Rep. Ann M. Williams

Filed: 4/25/2023

 

 


 

 


 
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1
AMENDMENT TO SENATE BILL 1999

2    AMENDMENT NO. ______. Amend Senate Bill 1999 by replacing
3everything after the enacting clause with the following:
 
4    "Section 10. The Abandoned Newborn Infant Protection Act
5is amended by changing Sections 5, 10, 20, 22, 35, 37, 40, 45,
650, 55, 60, and 65 as follows:
 
7    (325 ILCS 2/5)
8    Sec. 5. Public policy. Illinois recognizes that newborn
9infants have been abandoned to the environment or to other
10circumstances that may be unsafe to the newborn infant. These
11circumstances have caused injury and death to newborn infants
12and give rise to potential civil or criminal liability to
13parents who may be under severe emotional distress. It is
14recognized that establishing an adoption plan is preferable to
15relinquishing a child using the procedures outlined in this
16Act, but to reduce the chance of injury to a newborn infant,

 

 

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1this Act provides a safer alternative. This Act is intended to
2provide a mechanism for a newborn infant to be relinquished to
3a safe environment and for the parents of the infant to remain
4anonymous if they choose and to avoid civil or criminal
5liability for the act of relinquishing the infant. It is
6recognized that establishing an adoption plan is preferable to
7relinquishing a child using the procedures outlined in this
8Act, but to reduce the chance of injury to a newborn infant,
9this Act provides a safer alternative.
10    A public information campaign on this delicate issue shall
11be implemented to encourage parents considering abandonment of
12their newborn child to relinquish the child under the
13procedures outlined in this Act, to choose a traditional
14adoption plan, or to parent a child themselves rather than
15place the newborn infant in harm's way.
16(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01.)
 
17    (325 ILCS 2/10)
18    Sec. 10. Definitions. In this Act:
19    "Abandon" has the same meaning as in the Abused and
20Neglected Child Reporting Act.
21    "Abused child" has the same meaning as in the Abused and
22Neglected Child Reporting Act.
23    "Child welfare Child-placing agency" means an Illinois a
24licensed public or private agency that receives a child for
25the purpose of placing or arranging for the placement of the

 

 

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1child in a foster or pre-adoptive family home or other
2facility for child care, apart from the custody of the child's
3parents.
4    "Department" or "DCFS" means the Illinois Department of
5Children and Family Services.
6    "Emergency medical facility" means a freestanding
7emergency center or trauma center, as defined in the Emergency
8Medical Services (EMS) Systems Act.
9    "Emergency medical professional" includes licensed
10physicians, and any emergency medical technician, emergency
11medical technician-intermediate, advanced emergency medical
12technician, paramedic, trauma nurse specialist, and
13pre-hospital registered nurse, as defined in the Emergency
14Medical Services (EMS) Systems Act.
15    "Fire station" means a fire station within the State with
16at least one staff person.
17    "Hospital" has the same meaning as in the Hospital
18Licensing Act.
19    "Legal custody" means the relationship created by a court
20order in the best interest of a newborn infant that imposes on
21the infant's custodian the responsibility of physical
22possession of the infant, the duty to protect, train, and
23discipline the infant, and the duty to provide the infant with
24food, shelter, education, and medical care, except as these
25are limited by parental rights and responsibilities.
26    "Neglected child" has the same meaning as in the Abused

 

 

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1and Neglected Child Reporting Act.
2    "Newborn infant" means a child who a licensed physician
3reasonably believes is 30 days old or less at the time the
4child is initially relinquished to a hospital, police station,
5fire station, or emergency medical facility, and who is not an
6abused or a neglected child.
7    "Parent" or "biological parent" or "birth parent" means a
8person who has established maternity or paternity of the
9newborn infant through genetic testing.
10    "Police station" means a municipal police station, a
11county sheriff's office, a campus police department located on
12any college or university owned or controlled by the State or
13any private college or private university that is not owned or
14controlled by the State when employees of the campus police
15department are present, or any of the district headquarters of
16the Illinois State Police.
17    "Relinquish" means to bring a newborn infant, who a
18licensed physician reasonably believes is 30 days old or less,
19to a hospital, police station, fire station, or emergency
20medical facility and to leave the infant with personnel of the
21facility, if the person leaving the infant does not express an
22intent to return for the infant or states that he or she will
23not return for the infant. In the case of a mother who gives
24birth to an infant in a hospital, the mother's act of leaving
25that newborn infant at the hospital (i) without expressing an
26intent to return for the infant or (ii) stating that she will

 

 

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1not return for the infant is not a "relinquishment" under this
2Act.
3    "Temporary protective custody" means the temporary
4placement of a newborn infant within a hospital or other
5medical facility out of the custody of the infant's parent.
6(Source: P.A. 97-293, eff. 8-11-11; 98-973, eff. 8-15-14.)
 
7    (325 ILCS 2/20)
8    Sec. 20. Procedures with respect to relinquished newborn
9infants.
10    (a) Hospitals. Every hospital must accept and provide all
11necessary emergency services and care to a relinquished
12newborn infant, in accordance with this Act. The hospital
13shall examine a relinquished newborn infant and perform tests
14that, based on reasonable medical judgment, are appropriate in
15evaluating whether the relinquished newborn infant was abused
16or neglected.
17    The act of relinquishing a newborn infant serves as
18implied consent for the hospital and its medical personnel and
19physicians on staff to treat and provide care for the infant.
20    The hospital shall be deemed to have temporary protective
21custody of a relinquished newborn infant until the infant is
22discharged to the custody of a child welfare child-placing
23agency or the Department. The hospital shall provide all
24available medical records and information to the Department
25and the child welfare agency that has accepted the referral of

 

 

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1the infant in accordance with Section 50.
2    (b) Fire stations and emergency medical facilities. Every
3fire station and emergency medical facility must accept and
4provide all necessary emergency services and care to a
5relinquished newborn infant, in accordance with this Act.
6    The act of relinquishing a newborn infant serves as
7implied consent for the fire station or emergency medical
8facility and its emergency medical professionals to treat and
9provide care for the infant, to the extent that those
10emergency medical professionals are trained to provide those
11services.
12    After the relinquishment of a newborn infant to a fire
13station or emergency medical facility, the fire station or
14emergency medical facility's personnel must arrange for the
15transportation of the infant to the nearest hospital as soon
16as transportation can be arranged.
17    If the person who relinquished or a person claiming to be
18the parent of a newborn infant returns to reclaim the infant
19child within 30 days 72 hours after the infant was
20relinquished relinquishing the child to a fire station or
21emergency medical facility, the fire station or emergency
22medical facility must inform such person the parent of the
23name and location of the hospital to which the infant was
24transported.
25    (c) Police stations. Every police station must accept a
26relinquished newborn infant, in accordance with this Act.

 

 

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1After the relinquishment of a newborn infant to a police
2station, the police station must arrange for the
3transportation of the infant to the nearest hospital as soon
4as transportation can be arranged. The act of relinquishing a
5newborn infant serves as implied consent for the hospital to
6which the infant is transported and that hospital's medical
7personnel and physicians on staff to treat and provide care
8for the infant.
9    If the person who relinquished or a person claiming to be
10the parent of a newborn infant returns to reclaim the infant
11within 30 days 72 hours after the infant was relinquished
12relinquishing the infant to a police station, the police
13station must inform such person the parent of the name and
14location of the hospital to which the infant was transported.
15(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
1693-820, eff. 7-27-04.)
 
17    (325 ILCS 2/22)
18    Sec. 22. Signage Signs. Every hospital, fire station,
19emergency medical facility, and police station that is
20required to accept a relinquished newborn infant in accordance
21with this Act must post, either by physical or electronic
22means, a sign in a conspicuous place on the exterior of the
23building housing the facility informing persons that a newborn
24infant may be relinquished at the facility in accordance with
25this Act. The Department shall prescribe specifications for

 

 

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1the signs and for their placement that will ensure statewide
2uniformity.
3    This Section does not apply to a hospital, fire station,
4emergency medical facility, or police station that has a sign
5that is consistent with the requirements of this Section that
6is posted on the effective date of this amendatory Act of the
795th General Assembly.
8(Source: P.A. 102-4, eff. 4-27-21.)
 
