .... (the "Agency"), a |
18 | | (public) (licensed) child
welfare agency with its principal |
19 | | office in the City of ...., County of
.... and State of ...., |
20 | | for the purpose of enabling it to care for and
supervise the |
21 | | care of such child, to place such child for adoption and
to |
22 | | consent to the legal adoption of such child.
|
23 | | That I hereby grant to the Agency full power and authority |
24 | | to place
such child with any person or persons it may in its |
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1 | | sole discretion
select to become the adopting parent or |
2 | | parents and to consent to the
legal adoption of such child by |
3 | | such person or persons; and to take any
and all measures which, |
4 | | in the judgment of the Agency, may be for the
best interests of |
5 | | such child, including authorizing medical, surgical
and dental |
6 | | care and treatment including inoculation and anaesthesia for
|
7 | | such child.
|
8 | | That I wish to and understand that by signing this |
9 | | surrender I do
irrevocably and permanently give up all custody |
10 | | and other parental
rights I have to such child.
|
11 | | That I understand I cannot under any circumstances, after |
12 | | signing
this surrender, change my mind and revoke or cancel |
13 | | this surrender or
obtain or recover custody or any other |
14 | | rights over such child.
|
15 | | That I have read and understand the above and I am signing |
16 | | it as my
free and voluntary act.
|
17 | | Dated (insert date).
|
18 | | ........................
|
19 | | C-5. The form of a Final and Irrevocable Designated |
20 | | Surrender for Purposes of Adoption to any agency given by a |
21 | | parent of a born child who is to be subsequently placed for |
22 | | adoption is to be used by legal parents only. The form shall be |
23 | | substantially as follows and shall contain such other facts |
24 | | and statements as the particular agency shall require: |
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1 | | FINAL AND IRREVOCABLE DESIGNATED SURRENDER |
2 | | FOR PURPOSES OF ADOPTION |
3 | | I, .... (relationship, e.g., mother, father, relative, |
4 | | guardian) of ...., a male or female (circle one) child, state: |
5 | | 1. That such child was born on ...., at ..... |
6 | | 2. That I reside at ...., County of ...., and State of |
7 | | ....., my email address (if I have one) is .... my cell phone |
8 | | number where I can receive text messages (if I have one) is |
9 | | .... and my land line phone number (if I have one) is ...., and |
10 | | any other contact information is .... |
11 | | 3. That I am of the age of .... years. |
12 | | 4. That I do hereby surrender and entrust the entire |
13 | | custody and control of such child to the .... (the "Agency"), a |
14 | | (public) (licensed) child welfare agency with its principal |
15 | | office in the City of ...., County of .... and State of ...., |
16 | | for the purpose of enabling it to care for and supervise the |
17 | | care of such child, to place such child for adoption with |
18 | | ............................. (specified person or persons) |
19 | | and to consent to the legal adoption of such child and to take |
20 | | any and all measures which, in the judgment of the Agency, may |
21 | | be for the best interests of such child, including authorizing |
22 | | medical, surgical and dental care and treatment including |
23 | | inoculation and anesthesia for such child. If only first names |
24 | | are used for the specified person or persons, I voluntarily |
25 | | sign this designated surrender without disclosure to me of the |
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1 | | last name of the specified person or persons. However, I |
2 | | understand that if I wish to know the last name of the |
3 | | specified person or persons, I may request it before signing |
4 | | the form. If I do not receive the last name, I may choose not |
5 | | to sign the designated surrender form. |
6 | | 5. That I wish to and understand that by signing this |
7 | | surrender I do irrevocably and permanently give up all custody |
8 | | and other parental rights I have to such child. |
9 | | 6. That if the petition for adoption is not filed by the
|
10 | | specified person or persons designated herein or, if the
|
11 | | petition for adoption is filed but the adoption petition is
|
12 | | dismissed with prejudice or the adoption proceeding is
|
13 | | otherwise concluded without an order declaring the child to be
|
14 | | the adopted child of each specified person, then I understand |
15 | | that the Agency will send notice to me at the mailing address, |
16 | | at the email address, through a text message to my cell phone |
17 | | number provided in paragraph 2, and to any other contact |