9    (325 ILCS 2/35)
10    Sec. 35. Information for relinquishing person.
11    (a) The A hospital, police station, fire station, or
12emergency medical facility that receives a newborn infant
13relinquished in accordance with this Act shall must offer an
14information packet to the relinquishing person information
15about the relinquishment process and, either in writing or by
16referring such person to a website or other electronic
17resource, such information shall state if possible, must
18clearly inform the relinquishing person that his or her
19acceptance of the information is completely voluntary. The
20information packet must include all of the following:
21        (1) (Blank).
22        (2) Written notice of the following:
23            (A) No sooner than 60 days following the date of
24        the initial relinquishment of the infant to a
25        hospital, police station, fire station, or emergency

 

 

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1        medical facility, the child welfare child-placing
2        agency or the Department will commence proceedings for
3        the termination of parental rights and placement of
4        the infant for adoption.
5            (B) Failure of a parent of the infant to contact
6        the Department and petition for the return of custody
7        of the infant before termination of parental rights
8        bars any future action asserting legal rights with
9        respect to the infant.
10        (3) A resource list of providers of counseling
11    services including grief counseling, pregnancy counseling,
12    and counseling regarding adoption and other available
13    options for placement of the infant.
14    Upon request of a parent, the Department of Public Health
15shall provide the application forms for the Illinois Adoption
16Registry and Medical Information Exchange.
17    (b) The information offered packet given to a
18relinquishing person parent in accordance with this Act shall
19include, in addition to other information required under this
20Act, the following:
21        (1) Information A brochure (with a self-mailer
22    attached) that describes this Act and the rights of birth
23    parents, including an option optional section for the
24    parent to complete and mail to the Department of Children
25    and Family Services a form , that shall ask for basic
26    anonymous background information about the relinquished

 

 

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1    child. This form brochure shall be maintained by the
2    Department on its website.
3        (2) Information about A brochure that describes the
4    Illinois Adoption Registry, including a toll-free number
5    and website information. This brochure shall be maintained
6    on the Office of Vital Records website.
7        (3) Information about a mother's A brochure describing
8    postpartum health information for the mother.
9    The information provided in writing or through electronic
10means packet shall be designed in coordination between the
11Office of Vital Records and the Department of Children and
12Family Services. The Failure to provide such information under
13this Section or the failure of the relinquishing person to
14accept such information shall not invalidate the
15relinquishment under this Act. , with the exception of the
16resource list of providers of counseling services and adoption
17agencies, which shall be provided by the hospital, fire
18station, police station, sheriff's office, or emergency
19medical facility.
20(Source: P.A. 96-1114, eff. 7-20-10; 97-333, eff. 8-12-11.)
 
21    (325 ILCS 2/37)
22    Sec. 37. Public disclosure of information prohibited.
23Emergency medical professionals, employees, or other persons
24engaged in the administration or operation of a fire station,
25police station, hospital, emergency medical facility, child

 

 

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1welfare child placing agency, or the Department where a
2newborn infant baby has been relinquished or transferred under
3this Act, are prohibited from publicly disclosing any
4information concerning the relinquishment of the infant and
5the individuals involved, except as otherwise provided by law.
6(Source: P.A. 95-549, eff. 6-1-08.)
 
7    (325 ILCS 2/40)
8    Sec. 40. Reporting requirements.
9    (a) Within 12 hours after accepting a newborn infant from
10a relinquishing person or from a police station, fire station,
11or emergency medical facility in accordance with this Act, a
12hospital must report to the Department's State Central
13Registry for the purpose of transferring physical custody of
14the infant from the hospital to either a child welfare
15child-placing agency or the Department.
16    (b) Within 24 hours after receiving a report under
17subsection (a), the Department must request assistance from
18law enforcement officials to investigate the matter using the
19National Crime Information Center to ensure that the
20relinquished newborn infant is not a missing child.
21    (c) Once a hospital has made a report to the Department
22under subsection (a), the Department must arrange for a
23licensed child welfare child-placing agency to accept physical
24custody of the relinquished newborn infant.
25    (d) If a relinquished child is not a newborn infant as

 

 

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1defined in this Act, the hospital and the Department must
2proceed as if the child is an abused or neglected child.
3(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
493-820, eff. 7-27-04.)
 
5    (325 ILCS 2/45)
6    Sec. 45. Medical assistance. Notwithstanding any other
7provision of law, a newborn infant relinquished in accordance
8with this Act shall be deemed eligible for medical assistance
9under the Illinois Public Aid Code, and a hospital providing
10medical services to such an infant shall be reimbursed for
11those services in accordance with the payment methodologies
12authorized under that Code. In addition, for any day that a
13hospital has custody of a newborn infant relinquished in
14accordance with this Act and the infant does not require
15medically necessary care, the hospital shall be reimbursed by
16the Department of Healthcare and Family Services at the
17general acute care per diem rate, in accordance with 89 Ill.
18Adm. Code 148.270(c). The hospital shall complete and submit
19an application for medical assistance provided under Article V
20of the Illinois Public Aid Code on behalf of the infant. The
21Department of Healthcare and Family Services may adopt rules
22in accordance with this Section.
23(Source: P.A. 95-331, eff. 8-21-07.)
 
24    (325 ILCS 2/50)

 

 

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1    Sec. 50. Child welfare Child-placing agency procedures.
2    (a) The Department's State Central Registry must maintain
3a list of licensed child welfare child-placing agencies
4willing to take legal custody of newborn infants relinquished
5in accordance with this Act. The child welfare child-placing
6agencies on the list must be contacted by the Department on a
7rotating basis upon notice from a hospital that a newborn
8infant has been relinquished in accordance with this Act.
9    (b) Upon notice from the Department that a newborn infant
10has been relinquished in accordance with this Act, a child
11welfare child-placing agency must accept the newborn infant if
12the agency has the accommodations to do so. The child welfare
13child-placing agency must seek an order for legal custody of
14the infant upon its acceptance of the infant.
15    (c) Within 3 business days after accepting the referral
16from the Department assuming physical custody of the infant,
17the child welfare child-placing agency shall file a petition
18for custody in the division of the circuit court in which
19petitions for adoption would normally be heard. The petition
20for custody shall allege that the newborn infant has been
21relinquished in accordance with this Act and shall request
22state that the child welfare child-placing agency be given the
23authority intends to place the infant in an adoptive home,
24foster home, child care facility, or other facility
25appropriate for the needs of the infant. No filing or
26appearance fees shall be charged to any petitioner.

 

 

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1    (d) If no licensed child welfare child-placing agency is
2able to accept the relinquished newborn infant, then the
3Department must assume responsibility for the infant as soon
4as practicable.
5    (e) A custody order issued under subsection (b) shall
6grant the child welfare agency the authority to make medical
7and health-related decisions for the infant. The order shall
8remain in effect until a final adoption order based on the
9relinquished newborn infant's best interests is issued in
10accordance with this Act and the Adoption Act.
11    (f) When possible, the child welfare child-placing agency
12must place a relinquished newborn infant in a prospective
13adoptive home.
14    (g) The Department or child welfare child-placing agency
15must initiate proceedings to (i) terminate the parental rights
16of the relinquished newborn infant's known or unknown parents,
17(ii) appoint a guardian for the infant, and (iii) obtain
18consent to the infant's adoption in accordance with this Act
19no sooner than 60 days following the date of the initial
20relinquishment of the infant to the hospital, police station,
21fire station, or emergency medical facility.
22    (h) Before filing a petition for termination of parental
23rights, the Department or child welfare child-placing agency
24must do the following:
25        (1) If the name of either the biological parent is
26    known, search the Illinois Search its Putative Father

 

 

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1    Registry for the purpose of determining the identity and
2    location of the putative father of the relinquished
3    newborn infant who is, or is expected to be, the subject of
4    an adoption proceeding, in order to provide notice of the
5    proceeding to the putative father. At least one search of
6    the Registry must be conducted, at least 30 days after the
7    relinquished newborn infant's estimated date of birth;
8    earlier searches may be conducted, however. Notice to any
9    potential putative father discovered in a search of the
10    Registry according to the estimated age of the
11    relinquished newborn infant must be in accordance with the
12    Code of Civil Procedure or Section 12a of the Adoption
13    Act. If the names of all the alleged parents are unknown,
14    then a search is not required under this Section.
15        (2) Verify with the Department that, in accordance
16    with subsection (b) of Section 40, with law enforcement
17    officials, using the National Crime Information Center,
18    that the relinquished newborn infant is not a missing
19    child.
20(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
2193-820, eff. 7-27-04.)
 
22    (325 ILCS 2/55)
23    Sec. 55. Petition for return of custody.
24    (a) A parent or person claiming to be a parent of a newborn
25infant relinquished in accordance with this Act may petition

 

 

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1for the return of custody of the infant before the termination
2of parental rights with respect to the infant.
3    (b) A parent of a newborn infant relinquished in
4accordance with this Act may petition for the return of
5custody of the infant by contacting the Department for the
6purpose of obtaining the name of the child welfare
7child-placing agency with custody of the infant and the
8appropriate court in which the petition for return of custody
9of the infant must be filed, and then filing a petition for
10return of custody in the circuit court in which the proceeding
11for the termination of parental rights is pending. No filing
12fees or appearance fees shall be charged to any petitioner.
13    (c) (Blank). If a petition for the termination of parental
14rights has not been filed by the Department or the
15child-placing agency, the parent of the relinquished newborn
16infant must contact the Department, which must notify the
17parent of the appropriate court in which the petition for
18return of custody must be filed.
19    (d) The circuit court may hold the proceeding for the
20termination of parental rights in abeyance for a period not to
21exceed 60 days from the date that the petition for return of
22custody was filed without a showing of good cause. During that
23period:
24        (1) The court shall order genetic testing to establish
25    maternity or paternity, or both.
26        (2) The Department shall conduct a child protective

 

 

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1    investigation and home study to develop recommendations to
2    the court.
3        (3) When indicated as a result of the Department's
4    investigation and home study, further proceedings under
5    the Juvenile Court Act of 1987 as the court determines
6    appropriate, may be conducted. However, relinquishment of
7    a newborn infant in accordance with this Act does not
8    render the infant abused, neglected, or abandoned solely
9    because the newborn infant was relinquished to a hospital,
10    police station, fire station, or emergency medical
11    facility in accordance with this Act.
12        (4) The court shall appoint a guardian ad litem to
13    represent the interests of the infant.
14    (e) Failure to file a petition for the return of custody of
15a relinquished newborn infant before the termination of
16parental rights bars any future action asserting legal rights
17with respect to the infant unless the parent's act of
18relinquishment that led to the termination of parental rights
19involved fraud perpetrated against and not stemming from or
20involving the parent of the newborn infant. No action to void
21or revoke the termination of parental rights of a parent of a
22newborn infant relinquished in accordance with this Act,
23including an action based on fraud, may be commenced after 12
24months after the date that the newborn infant was initially
25relinquished to a hospital, police station, fire station, or
26emergency medical facility.

 

 

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1(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
293-820, eff. 7-27-04.)
 
3    (325 ILCS 2/60)
4    Sec. 60. Department's duties. The Department must
5implement a public information program to promote safe
6placement alternatives for newborn infants. The public
7information program must inform the public of the following:
8        (1) The relinquishment alternative provided for in
9    this Act, which results in the adoption of a newborn
10    infant relinquished under 30 7 days of age and which
11    provides for the parent's anonymity, if the parent so
12    chooses.
13        (2) The alternative of adoption through a public or
14    private agency, in which the parent's identity may or may
15    not be known to the agency, but is kept anonymous from the
16    adoptive parents, if the birth parent so desires, and
17    which allows the parent to be actively involved in the
18    child's adoption plan.
19    The public information program may include, but need not
20be limited to, the following elements:
21        (i) Educational and informational materials in print,
22    audio, video, electronic or other media.
23        (ii) Establishment of a web site.
24        (iii) Public service announcements and advertisements.
25        (iv) Establishment of toll-free telephone hotlines to

 

 

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1    provide information.
2(Source: P.A. 94-941, eff. 6-26-06.)
 
3    (325 ILCS 2/65)
4    Sec. 65. Evaluation.
5    (a) The Department shall collect and analyze information
6regarding the relinquishment of newborn infants and placement
7of children under this Act. Police stations, fire stations,
8emergency medical facilities, and medical professionals
9accepting and providing services to a newborn infant under
10this Act shall report to the Department data necessary for the
11Department to evaluate and determine the effect of this Act in
12the prevention of injury or death of newborn infants. Child
13welfare Child-placing agencies shall report to the Department
14data necessary to evaluate and determine the effectiveness of
15these agencies in providing child protective and child welfare
16services to newborn infants relinquished under this Act.
17    (b) The information collected shall include, but need not
18be limited to: the number of newborn infants relinquished; the
19category of the place of relinquishment (hospital, police
20station, fire station, or emergency medical facility); the
21services provided to relinquished newborn infants; the outcome
22of care for the relinquished newborn infants; the number and
23disposition of cases of relinquished newborn infants subject
24to placement; the number of children accepted and served by
25child welfare child-placing agencies; and the services

 

 

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1provided by child welfare child-placing agencies and the
2disposition of the cases of the children placed under this
3Act.
4    (c) The Department shall submit a report by January 1,
52002, and on January 1 of each year thereafter, to the Governor
6and General Assembly regarding the prevention of injury or
7death of newborn infants and the effect of placements of
8children under this Act. The report shall include, but need
9not be limited to, a summary of collected data, an analysis of
10the data and conclusions regarding the Act's effectiveness, a
11determination whether the purposes of the Act are being
12achieved, and recommendations for changes that may be
13considered necessary to improve the administration and
14enforcement of this Act.
15(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
1693-820, eff. 7-27-04.)
 
17    Section 15. The Immunization Data Registry Act is amended
18by changing Section 20 as follows:
 
19    (410 ILCS 527/20)
20    Sec. 20. Confidentiality of information; release of
21information; statistics; panel on expanding access.
22    (a) Records maintained as part of the immunization data
23registry are confidential.
24    (b) The Department may release an individual's

 

 

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1confidential information to the individual or to the
2individual's parent or guardian if the individual is less than
318 years of age.
4    (c) Subject to subsection (d) of this Section, the
5Department may release information in the immunization data
6registry concerning an individual to the following entities:
7        (1) The immunization data registry of another state.
8        (2) A health care provider or a health care provider's
9    designee.
10        (3) A local health department.
11        (4) An elementary or secondary school that is attended
12    by the individual.
13        (5) A licensed child care center in which the
14    individual is enrolled.
15        (6) A licensed child welfare child-placing agency.
16        (7) A college or university that is attended by the
17    individual.
18        (8) The Department of Healthcare and Family Services
19    or a managed care entity contracted with the Department of
20    Healthcare and Family Services to coordinate the provision
21    of medical care to enrollees of the medical assistance
22    program.
23    (d) Before immunization data may be released to an entity,
24the entity must enter into an agreement with the Department
25that provides that information that identifies a patient will
26not be released to any other person without the written

 

 

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1consent of the patient.
2    (e) The Department may release summary statistics
3regarding information in the immunization data registry if the
4summary statistics do not reveal the identity of an
5individual.
6(Source: P.A. 97-117, eff. 7-14-11; 98-651, eff. 6-16-14.)
 
7    Section 20. The Illinois Parentage Act of 2015 is amended
8by changing Section 602 as follows:
 
9    (750 ILCS 46/602)
10    Sec. 602. Standing. A complaint to adjudicate parentage
11shall be verified, shall be designated a petition, and shall
12name the person or persons alleged to be the parent of the
13child. Subject to Article 3 and Sections 607, 608, and 609 of
14this Act, a proceeding to adjudicate parentage may be
15maintained by:
16        (a) the child;
17        (b) the mother of the child;
18        (c) a pregnant woman;
19        (d) a man presumed or alleging himself to be the
20    parent of the child;
21        (e) a woman presumed or alleging herself to be the
22    parent of the child;
23        (f) the support-enforcement agency or other
24    governmental agency authorized by other law;

 

 

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1        (g) any person or public agency that has physical
2    possession of or has custody of or has been allocated
3    parental responsibilities for, is providing financial
4    support to, or has provided financial support to the
5    child;
6        (h) the Department of Healthcare and Family Services
7    if it is providing, or has provided, financial support to
8    the child or if it is assisting with child support
9    collections services;
10        (i) an authorized adoption agency or licensed child
11    welfare child-placing agency;
12        (j) a representative authorized by law to act for an
13    individual who would otherwise be entitled to maintain a
14    proceeding but who is deceased, incapacitated, or a minor;
15    or
16        (k) an intended parent.
17(Source: P.A. 99-85, eff. 1-1-16; 99-769, eff. 1-1-17.)
 