18 | | information I have provided in paragraph 2 within 5 business |
19 | | days of this occurrence. The person sending the notice shall |
20 | | prepare an affidavit of notice. I understand that I will have |
21 | | 15 business days from the date that the written notice was sent |
22 | | to respond, within which time I may choose to designate other |
23 | | adoptive parent(s). However, I acknowledge that
the Agency has |
24 | | full power and authority to place the child for adoption with
|
25 | | any person or persons it may in its sole discretion select to
|
26 | | become the adopting parent or parents and to consent to the
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1 | | legal adoption of the child by such person or persons. |
2 | | 7. That I acknowledge that this surrender is valid even if |
3 | | the specified persons separate or divorce or one of the |
4 | | specified persons dies prior to the entry of the final |
5 | | judgment for adoption. |
6 | | 8. That I expressly acknowledge that the above paragraphs |
7 | | 6 and 7 do not impair the validity and absolute finality of |
8 | | this surrender under any circumstance. |
9 | | 9. That I understand that I have a remaining obligation to |
10 | | keep the Agency informed of my current contact information |
11 | | until the adoption of the child has been finalized if I wish to |
12 | | be notified in the event the adoption by the specified |
13 | | person(s) cannot proceed. |
14 | | 10. That I understand I cannot under any circumstances, |
15 | | after signing this surrender, change my mind and revoke or |
16 | | cancel this surrender or obtain or recover custody or any |
17 | | other rights over such child. |
18 | | 11. That I have read and understand the above and I am |
19 | | signing it as my free and voluntary act. |
20 | | Dated (insert date). |
21 | | .............................. |
22 | | D. The form of surrender to an agency given by a parent of |
23 | | an unborn
child who is to be subsequently placed for adoption |
24 | | shall be
substantially as follows and shall contain such other |
25 | | facts and
statements as the particular agency shall require.
|
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1 | | SURRENDER OF UNBORN CHILD FOR
|
2 | | PURPOSES OF ADOPTION
|
3 | | I, .... (father), state:
|
4 | | That I am the father of a child expected to be born on or |
5 | | about ....
to .... (name of mother).
|
6 | | That I reside at ...., County of ...., and State of .....
|
7 | | That I am of the age of .... years.
|
8 | | That I do hereby surrender and entrust the entire custody |
9 | | and control
of such child to the .... (the "Agency"), a |
10 | | (public) (licensed) child
welfare agency with its principal |
11 | | office in the City of ...., County of
.... and State of ...., |
12 | | for the purpose of enabling it to care for and
supervise the |
13 | | care of such child, to place such child for adoption and
to |
14 | | consent to the legal adoption of such child, and that I have |
15 | | not
previously executed a consent or surrender with respect to |
16 | | such child.
|
17 | | That I hereby grant to the Agency full power and authority |
18 | | to place
such child with any person or persons it may in its |
19 | | sole discretion
select to become the adopting parent or |
20 | | parents and to consent to the
legal adoption of such child by |
21 | | such person or persons; and to take any
and all measures which, |
22 | | in the judgment of the Agency, may be for the
best interests of |
23 | | such child, including authorizing medical, surgical
and dental |
24 | | care and treatment, including inoculation and anaesthesia for
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1 | | such child.
|
2 | | That I wish to and understand that by signing this |
3 | | surrender I do
irrevocably and permanently give up all custody |
4 | | and other parental
rights I have to such child.
|
5 | | That I understand I cannot under any circumstances, after |
6 | | signing
this surrender, change my mind and revoke or cancel |
7 | | this surrender or
obtain or recover custody or any other |
8 | | rights over such child, except
that I have the right to revoke |
9 | | this surrender by giving written notice
of my revocation not |
10 | | later than 72 hours after the birth of such child.
|
11 | | That I have read and understand the above and I am signing |
12 | | it as my
free and voluntary act.
|
13 | | Dated (insert date).
|
14 | | ........................
|
15 | | E. The form of consent required from the parents for the |
16 | | adoption of
an adult, when such adult elects to obtain such |
17 | | consent, shall be
substantially as follows:
|
18 | | CONSENT
|
19 | | I, ...., (father) (mother) of ...., an adult, state:
|
20 | | That I reside at ...., County of .... and State of .....