18    Section 25. The Adoption Act is amended by changing
19Sections 4.1 and 10 as follows:
 
20    (750 ILCS 50/4.1)  (from Ch. 40, par. 1506)
21    Sec. 4.1. Adoption between multiple jurisdictions. It is
22the public policy of this State to promote child welfare in
23adoption between multiple jurisdictions by implementing
24standards that foster permanency for children in an

 

 

10300SB1999ham001- 24 -LRB103 30669 KTG 60671 a

1expeditious manner while considering the best interests of the
2child as paramount. Ensuring that standards for
3interjurisdictional adoption are clear and applied
4consistently, efficiently, and reasonably will promote the
5best interests of the child in finding a permanent home.
6    (a) The Department of Children and Family Services shall
7promulgate rules regarding the approval and regulation of
8agencies providing, in this State, adoption services, as
9defined in Section 2.24 of the Child Care Act of 1969, which
10shall include, but not be limited to, a requirement that any
11agency shall be licensed in this State as a child welfare
12agency as defined in Section 2.08 of the Child Care Act of
131969. Any out-of-state agency, if not licensed in this State
14as a child welfare agency, must obtain the approval of the
15Department in order to act as a sending agency, as defined in
16Section 1 of the Interstate Compact on Placement of Children
17Act, seeking to place a child into this State through a
18placement subject to the Interstate Compact on the Placement
19of Children. An out-of-state agency, if not licensed in this
20State as a child welfare agency, is prohibited from providing
21in this State adoption services, as defined by Section 2.24 of
22the Child Care Act of 1969; shall comply with Section 12C-70 of
23the Criminal Code of 2012; and shall provide all of the
24following to the Department:
25        (1) A copy of the agency's current license or other
26    form of authorization from the approving authority in the

 

 

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1    agency's state. If no license or authorization is issued,
2    the agency must provide a reference statement, from the
3    approving authority, stating that the agency is authorized
4    to place children in foster care or adoption or both in its
5    jurisdiction.
6        (2) A description of the program, including home
7    studies, placements, and supervisions, that the child
8    welfare child placing agency conducts within its
9    geographical area, and, if applicable, adoptive placements
10    and the finalization of adoptions. The child welfare child
11    placing agency must accept continued responsibility for
12    placement planning and replacement if the placement fails.
13        (3) Notification to the Department of any significant
14    child welfare child placing agency changes after approval.
15        (4) Any other information the Department may require.
16    The rules shall also provide that any agency that places
17children for adoption in this State may not, in any policy or
18practice relating to the placement of children for adoption,
19discriminate against any child or prospective adoptive parent
20on the basis of race.
21    (a-5) (Blank).
22    (b) Interstate adoptions.
23        (1) All interstate adoption placements under this Act
24    shall comply with the Child Care Act of 1969 and the
25    Interstate Compact on the Placement of Children. The
26    placement of children with relatives by the Department of

 

 

10300SB1999ham001- 26 -LRB103 30669 KTG 60671 a

1    Children and Family Services shall also comply with
2    subsection (b) of Section 7 of the Children and Family
3    Services Act. The Department may promulgate rules to
4    implement interstate adoption placements, including those
5    requirements set forth in this Section.
6        (2) If an adoption is finalized prior to bringing or
7    sending a child to this State, compliance with the
8    Interstate Compact on the Placement of Children is not
9    required.
10        (3) Approval requirements. The Department shall
11    promulgate procedures for interstate adoption placements
12    of children under this Act. No later than September 24,
13    2017 (30 days after the effective date of Public Act
14    100-344), the Department shall distribute a written list
15    of all preadoption approval requirements to all Illinois
16    licensed child welfare agencies performing adoption
17    services, and all out-of-state agencies approved under
18    this Section, and shall post the requirements on the
19    Department's website. The Department may not require any
20    further preadoption requirements other than those set
21    forth in the procedures required under this paragraph. The
22    procedures shall reflect the standard of review as stated
23    in the Interstate Compact on the Placement of Children and
24    approval shall be given by the Department if the placement
25    appears not to be contrary to the best interests of the
26    child.

 

 

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1        (4) Time for review and decision. In all cases where
2    the child to be placed is not a youth in care in Illinois
3    or any other state, a provisional or final approval for
4    placement shall be provided in writing from the Department
5    in accordance with the Interstate Compact on the Placement
6    of Children. Approval or denial of the placement must be
7    given by the Department as soon as practicable, but in no
8    event more than 3 business days of the receipt of the
9    completed referral packet by the Department's Interstate
10    Compact Administrator. Receipt of the packet shall be
11    evidenced by the packet's arrival at the address
12    designated by the Department to receive such referrals.
13    The written decision to approve or deny the placement
14    shall be communicated in an expeditious manner, including,
15    but not limited to, electronic means referenced in
16    paragraph (b)(7) of this Section, and shall be provided to
17    all Illinois licensed child welfare agencies involved in
18    the placement, all out-of-state child placing agencies
19    involved in the placement, and all attorneys representing
20    the prospective adoptive parent or biological parent. If,
21    during its initial review of the packet, the Department
22    believes there are any incomplete or missing documents, or
23    missing information, as required in paragraph (b)(3), the
24    Department shall, as soon as practicable, but in no event
25    more than 2 business days of receipt of the packet,
26    communicate a list of any incomplete or missing documents

 

 

10300SB1999ham001- 28 -LRB103 30669 KTG 60671 a

1    and information to all Illinois licensed child welfare
2    agencies involved in the placement, all out-of-state child
3    placing agencies involved in the placement, and all
4    attorneys representing the adoptive parent or biological
5    parent. This list shall be communicated in an expeditious
6    manner, including, but not limited to, electronic means
7    referenced in paragraph (b)(7) of this Section.
8        (5) Denial of approval. In all cases where the child
9    to be placed is not a youth in the care of any state, if
10    the Department denies approval of an interstate placement,
11    the written decision referenced in paragraph (b)(4) of
12    this Section shall set forth the reason or reasons why the
13    placement was not approved and shall reference which
14    requirements under paragraph (b)(3) of this Section were
15    not met. The written decision shall be communicated in an
16    expeditious manner, including, but not limited to,
17    electronic means referenced in paragraph (b)(7) of this
18    Section, to all Illinois licensed child welfare agencies
19    involved in the placement, all out-of-state child placing
20    agencies involved in the placement, and all attorneys
21    representing the prospective adoptive parent or biological
22    parent.
23        (6) Provisional approval. Nothing in paragraphs (b)(3)
24    through (b)(5) of this Section shall preclude the
25    Department from issuing provisional approval of the
26    placement pending receipt of any missing or incomplete

 

 

10300SB1999ham001- 29 -LRB103 30669 KTG 60671 a

1    documents or information.
2        (7) Electronic communication. All communications
3    concerning an interstate placement made between the
4    Department and an Illinois licensed child welfare agency,
5    an out-of-state child placing agency, and attorneys
6    representing the prospective adoptive parent or biological
7    parent, including the written communications referenced in
8    this Section, may be made through any type of electronic
9    means, including, but not limited to, electronic mail.
10    (c) Intercountry adoptions. The adoption of a child, if
11the child is a habitual resident of a country other than the
12United States and the petitioner is a habitual resident of the
13United States, or, if the child is a habitual resident of the
14United States and the petitioner is a habitual resident of a
15country other than the United States, shall comply with the
16Intercountry Adoption Act of 2000, as amended, and the
17Immigration and Nationality Act, as amended. In the case of an
18intercountry adoption that requires oversight by the adoption
19services governed by the Intercountry Adoption Universal
20Accreditation Act of 2012, this State shall not impose any
21additional preadoption requirements.
22    (d) (Blank).
23    (e) Re-adoption after an intercountry adoption.
24        (1) Any time after a minor child has been adopted in a
25    foreign country and has immigrated to the United States,
26    the adoptive parent or parents of the child may petition

 

 

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1    the court for a judgment of adoption to re-adopt the child
2    and confirm the foreign adoption decree.
3        (2) The petitioner must submit to the court one or
4    more of the following to verify the foreign adoption:
5            (i) an immigrant visa for the child issued by
6        United States Citizenship and Immigration Services of
7        the U.S. Department of Homeland Security that was
8        valid at the time of the child's immigration;
9            (ii) a decree, judgment, certificate of adoption,
10        adoption registration, or equivalent court order,
11        entered or issued by a court of competent jurisdiction
12        or administrative body outside the United States,
13        establishing the relationship of parent and child by
14        adoption; or
15            (iii) such other evidence deemed satisfactory by
16        the court.
17        (3) The child's immigrant visa shall be prima facie
18    proof that the adoption was established in accordance with
19    the laws of the foreign jurisdiction and met United States
20    requirements for immigration.
21        (4) If the petitioner submits documentation that
22    satisfies the requirements of paragraph (2), the court
23    shall not appoint a guardian ad litem for the minor who is
24    the subject of the proceeding, shall not require any
25    further termination of parental rights of the child's
26    biological parents, nor shall it require any home study,

 

 

10300SB1999ham001- 31 -LRB103 30669 KTG 60671 a

1    investigation, post-placement visit, or background check
2    of the petitioner.
3        (5) The petition may include a request for change of
4    the child's name and any other request for specific relief
5    that is in the best interests of the child. The relief may
6    include a request for a revised birth date for the child if
7    supported by evidence from a medical or dental
8    professional attesting to the appropriate age of the child
9    or other collateral evidence.
10        (6) Two adoptive parents who adopted a minor child
11    together in a foreign country while married to one another
12    may file a petition for adoption to re-adopt the child
13    jointly, regardless of whether their marriage has been
14    dissolved. If either parent whose marriage was dissolved
15    has subsequently remarried or entered into a civil union
16    with another person, the new spouse or civil union partner
17    shall not join in the petition to re-adopt the child,
18    unless the new spouse or civil union partner is seeking to
19    adopt the child. If either adoptive parent does not join
20    in the petition, he or she must be joined as a party
21    defendant. The defendant parent's failure to participate
22    in the re-adoption proceeding shall not affect the
23    existing parental rights or obligations of the parent as
24    they relate to the minor child, and the parent's name
25    shall be placed on any subsequent birth record issued for
26    the child as a result of the re-adoption proceeding.