|
21 | | That I do hereby consent and agree to the adoption of such |
22 | | adult by
.... and .....
|
23 | | Dated (insert date).
|
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1 | | .........................
|
2 | | F. The form of consent required for the adoption of a child |
3 | | of the
age of 14 years or over, or of an adult, to be given by |
4 | | such person,
shall be substantially as follows:
|
5 | | CONSENT
|
6 | | I, ...., state:
|
7 | | That I reside at ...., County of .... and State of ..... |
8 | | That I am
of the age of .... years. That I hereby enter my |
9 | | appearance in this proceeding and waive service of summons on |
10 | | me. That I consent and agree to my adoption by
.... and .....
|
11 | | Dated (insert date).
|
12 | | ........................
|
13 | | G. The form of consent given by an agency to the adoption |
14 | | by
specified persons of a child previously surrendered to it |
15 | | shall set
forth that the agency has the authority to execute |
16 | | such consent. The
form of consent given by a guardian of the |
17 | | person of a child sought to
be adopted, appointed by a court of |
18 | | competent jurisdiction, shall set
forth the facts of such |
19 | | appointment and the authority of the guardian to
execute such |
20 | | consent.
|
21 | | H. A consent (other than that given by an agency, or |
22 | | guardian of the
person of the child sought to be adopted who |
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1 | | was appointed by a court of
competent jurisdiction) shall be |
2 | | acknowledged by a parent before a judge of a court of competent |
3 | | jurisdiction or, except as otherwise provided in
this Act, |
4 | | before a representative of an agency, or before a person, |
5 | | other than the attorney for the prospective adoptive parent or |
6 | | parents, designated by a court of competent
jurisdiction.
|
7 | | I. A surrender, or any other document equivalent to a |
8 | | surrender, by
which a child is surrendered to an agency shall |
9 | | be acknowledged by the
person signing such surrender, or other |
10 | | document, before a judge of a court of competent jurisdiction, |
11 | | or, except as otherwise provided in this Act, before a |
12 | | representative of an agency, or before a person designated by |
13 | | a court
of competent jurisdiction.
|
14 | | J. The form of the certificate of acknowledgment for a |
15 | | consent, a
surrender, or any other document equivalent to a |
16 | | surrender, shall be
substantially as follows:
|
17 | | STATE OF ....)
|
18 | | ) SS.
|
19 | | COUNTY OF ...)
|
20 | | I, .... (Name of judge or other person), .... (official |
21 | | title, name and
location of court or status or position of |
22 | | other person),
certify that ...., personally known to me to be |
23 | | the same person whose
name is subscribed to the foregoing |
24 | | (consent) (surrender), appeared
before me this day in person |
25 | | and acknowledged that (she) (he) signed and
delivered such |
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1 | | (consent) (surrender) as (her) (his) free and voluntary
act, |
2 | | for the specified purpose.
|
3 | | I have fully explained that by signing such (consent) |
4 | | (surrender)
(she) (he) is irrevocably relinquishing all |
5 | | parental rights to such
child or adult and (she) (he) has |
6 | | stated that such is (her) (his)
intention and desire. (Add if |
7 | | Consent only) I am further satisfied that, before signing this |
8 | | Consent, ........ has read, or has had read to him or her, the |
9 | | Birth Parent Rights and Responsibilities-Private Form.
|
10 | | Dated (insert date).
|
11 | | Signature ...............
|
12 | | K. When the execution of a consent or a surrender is |
13 | | acknowledged
before someone other than a judge,
such other |
14 | | person shall have his or her signature on the certificate
|
15 | | acknowledged before a notary public, in form substantially as |
16 | | follows:
|
17 | | STATE OF ....)
|
18 | | ) SS.
|
19 | | COUNTY OF ...)
|
20 | | I, a Notary Public, in and for the County of ......, in the |
21 | | State of
......, certify that ...., personally known to me to |
22 | | be the
same person whose name is subscribed to the foregoing |
23 | | certificate of
acknowledgment, appeared before me in person |
24 | | and acknowledged that (she)
(he) signed such certificate as |
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1 | | (her) (his) free and voluntary act and
that the statements |
2 | | made in the certificate are true.