 

 

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1        (7) An adoptive parent who adopted a minor child in a
2    foreign country as an unmarried person may file a petition
3    for adoption to re-adopt the child as a sole petitioner,
4    even if the adoptive parent has subsequently married or
5    entered into a civil union.
6        (8) If one of the adoptive parents who adopted a minor
7    child dies prior to a re-adoption proceeding, the deceased
8    parent's name shall be placed on any subsequent birth
9    record issued for the child as a result of the re-adoption
10    proceeding.
11(Source: P.A. 99-49, eff. 7-15-15; 100-344, eff. 8-25-17;
12100-863, eff. 8-14-18.)
 
13    (750 ILCS 50/10)  (from Ch. 40, par. 1512)
14    Sec. 10. Forms of consent and surrender; execution and
15acknowledgment thereof.
16    A. The form of consent required for the adoption of a born
17child shall be substantially as follows:
 
18
FINAL AND IRREVOCABLE CONSENT TO ADOPTION

 
19    I, ...., (relationship, e.g., mother, father, relative,
20guardian) of ...., a male or female (circle one) child, state:
21    That such child was born on .... at ....
22    That I reside at ...., County of .... and State of ....
23    That I am of the age of .... years.

 

 

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1    That I hereby enter my appearance in this proceeding and
2waive service of summons on me.
3    That I hereby acknowledge that I have been provided with a
4copy of the Birth Parent Rights and Responsibilities-Private
5Form before signing this Consent and that I have had time to
6read, or have had read to me, this Form. I understand that if I
7do not receive any of the rights as described in this Form, it
8shall not constitute a basis to revoke this Final and
9Irrevocable Consent.
10    That I do hereby consent and agree to the adoption of such
11child.
12    That I wish to and understand that by signing this consent
13I do irrevocably and permanently give up all custody and other
14parental rights I have to such child.
15    That I understand such child will be placed for adoption
16and that I cannot under any circumstances, after signing this
17document, change my mind and revoke or cancel this consent or
18obtain or recover custody or any other rights over such child.
19That I have read and understand the above and I am signing it
20as my free and voluntary act.
21    Dated (insert date).
22.........................
 
23    If under Section 8 the consent of more than one person is
24required, then each such person shall execute a separate
25consent.

 

 

10300SB1999ham001- 34 -LRB103 30669 KTG 60671 a

1    A-1. (1) The form of the Final and Irrevocable Consent to
2Adoption by a Specified Person or Persons: Non-DCFS Case set
3forth in this subsection A-1 is to be used by legal parents
4only. This form is not to be used in cases in which there is a
5pending petition under Section 2-13 of the Juvenile Court Act
6of 1987.
7    (2) The form of the Final and Irrevocable Consent to
8Adoption by a Specified Person or Persons in a non-DCFS case
9shall have the caption of the proceeding in which it is to be
10filed and shall be substantially as follows:
 
11
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
12
A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE

 
13    I, ...., (relationship, e.g., mother, father) of ...., a
14male or female (circle one) child, state:
15    1. That such child was born on ...., at ....., in the
16City/Town of ... and State of ....
17    2. That I reside at ...., County of .... and State of ....,
18my email address (if I have one) is .... my cell phone number
19where I can receive text messages (if I have one) is .... and
20my land line phone number (if I have one) is ...., and any
21other contact information is ....
22    3. That I am of the age of .... years.
23    4. That I hereby enter my appearance in this proceeding
24and waive service of summons on me.

 

 

10300SB1999ham001- 35 -LRB103 30669 KTG 60671 a

1    5. That I hereby acknowledge that I have been provided a
2copy of the Birth Parent Rights and Responsibilities-Private
3Form before signing this Consent and that I have had time to
4read, or have had read to me, this Form and that I understand
5the Rights and Responsibilities described in this Form. I
6understand that if I do not receive any of my rights as
7described in said Form, it shall not constitute a basis to
8revoke this Final and Irrevocable Consent to Adoption by a
9Specified Person.
10    6. That I do hereby consent and agree to the adoption of
11such child by .... (specified person or persons) only. If only
12first names are used for the specified person or persons, I
13voluntarily sign this specified consent form without
14disclosure to me of the last name of the specified person or
15persons. However, I understand that if I wish to know the last
16name of the specified person or persons, I may request it
17before signing the form. If I do not receive the last name, I
18may choose not to sign the specified consent form.
19    7. That I wish to and understand that upon signing this
20consent I do irrevocably and permanently give up all custody
21and other parental rights I have to such child if such child is
22adopted by .... (specified person or persons). I hereby
23transfer all of my rights to the custody, care and control of
24such child to ............................. (specified person
25or persons).
26    8. That I understand such child will be adopted by

 

 

10300SB1999ham001- 36 -LRB103 30669 KTG 60671 a

1....................... (specified person or persons) and that
2I cannot under any circumstances, after signing this document,
3change my mind and revoke or cancel this consent or obtain or
4recover custody or any other rights over such child if
5............................ (specified person or persons)
6adopt(s) such child; PROVIDED that each specified person has
7filed or shall file, within 60 days from the date hereof, a
8petition for the adoption of such child.
9    9. That if the specified person or persons designated
10herein do not file a petition for adoption within the
11time-frame specified above, or, if said petition for adoption
12is filed within the time-frame specified above but the
13adoption petition is dismissed with prejudice or the adoption
14proceeding is otherwise concluded without an order declaring
15the child to be the adopted child of the specified person or
16persons, then I understand that I will be sent written notice
17of such circumstances at the mailing address, at the email
18address, through a text message to my cell phone number, and to
19any other contact information I have provided in paragraph 2
20within 5 business days of this occurrence. I understand that
21the notice will be directed to me using the contact
22information I have provided in this consent. I understand that
23I will have 15 business days from the date that the written
24notice is sent to me to respond in the manner described in the
25notice, within which time I may request the Court to declare
26this consent voidable and return the child to me. I further

 

 

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1understand that the Court will make the final decision of
2whether or not the child will be returned to me. If I do not
3make such request within 15 business days of the date the
4notice was sent, then I expressly waive any other notice or
5service of process in any legal proceeding regarding the
6child, including a legal proceeding for someone other than
7..... (specified person or persons) to adopt the child, and
8that I will have no parental rights as to the child. The person
9sending the notice shall file an affidavit of notice as proof
10of the date sent.
11    10. That I expressly acknowledge that nothing in this
12Consent impairs the validity and absolute finality of this
13Consent under any circumstance other than those described in
14paragraph 9 of this Consent.
15    11. That I understand that I have a remaining duty and
16obligation to keep .............. (insert name and address of
17the attorney for the specified person or persons) informed of
18my current address or other preferred contact information
19until this adoption has been finalized. My failure to do so may
20result in the termination of my parental rights and the child
21being placed for adoption in another home.
22    12. That I do expressly waive any other notice or service
23of process in any of the legal proceedings for the adoption of
24the child as long as the adoption proceeding by the specified
25person or persons is pending.
26    13. That I have read and understand the above and I am

 

 

10300SB1999ham001- 38 -LRB103 30669 KTG 60671 a

1signing it as my free and voluntary act.
2    14. That I acknowledge that this consent is valid even if
3the specified person or persons separate or divorce or one of
4the specified persons dies prior to the entry of the final
5judgment for adoption.
6    Dated (insert date).
7    .............................................
8    Signature of parent.
9    .............................................
10    Address of parent.
11    .............................................
12    Phone number(s) of parent.
13    .............................................
14    Personal email(s) of parent.
15    .............................................
 
16    (3) The form of the certificate of acknowledgement for a
17Final and Irrevocable Consent for Adoption by a Specified
18Person or Persons: Non-DCFS Case shall be substantially as
19follows:
 
20STATE OF ..............)
21                       ) SS.
22COUNTY OF .............)
23    I, .................... (Name of Judge or other person),
24..................... (official title, name, and address),

 

 

10300SB1999ham001- 39 -LRB103 30669 KTG 60671 a

1certify that ............., personally known to me to be the
2same person whose name is subscribed to the foregoing Final
3and Irrevocable Consent for Adoption by a Specified Person or
4Persons; non-DCFS case, appeared before me this day in person
5and acknowledged that (she)(he) signed and delivered the
6consent as (her)(his) free and voluntary act, for the
7specified purpose. I am further satisfied that, before signing
8this Consent, ........ has read, or has had read to him or her,
9the Birth Parent Rights and Responsibilities-Private Form.
 
10    A-2. Birth Parent Rights and Responsibilities-Private
11Form. The Birth Parent Rights and Responsibilities-Private
12Form must be read by, or have been read to, any person
13executing a Final and Irrevocable Consent to Adoption under
14subsection A, a Final and Irrevocable Consent to Adoption by a
15Specified Person or Persons: Non-DCFS Case under subsection
16A-1, or a Consent to Adoption of Unborn Child under subsection
17B prior to the execution of said Consent. The form of the Birth
18Parent Rights and Responsibilities-Private Form shall be
19substantially as follows:
 
20
Birth Parent Rights and Responsibilities-Private Form

 
21
THIS FORM DOES NOT CONSTITUTE LEGAL ADVICE. LEGAL ADVICE IS
22
DEPENDENT ON THE SPECIFIC CIRCUMSTANCES OF EACH SITUATION AND
23
JURISDICTION. THE INFORMATION IN THIS FORM CANNOT REPLACE THE

 

 

10300SB1999ham001- 40 -LRB103 30669 KTG 60671 a

1
ADVICE OF AN ATTORNEY LICENSED IN YOUR STATE.
2    As a birth parent in the State of Illinois, you have the
3right:
4    1. To have your own attorney represent you. The
5prospective adoptive parents may agree to pay for the cost of
6your attorney in a manner consistent with Illinois law, but
7they are not required to do so.
8    2. To be treated with dignity and respect at all times and
9to make decisions free from coercion and pressure.
10    3. To request to receive counseling before and after
11signing a Final and Irrevocable Consent to Adoption
12("Consent"), a Final and Irrevocable Consent to Adoption by a
13Specified Person or Persons: Non-DCFS Case ("Specified
14Consent"), or a Consent to Adoption of Unborn Child ("Unborn
15Consent"). The prospective adoptive parents may agree to pay
16for the cost of counseling in a manner consistent with
17Illinois law, but they are not required to do so.
18    4. To ask to be involved in choosing your child's
19prospective adoptive parents and to ask to meet them.
20    5. To ask your child's prospective adoptive parents any
21questions that pertain to your decision to place your child
22with them.
23    6. To see your child before signing a Consent or Specified
24Consent if you are the custodial parent, and to request to see
25your child if you are not the custodial parent.
26    7. To request contact with your child and/or the child's

 

 

10300SB1999ham001- 41 -LRB103 30669 KTG 60671 a

1prospective adoptive parents, with the understanding that any
2promises regarding contact with your child or receipt of
3information about the child after signing a Consent, Specified
4Consent, or Unborn Consent cannot be enforced under Illinois
5law.
6    8. To receive copies of all documents that you sign and
7have those documents provided to you in your preferred
8language.
9    9. To request that your identifying information remain
10confidential, unless required otherwise by Illinois law or
11court order, and to voluntarily share your medical,
12background, and identifying information, including information
13on the original birth certificate of your child. This can be
14done through the Illinois Adoption Registry and Medical
15Information Exchange or through completing the Birth Parent
16Preference Form. Please visit http://dph.illinois.gov or
17www.newillinoisadoptionlaw.com.
18    10. To access the Confidential Intermediary Program which
19provides a way for a court appointed person to connect and/or
20exchange information between adoptees, adoptive parents and
21birth parents, and other biological family members, provided
22in most cases that mutual consent is given. Please visit
23www.ci-illinois.org or call (800) 526-9022(x29).
24    11. To work with an adoption agency or attorney of your
25choice, or change said agency or attorney, provided you
26promptly inform all of the parties currently involved.

 

 

10300SB1999ham001- 42 -LRB103 30669 KTG 60671 a

1    12. To receive, upon request, a written list of any
2promised support, financial or otherwise, from your attorney
3or the attorney for your child's prospective adoptive parents.
4    13. To delay signing a Consent, Specified Consent, or
5Unborn Consent if you are not ready to do so.
6    14. To decline to sign a Consent, Specified Consent, or
7Unborn Consent even if you have received financial support
8from the prospective adoptive parents.
9    If you do not receive any of the rights described in this
10Form, it shall not be a basis to revoke a Consent, Specified
11Consent, or Unborn Consent.
12    As a Birth Parent in the State of Illinois, you have the
13responsibility:
14    1. To carefully consider your reasons for choosing
15adoption.
16    2. (Birth mothers only) To accurately complete an
17Affidavit of Identification, which identifies the father of
18the child when known, with the understanding that a birth
19mother has a right to decline to identify the birth father.
20    3. To provide the necessary documentation regarding
21financial need to make an appropriate determination of
22reasonable pregnancy-related expenses.
23    4. To not accept financial support or reimbursement of
24pregnancy related expenses simultaneously from more than one
25source or if you are not pregnant, as doing so is a crime.
26    5. To voluntarily provide all known medical, background,

 

 

10300SB1999ham001- 43 -LRB103 30669 KTG 60671 a

1and family information about yourself and your immediate
2family to your child's prospective adoptive parents or their
3attorney. For the health of your child, you are strongly
4encouraged, but not required, to do so as set forth on the
5following form:
6
Birth Parent Medical Information
7    The purpose of this form is to gather your health history,
8genetic history, and social background information to share
9with the adoptive parents. It is important the adoptive family
10provide this information to the child's physician. It will
11become a part of the child's medical and family history. This
12form, in its entirety, will be given to the adoptive
13parent(s).
14    The following information is true and complete to the best
15of my knowledge and belief.
16    Birth parent name:
17......................................
18    Signature:
19..............................................
20    Date:....................................................
21    YES or NO (circle one) I agree to release my full name on
22this form to the adoptive family. If NO is circled then the
23birth parent's name shall be redacted on this form.
24    MOTHER'S PHYSICAL CHARACTERISTICS:
25Eyes: ... Hair: .... Complexion: .... Height: ....
26Weight: .... Body build: ..... Race: .....

 

 

10300SB1999ham001- 44 -LRB103 30669 KTG 60671 a

1Nationality/Descent: ....... Blood type: .... Rh factor: ....
2Eye glasses or contact lenses? Yes /.../ No /.../
3Right /.../ Left /.../ handed
4Age: .... or Date of birth: ..... Religion: .................
5    Please list your highest education level, occupation,
6hobbies, interests, and talents:
7............................
8Existence of any disabilities? Yes /.../ No /.../
9If yes, explain:.............................................
10    If you have other children, list them below. Include any
11children previously placed for adoption.
12....................
13    Describe your relationship with the birth father: .......
14    FATHER'S PHYSICAL CHARACTERISTICS:
15Eyes: ... Hair: .... Complexion: .... Height: ....
16Weight: .... Body build: ..... Race: .....
17Nationality/Descent: ....... Blood type: .... Rh factor: ....
18Eye glasses or contact lenses? Yes /.../ No /.../
19Right /.../ Left /.../ handed
20Age: .... or Date of birth: ..... Religion: .................
21    Please list your highest education level, occupation,
22hobbies, interests, and talents:
23............................
24Existence of any disabilities? Yes /.../ No /.../
25If yes, explain:.............................................
26    If you have other children, list them below. Include any

 

 

10300SB1999ham001- 45 -LRB103 30669 KTG 60671 a

1children previously placed for adoption.
2....................
3
PREGNANCY HISTORY INVOLVING THIS CHILD
4    Month prenatal care began during this pregnancy:.........
5    Complications during pregnancy: Yes ... No ... If yes,
6explain: ....................................................
7    .............................................................
8
MEDICATION AND OTHER SUBSTANCES USED DURING
9
PREGNANCY OR YEAR PRIOR TO PREGNANCY
10FREQUENCY/ FREQUENCY/
11AMOUNT AMOUNT
12DURING PRIOR TO
13YES NO PREGNANCY PREGNANCY
14Alcohol/../ /../................. ...............
15Amphetamines/../ /../................................
16Barbiturates/../ /../................................
17Cocaine/../ /../................................
18Heroin/../ /../................................
19LSD/../ /../................................
20Marijuana/../ /../ ................. ...............
21Caffeine
22(Coffee,
23tea, etc)/../ /../ ................................
24Prescription
25drugs/../ /../ ................. ...............
26Non-

 

 

 

10300SB1999ham001- 46 -LRB103 30669 KTG 60671 a

1prescription
2drugs /../ /../................................
3Other /../ /../ ................. ...............
4    In addition to this form, a birth parent shall also be
5provided the forms for the Illinois Adoption Registry and
6Medical Information Exchange.
7    B. The form of consent required for the adoption of an
8unborn child shall be substantially as follows:
 
9
CONSENT TO ADOPTION OF UNBORN CHILD

 
10    I, ...., state:
11    That I am the father of a child expected to be born on or
12about .... to .... (name of mother).
13    That I reside at .... County of ...., and State of .....
14    That I am of the age of .... years.
15    That I hereby enter my appearance in such adoption
16proceeding and waive service of summons on me.
17    That I hereby acknowledge that I have been provided with a
18copy of the Birth Parent Rights and Responsibilities-Private
19Form before signing this Consent, and that I have had time to
20read, or have had read to me, this Form. I understand that if I
21do not receive any of the rights as described in this Form, it
22shall not constitute a basis to revoke this Consent to
23Adoption of Unborn Child.