|
3 | | Dated (insert date).
|
4 | | Signature ...................... Notary Public
|
5 | | (official seal)
|
6 | | There shall be attached a certificate of magistracy, or |
7 | | other
comparable proof of office of the notary public |
8 | | satisfactory to the
court, to a consent signed and |
9 | | acknowledged in another state.
|
10 | | L. A surrender or consent executed and acknowledged |
11 | | outside of this
State, either in accordance with the law of |
12 | | this State or in accordance
with the law of the place where |
13 | | executed, is valid.
|
14 | | M. Where a consent or a surrender is signed in a foreign |
15 | | country,
the execution of such consent shall be acknowledged |
16 | | or affirmed in a
manner conformable to the law and procedure of |
17 | | such country.
|
18 | | N. If the person signing a consent or surrender is in the |
19 | | military
service of the United States, the execution of such |
20 | | consent or surrender
may be acknowledged before a commissioned |
21 | | officer and the signature of
such officer on such certificate |
22 | | shall be verified or acknowledged
before a notary public or by |
23 | | such other procedure as is then in effect
for such division or |
24 | | branch of the armed forces.
|
25 | | O. (1) The parent or parents of a child in whose interests |
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1 | | a petition
under Section 2-13 of the Juvenile Court Act of 1987 |
2 | | is pending may, with the
approval of the designated |
3 | | representative of the Department of Children and
Family |
4 | | Services ("Department" or "DCFS"), execute a consent to |
5 | | adoption by a specified person or
persons:
|
6 | | (a) in whose physical custody the child has resided |
7 | | for at least 6
months;
or
|
8 | | (b) in whose physical custody at least one sibling of |
9 | | the child who is the
subject of this consent has resided |
10 | | for at least 6 months, and
the child who is
the subject of |
11 | | this consent is currently residing in this foster home; or
|
12 | | (c) in whose physical custody a child under one year |
13 | | of age has resided
for at least 3 months.
|
14 | | The court may waive the time frames in subdivisions (a), |
15 | | (b), and (c) for good cause shown if the court finds it to be |
16 | | in the child's best interests. |
17 | | A consent under this subsection O shall be acknowledged by |
18 | | a parent pursuant to
subsection H and subsection K of this |
19 | | Section.
|
20 | | (2) The final and irrevocable consent to adoption by a |
21 | | specified person or persons in a Department of Children and |
22 | | Family Services (DCFS) case shall be substantially
as follows:
|
23 | | FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
|
24 | | A SPECIFIED PERSON OR PERSONS: DCFS CASE
|
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1 | | I, ......................................, the |
2 | | .................. mother or
father (circle one) of a male or |
3 | | female (circle one) child, state:
|
4 | | 1. My child ............................ (name of |
5 | | child) was born on .....
(insert date) at |
6 | | .................... Hospital in the City/Town of |
7 | | ........., in
................ County, State of |
8 | | ...............
|
9 | | 2. I reside at ......................, County of |
10 | | ............. and
State of .............. |
11 | | Mail may also be sent to me at this address |
12 | | ............................, in care of |
13 | | ................. |
14 | | My home telephone number is ...................... |
15 | | My cell telephone number is ...................... |
16 | | My e-mail address is .................................
|
17 | | 3. I, ..........................., am .... years old.
|
18 | | 4. I enter my appearance in this action for my child to |
19 | | be adopted by the
person or persons specified herein by me |
20 | | and waive service of
summons on me in this action only.
|
21 | | 5. I hereby acknowledge that I have been provided a |
22 | | copy of the Birth Parent Rights and Responsibilities in |
23 | | Illinois for Final and Irrevocable Consents to Adoption by |
24 | | a Specified Person or Persons for DCFS Cases before |
25 | | signing this Consent and that I have had time to read this |
26 | | form or have it read to me and that I understand the rights |
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1 | | and responsibilities described in this form. I understand |
2 | | that if I do not receive any of my rights as described in |
3 | | the form, it shall not constitute a basis to revoke this |
4 | | Final and Irrevocable Consent to Adoption by a Specified |
5 | | Person or Persons. |
6 | | 6. I do hereby consent and agree to the adoption of |
7 | | such child by .......... (names of current foster |
8 | | parent(s) or caregiver(s), hereinafter referred to as the |
9 | | "specified person or persons") only. |
10 | | 7. I wish to sign this consent and I understand that by |
11 | | signing this consent I irrevocably and permanently give up |
12 | | all my parental rights I have to my child. |
13 | | 8. I understand that this consent allows my child to |
14 | | be adopted by the specified person or persons only and |
15 | | that I cannot under any circumstances after signing this |
16 | | document change my mind and revoke or cancel this consent. |
17 | | 9. I understand that this consent will be void if: |
18 | | (a) the Department places my child with someone |
19 | | other than the specified person or persons; or |
20 | | (b) a court denies the adoption petition for the |
21 | | specified person or persons to adopt my child; or |
22 | | (c) the DCFS Guardianship Administrator refuses to |
23 | | consent to my child's adoption by the specified person |
24 | | or persons on the basis that the adoption is not in my |
25 | | child's best interests. |
26 | | I understand that if this consent is void I have |
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1 | | parental rights to my child, subject to any applicable |
2 | | court orders including those entered under Article II of |
3 | | the Juvenile Court Act of 1987, unless and until I sign a |
4 | | new consent or surrender or my parental rights are |
5 | | involuntarily terminated. I understand that if this |
6 | | consent is void, my child may be adopted by someone other |
7 | | than the specified person or persons only if I sign a new |
8 | | consent or surrender, or my parental rights are |
9 | | involuntarily terminated. I understand that if this |
10 | | consent is void, the Department will notify me within 30 |
11 | | days using the addresses and telephone numbers I provided |
12 | | in paragraph 2 of this form. I understand that if I receive |
13 | | such a notice, it is very important that I contact the |
14 | | Department immediately, and preferably within 30 days, to |
15 | | have input into the plan for my child's future. |
16 | | 10. I understand that if a petition for adoption of my |
17 | | child is filed by someone other than the specified person |
18 | | or persons, the Department will notify me within 14 days |
19 | | after the Department becomes aware of the petition. The |
20 | | fact that someone other than the specified person or |
21 | | persons files a petition to adopt my child does not make |
22 | | this consent void. |
23 | | 11. If a person other than the specified person or |
24 | | persons files a petition to adopt my child or if the |
25 | | consent is void under paragraph 9, the Department will |
26 | | send written notice to me using the mailing address and |
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1 | | email address provided by me in paragraph 2 of this form. |
2 | | The Department will also contact me using the telephone |
3 | | numbers I provided in paragraph 2 of this form. It is very |
4 | | important that I let the Department know if any of my |
5 | | contact information changes. If I do not let the |
6 | | Department know if any of my contact information changes, |
7 | | I understand that I may not receive notification from the |
8 | | Department if this consent is void or if someone other |
9 | | than the specified person or persons files a petition to |
10 | | adopt my child. If any of my contact information changes, |
11 | | I should immediately notify: |
12 | | Caseworker's name and telephone number: |
13 | | ............................................................; |
14 | | Agency name, address, zip code, and telephone number: |
15 | | ............................................................; |
16 | | Supervisor's name and telephone number: |
17 | | ............................................................; |
18 | | DCFS Advocacy Office for Children and Families: |
19 | | 800-232-3798. |
20 | | 12. I expressly acknowledge that paragraph 9 (and |
21 | | paragraphs 8a and 8b, if applicable) do not impair the |
22 | | validity and finality of this consent under any |
23 | | circumstances.
|
24 | | 13. I have read and understand the above and I am |
25 | | signing it as my free
and voluntary act.
|
26 | | Dated (insert date).
|
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1 | | .............................................