 

 

10300SB1999ham001- 47 -LRB103 30669 KTG 60671 a

1    That I do hereby consent and agree to the adoption of such
2child, and that I have not previously executed a consent or
3surrender with respect to such child.
4    That I wish to and do understand that by signing this
5consent I do irrevocably and permanently give up all custody
6and other parental rights I have to such child, except that I
7have the right to revoke this consent by giving written notice
8of my revocation not later than 72 hours after the birth of the
9child.
10    That I understand such child will be placed for adoption
11and that, except as hereinabove provided, I cannot under any
12circumstances, after signing this document, change my mind and
13revoke or cancel this consent or obtain or recover custody or
14any other rights over such child.
15    That I have read and understand the above and I am signing
16it as my free and voluntary act.
17    Dated (insert date).
18........................
 
19    B-5. (1) The parent of a child may execute a consent to
20standby adoption by a specified person or persons. A consent
21under this subsection B-5 shall be acknowledged by a parent
22pursuant to subsection H and subsection K of this Section. The
23form of consent required for the standby adoption of a born
24child effective at a future date when the consenting parent of
25the child dies or requests that a final judgment of adoption be

 

 

10300SB1999ham001- 48 -LRB103 30669 KTG 60671 a

1entered shall be substantially as follows:
 
2
FINAL AND IRREVOCABLE CONSENT
3
TO STANDBY ADOPTION

 
4    I, ..., (relationship, e.g. mother or father) of ...., a
5male or female (circle one) child, state:
6    That the child was born on .... at .....
7    That I reside at ...., County of ...., and State of .....
8    That I am of the age of .... years.
9    That I hereby enter my appearance in this proceeding and
10waive service of summons on me in this action only.
11    That I do hereby consent and agree to the standby adoption
12of the child, and that I have not previously executed a consent
13or surrender with respect to the child.
14    That I wish to and understand that by signing this consent
15I do irrevocably and permanently give up all custody and other
16parental rights I have to the child, effective upon (my death)
17(the child's other parent's death) or upon (my) (the other
18parent's) request for the entry of a final judgment for
19adoption if ..... (specified person or persons) adopt my
20child.
21    That I understand that until (I die) (the child's other
22parent dies), I retain all legal rights and obligations
23concerning the child, but at that time, I irrevocably give all
24custody and other parental rights to .... (specified person or

 

 

10300SB1999ham001- 49 -LRB103 30669 KTG 60671 a

1persons).
2    I understand my child will be adopted by .......
3(specified person or persons) only and that I cannot, under
4any circumstances, after signing this document, change my mind
5and revoke or cancel this consent or obtain or recover custody
6or any other rights over my child if ..... (specified person or
7persons) adopt my child.
8    I understand that this consent to standby adoption is
9valid only if the petition for standby adoption is filed and
10that if ....... (specified person or persons), for any reason,
11cannot or will not file a petition for standby adoption or if
12his, her, or their petition for standby adoption is denied,
13then this consent is void. I have the right to notice of any
14other proceeding that could affect my parental rights.
15    That I have read and understand the above and I am signing
16it as my free and voluntary act.
17    Dated (insert date).
18....................
 
19    If under Section 8 the consent of more than one person is
20required, then each such person shall execute a separate
21consent. A separate consent shall be executed for each child.
22    (2) If the parent consents to a standby adoption by 2
23specified persons, then the form shall contain 2 additional
24paragraphs in substantially the following form:
25    If .... (specified persons) obtain a judgment of

 

 

10300SB1999ham001- 50 -LRB103 30669 KTG 60671 a

1dissolution of marriage before the judgment for adoption is
2entered, then ..... (specified person) shall adopt my child. I
3understand that I cannot change my mind and revoke this
4consent or obtain or recover custody of my child if .....
5(specified persons) obtain a judgment of dissolution of
6marriage and ..... (specified person) adopts my child. I
7understand that I cannot change my mind and revoke this
8consent if ...... (specified persons) obtain a judgment of
9dissolution of marriage before the adoption is final. I
10understand that this consent to adoption has no effect on who
11will get custody of my child if ..... (specified persons)
12obtain a judgment of dissolution of marriage after the
13adoption is final. I understand that if either .....
14(specified persons) dies before the petition to adopt my child
15is granted, then the surviving person may adopt my child. I
16understand that I cannot change my mind and revoke this
17consent or obtain or recover custody of my child if the
18surviving person adopts my child.
19    A consent to standby adoption by specified persons on this
20form shall have no effect on a court's determination of
21custody or visitation under the Illinois Marriage and
22Dissolution of Marriage Act if the marriage of the specified
23persons is dissolved before the adoption is final.
24    (3) The form of the certificate of acknowledgement for a
25Final and Irrevocable Consent for Standby Adoption shall be
26substantially as follows:
 

 

 

10300SB1999ham001- 51 -LRB103 30669 KTG 60671 a

1STATE OF .....)
2              ) SS.
3COUNTY OF ....)
 
4    I, ....... (name of Judge or other person) ..... (official
5title, name, and address), certify that ......., personally
6known to me to be the same person whose name is subscribed to
7the foregoing Final and Irrevocable Consent to Standby
8Adoption, appeared before me this day in person and
9acknowledged that (she) (he) signed and delivered the consent
10as (her) (his) free and voluntary act, for the specified
11purpose.
12    I have fully explained that this consent to adoption is
13valid only if the petition to adopt is filed, and that if the
14specified person or persons, for any reason, cannot or will
15not adopt the child or if the adoption petition is denied, then
16this consent will be void. I have fully explained that if the
17specified person or persons adopt the child, by signing this
18consent (she) (he) is irrevocably and permanently
19relinquishing all parental rights to the child, and (she) (he)
20has stated that such is (her) (his) intention and desire.
21    Dated (insert date).
22    Signature ..............................
 
23    (4) If a consent to standby adoption is executed in this

 

 

10300SB1999ham001- 52 -LRB103 30669 KTG 60671 a

1form, the consent shall be valid only if the specified person
2or persons adopt the child. The consent shall be void if:
3        (a) the specified person or persons do not file a
4    petition for standby adoption of the child; or
5        (b) a court denies the standby adoption petition.
6    The parent shall not need to take further action to revoke
7the consent if the standby adoption by the specified person or
8persons does not occur, notwithstanding the provisions of
9Section 11 of this Act.
10    C. The form of surrender to any agency given by a parent of
11a born child who is to be subsequently placed for adoption
12shall be substantially as follows and shall contain such other
13facts and statements as the particular agency shall require.
 
14
FINAL AND IRREVOCABLE SURRENDER
15
FOR PURPOSES OF ADOPTION

 
16    I, .... (relationship, e.g., mother, father, relative,
17guardian) of ...., a male or female (circle one) child, state:
18    That such child was born on ...., at .....
19    That I reside at ...., County of ...., and State of .....
20    That I am of the age of .... years.
21    That I do hereby surrender and entrust the entire custody
22and control of such child to the .... (the "Agency"), a
23(public) (licensed) child welfare agency with its principal
24office in the City of ...., County of .... and State of ....,

 

 

10300SB1999ham001- 53 -LRB103 30669 KTG 60671 a

1for the purpose of enabling it to care for and supervise the
2care of such child, to place such child for adoption and to
3consent to the legal adoption of such child.
4    That I hereby grant to the Agency full power and authority
5to place such child with any person or persons it may in its
6sole discretion select to become the adopting parent or
7parents and to consent to the legal adoption of such child by
8such person or persons; and to take any and all measures which,
9in the judgment of the Agency, may be for the best interests of
10such child, including authorizing medical, surgical and dental
11care and treatment including inoculation and anaesthesia for
12such child.
13    That I wish to and understand that by signing this
14surrender I do irrevocably and permanently give up all custody
15and other parental rights I have to such child.
16    That I understand I cannot under any circumstances, after
17signing this surrender, change my mind and revoke or cancel
18this surrender or obtain or recover custody or any other
19rights over such child.
20    That I have read and understand the above and I am signing
21it as my free and voluntary act.
22    Dated (insert date).
23........................
 