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2 | | Signature of parent
|
3 | | (3) If the parent consents to an adoption by 2 specified |
4 | | persons, then the
form shall contain 2 additional paragraphs |
5 | | in substantially the following form:
|
6 | | 8a. I understand that I cannot change my mind or |
7 | | revoke this consent or recover custody of my child on the |
8 | | basis that the specified persons divorce or are granted a |
9 | | dissolution of a civil union or that one of the specified |
10 | | persons has died.
|
11 | | 8b. I understand that if the specified persons get a |
12 | | divorce or are granted a dissolution of a civil union |
13 | | before the petition to adopt my child is granted, this |
14 | | consent remains valid only for ............... (name only |
15 | | one specified person) to adopt my child.
|
16 | | 8c. I understand that if either of the specified |
17 | | persons dies before the petition to adopt my child is |
18 | | granted, this consent remains valid for the surviving |
19 | | person to adopt my child. |
20 | | (4) The form of the certificate of acknowledgement for a |
21 | | Final and
Irrevocable Consent for Adoption by a Specified |
22 | | Person or Persons: DCFS Case shall be
substantially as |
23 | | follows:
|
24 | | STATE OF ..............)
|
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1 | | ) SS.
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2 | | COUNTY OF .............)
|
3 | | I, .................... (Name of Judge or other person),
|
4 | | ..................... (official title, name, and address),
|
5 | | certify that ............., personally known to me to be the |
6 | | same person whose
name is subscribed to the foregoing Final |
7 | | and Irrevocable Consent for Adoption
by a Specified Person or |
8 | | Persons: DCFS Case, appeared before me this day
in person and |
9 | | acknowledged that (she)(he) signed and delivered the consent |
10 | | as
(her)(his) free and voluntary act, for the specified |
11 | | purpose.
|
12 | | I have fully explained that by signing this consent this |
13 | | parent is irrevocably
and permanently
relinquishing all |
14 | | parental rights to the child so that the child may be adopted |
15 | | by a specified person or persons, and this parent has stated |
16 | | that
such is (her)(his) intention and desire. I have fully |
17 | | explained that this consent is void only if:
|
18 | | (a) the placement is disrupted and the child is moved |
19 | | to a different placement; or |
20 | | (b) a court denies the petition for adoption; or |
21 | | (c) the Department of Children and Family Services |
22 | | Guardianship Administrator refuses to consent to the |
23 | | child's adoption by a specified person or persons on the |
24 | | basis that the adoption is not in the child's best |
25 | | interests. |
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1 | | Dated (insert date).
|
2 | | ...............................
|
3 | | Signature
|
4 | | (5) If a consent to adoption by a specified person or |
5 | | persons is executed in
this form, the following provisions |
6 | | shall apply. The consent shall be valid
only for the specified |
7 | | person or persons to adopt the child. The consent shall be void
|
8 | | if:
|
9 | | (a) the placement disrupts and the child is moved to |
10 | | another placement; or
|
11 | | (b) a court denies the petition for adoption; or
|
12 | | (c) the Department of Children and Family Services |
13 | | Guardianship
Administrator refuses to consent to the |
14 | | child's adoption by the specified person or persons on the |
15 | | basis that the adoption is not in the child's best |
16 | | interests.
|
17 | | If the consent is void under this Section, the parent |
18 | | shall not need to take further action to revoke the consent. No |
19 | | proceeding for termination of parental rights shall be brought |
20 | | unless the parent who executed the consent to adoption by a |
21 | | specified person or persons has been notified of the |
22 | | proceedings pursuant to Section 7 of this Act or subsection |
23 | | (4) of Section 2-13 of the Juvenile Court Act of 1987.
|
24 | | (6) The Department of Children and Family Services is |
25 | | authorized
to promulgate rules necessary to implement this |
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1 | | subsection O.
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2 | | (7) (Blank).
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3 | | (8) The Department of Children and Family Services shall |
4 | | promulgate a rule and procedures regarding Consents to |
5 | | Adoption by a Specified Person or Persons in DCFS cases. The |
6 | | rule and procedures shall provide for the development of the |
7 | | Birth Parent Rights and Responsibilities Form for DCFS
Cases. |
8 | | (9) A consent to adoption by specified persons on this
|
9 | | consent form shall have no effect on a court's determination |
10 | | of
custody or visitation under the Illinois Marriage and
|
11 | | Dissolution of Marriage Act or the Illinois Religious Freedom
|
12 | | Protection and Civil Union Act if the marriage or civil union |
13 | | of the
specified persons is dissolved after the adoption is |
14 | | final. |
15 | | P. If the person signing a consent is incarcerated or |
16 | | detained in a correctional facility, prison, jail, detention |
17 | | center, or other comparable institution, either in this State |
18 | | or any other jurisdiction, the execution of such consent may |
19 | | be acknowledged before social service personnel of such |
20 | | institution, or before a person designated by a court of |
21 | | competent jurisdiction. |
22 | | Q. A consent may be acknowledged telephonically, via |
23 | | audiovisual connection, or other electronic means, provided |
24 | | that a court of competent jurisdiction has entered an order |
25 | | approving the execution of the consent in such manner and has |
26 | | designated an individual to be physically present with the |
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1 | | parent executing such consent in order to verify the identity |
2 | | of the parent. |
3 | | R. An agency whose representative is acknowledging a |
4 | | consent pursuant to this Section shall be a public child |
5 | | welfare agency , or a child welfare agency , or a child placing |
6 | | agency that is authorized or licensed in the State or |
7 | | jurisdiction in which the consent is signed. |
8 | | S. The form of waiver by a putative or legal father of a |
9 | | born or unborn child shall be substantially as follows: |
10 | | FINAL AND IRREVOCABLE |
11 | | WAIVER OF PARENTAL RIGHTS OF PUTATIVE OR LEGAL FATHER |
12 | | I, ...................., state under oath or affirm as |
13 | | follows: |
14 | | 1. That the biological mother ............... has |
15 | | named me as a possible biological or
legal father of her |
16 | | minor child who was born, or is expected to be born on
|
17 | | ..........., ......, in the City/Town of........., State |
18 | | of ........... |
19 | | 2. That I understand that the biological mother |
20 | | ............. intends to or has placed the child
for |
21 | | adoption. |
22 | | 3. That I reside at ................, in the City/Town |
23 | | of...........,
State of ................ |
24 | | 4. That I am ................ years of age and my date |
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1 | | of birth is ..............., ............. |
2 | | 5. That I (select one): |
3 | | ..... am married to the biological mother. |
4 | | ..... am not married to the biological mother and |
5 | | have not been married to the biological
mother within |
6 | | 300 days before the child's birth or expected date of |
7 | | child's birth. |
8 | | ..... am not currently married to the biological |
9 | | mother, but was married to the biological
mother, |
10 | | within 300 days before the child's birth or expected |
11 | | date of child's birth. |
12 | | 6. That I (select one): |
13 | | ..... neither admit nor deny that I am the |
14 | | biological father of the child. |
15 | | ..... deny that I am the biological father of the |
16 | | child. |
17 | | 7. That I hereby agree to the termination of my |
18 | | parental rights, if any, without further notice to me
of |
19 | | any proceeding for the adoption of the minor child, even |
20 | | if I have taken any action to establish
parental rights or |
21 | | take any such action in the future including registering |
22 | | with any putative father
registry. |
23 | | 8. That I understand that by signing this Waiver I do |
24 | | irrevocably and permanently give up all
custody and other |
25 | | parental rights I may have to such child. |
26 | | 9. That I understand that this Waiver is FINAL AND |
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1 | | IRREVOCABLE and that I am permanently
barred from |
2 | | contesting any proceeding for the adoption of the child |
3 | | after I sign this Waiver. |
4 | | 10. That I waive any further service of summons or |
5 | | other pleadings in any proceeding to terminate
parental |
6 | | rights, if any to this child, or any proceeding for |
7 | | adoption of this child. |
8 | | 11. That I understand that if a final judgment or |
9 | | order of adoption for this child is not entered, then
any |
10 | | parental rights or responsibilities that I may have remain |
11 | | intact. |
12 | | 12. That I have read and understand the above and that |
13 | | I am signing it as my free and voluntary act. |
14 | | Dated: ..................., .............. |
15 | | ........................................... |
16 | | Signature |
17 | | OATH |
18 | | I have been duly sworn and I state under oath that I have read |
19 | | and understood this Final and Irrevocable
Waiver of Parental |
20 | | Rights of Putative or Legal Father. The facts contained in it |
21 | | are true and correct to the
best of my knowledge. I have signed |
22 | | this document as my free and voluntary act in order to |
23 | | facilitate the
adoption of the child. |