24    C-5. The form of a Final and Irrevocable Designated
25Surrender for Purposes of Adoption to any agency given by a

 

 

10300SB1999ham001- 54 -LRB103 30669 KTG 60671 a

1parent of a born child who is to be subsequently placed for
2adoption is to be used by legal parents only. The form shall be
3substantially as follows and shall contain such other facts
4and statements as the particular agency shall require:
 
5
FINAL AND IRREVOCABLE DESIGNATED SURRENDER
6
FOR PURPOSES OF ADOPTION

 
7    I, .... (relationship, e.g., mother, father, relative,
8guardian) of ...., a male or female (circle one) child, state:
9    1. That such child was born on ...., at .....
10    2. That I reside at ...., County of ...., and State of
11....., my email address (if I have one) is .... my cell phone
12number where I can receive text messages (if I have one) is
13.... and my land line phone number (if I have one) is ...., and
14any other contact information is ....
15    3. That I am of the age of .... years.
16    4. That I do hereby surrender and entrust the entire
17custody and control of such child to the .... (the "Agency"), a
18(public) (licensed) child welfare agency with its principal
19office in the City of ...., County of .... and State of ....,
20for the purpose of enabling it to care for and supervise the
21care of such child, to place such child for adoption with
22............................. (specified person or persons)
23and to consent to the legal adoption of such child and to take
24any and all measures which, in the judgment of the Agency, may

 

 

10300SB1999ham001- 55 -LRB103 30669 KTG 60671 a

1be for the best interests of such child, including authorizing
2medical, surgical and dental care and treatment including
3inoculation and anesthesia for such child. If only first names
4are used for the specified person or persons, I voluntarily
5sign this designated surrender without disclosure to me of the
6last name of the specified person or persons. However, I
7understand that if I wish to know the last name of the
8specified person or persons, I may request it before signing
9the form. If I do not receive the last name, I may choose not
10to sign the designated surrender form.
11    5. That I wish to and understand that by signing this
12surrender I do irrevocably and permanently give up all custody
13and other parental rights I have to such child.
14    6. That if the petition for adoption is not filed by the
15specified person or persons designated herein or, if the
16petition for adoption is filed but the adoption petition is
17dismissed with prejudice or the adoption proceeding is
18otherwise concluded without an order declaring the child to be
19the adopted child of each specified person, then I understand
20that the Agency will send notice to me at the mailing address,
21at the email address, through a text message to my cell phone
22number provided in paragraph 2, and to any other contact
23information I have provided in paragraph 2 within 5 business
24days of this occurrence. The person sending the notice shall
25prepare an affidavit of notice. I understand that I will have
2615 business days from the date that the written notice was sent

 

 

10300SB1999ham001- 56 -LRB103 30669 KTG 60671 a

1to respond, within which time I may choose to designate other
2adoptive parent(s). However, I acknowledge that the Agency has
3full power and authority to place the child for adoption with
4any person or persons it may in its sole discretion select to
5become the adopting parent or parents and to consent to the
6legal adoption of the child by such person or persons.
7    7. That I acknowledge that this surrender is valid even if
8the specified persons separate or divorce or one of the
9specified persons dies prior to the entry of the final
10judgment for adoption.
11    8. That I expressly acknowledge that the above paragraphs
126 and 7 do not impair the validity and absolute finality of
13this surrender under any circumstance.
14    9. That I understand that I have a remaining obligation to
15keep the Agency informed of my current contact information
16until the adoption of the child has been finalized if I wish to
17be notified in the event the adoption by the specified
18person(s) cannot proceed.
19    10. That I understand I cannot under any circumstances,
20after signing this surrender, change my mind and revoke or
21cancel this surrender or obtain or recover custody or any
22other rights over such child.
23    11. That I have read and understand the above and I am
24signing it as my free and voluntary act.
25    Dated (insert date).
26..............................
 

 

 

10300SB1999ham001- 57 -LRB103 30669 KTG 60671 a

1    D. The form of surrender to an agency given by a parent of
2an unborn child who is to be subsequently placed for adoption
3shall be substantially as follows and shall contain such other
4facts and statements as the particular agency shall require.
 
5
SURRENDER OF UNBORN CHILD FOR
6
PURPOSES OF ADOPTION

 
7    I, .... (father), state:
8    That I am the father of a child expected to be born on or
9about .... to .... (name of mother).
10    That I reside at ...., County of ...., and State of .....
11    That I am of the age of .... years.
12    That I do hereby surrender and entrust the entire custody
13and control of such child to the .... (the "Agency"), a
14(public) (licensed) child welfare agency with its principal
15office in the City of ...., County of .... and State of ....,
16for the purpose of enabling it to care for and supervise the
17care of such child, to place such child for adoption and to
18consent to the legal adoption of such child, and that I have
19not previously executed a consent or surrender with respect to
20such child.
21    That I hereby grant to the Agency full power and authority
22to place such child with any person or persons it may in its
23sole discretion select to become the adopting parent or

 

 

10300SB1999ham001- 58 -LRB103 30669 KTG 60671 a

1parents and to consent to the legal adoption of such child by
2such person or persons; and to take any and all measures which,
3in the judgment of the Agency, may be for the best interests of
4such child, including authorizing medical, surgical and dental
5care and treatment, including inoculation and anaesthesia for
6such child.
7    That I wish to and understand that by signing this
8surrender I do irrevocably and permanently give up all custody
9and other parental rights I have to such child.
10    That I understand I cannot under any circumstances, after
11signing this surrender, change my mind and revoke or cancel
12this surrender or obtain or recover custody or any other
13rights over such child, except that I have the right to revoke
14this surrender by giving written notice of my revocation not
15later than 72 hours after the birth of such child.
16    That I have read and understand the above and I am signing
17it as my free and voluntary act.
18    Dated (insert date).
19........................
 
20    E. The form of consent required from the parents for the
21adoption of an adult, when such adult elects to obtain such
22consent, shall be substantially as follows:
 
23
CONSENT

 

 

 

10300SB1999ham001- 59 -LRB103 30669 KTG 60671 a

1    I, ...., (father) (mother) of ...., an adult, state:
2    That I reside at ...., County of .... and State of .....
3    That I do hereby consent and agree to the adoption of such
4adult by .... and .....
5    Dated (insert date).
6.........................
 
7    F. The form of consent required for the adoption of a child
8of the age of 14 years or over, or of an adult, to be given by
9such person, shall be substantially as follows:
 
10
CONSENT

 
11    I, ...., state:
12    That I reside at ...., County of .... and State of .....
13That I am of the age of .... years. That I hereby enter my
14appearance in this proceeding and waive service of summons on
15me. That I consent and agree to my adoption by .... and .....
16    Dated (insert date).
17........................
 
18    G. The form of consent given by an agency to the adoption
19by specified persons of a child previously surrendered to it
20shall set forth that the agency has the authority to execute
21such consent. The form of consent given by a guardian of the
22person of a child sought to be adopted, appointed by a court of

 

 

10300SB1999ham001- 60 -LRB103 30669 KTG 60671 a

1competent jurisdiction, shall set forth the facts of such
2appointment and the authority of the guardian to execute such
3consent.
4    H. A consent (other than that given by an agency, or
5guardian of the person of the child sought to be adopted who
6was appointed by a court of competent jurisdiction) shall be
7acknowledged by a parent before a judge of a court of competent
8jurisdiction or, except as otherwise provided in this Act,
9before a representative of an agency, or before a person,
10other than the attorney for the prospective adoptive parent or
11parents, designated by a court of competent jurisdiction.
12    I. A surrender, or any other document equivalent to a
13surrender, by which a child is surrendered to an agency shall
14be acknowledged by the person signing such surrender, or other
15document, before a judge of a court of competent jurisdiction,
16or, except as otherwise provided in this Act, before a
17representative of an agency, or before a person designated by
18a court of competent jurisdiction.
19    J. The form of the certificate of acknowledgment for a
20consent, a surrender, or any other document equivalent to a
21surrender, shall be substantially as follows:
 
22STATE OF ....)
23             ) SS.
24COUNTY OF ...)
25    I, .... (Name of judge or other person), .... (official

 

 

10300SB1999ham001- 61 -LRB103 30669 KTG 60671 a

1title, name and location of court or status or position of
2other person), certify that ...., personally known to me to be
3the same person whose name is subscribed to the foregoing
4(consent) (surrender), appeared before me this day in person
5and acknowledged that (she) (he) signed and delivered such
6(consent) (surrender) as (her) (his) free and voluntary act,
7for the specified purpose.
8    I have fully explained that by signing such (consent)
9(surrender) (she) (he) is irrevocably relinquishing all
10parental rights to such child or adult and (she) (he) has
11stated that such is (her) (his) intention and desire. (Add if
12Consent only) I am further satisfied that, before signing this
13Consent, ........ has read, or has had read to him or her, the
14Birth Parent Rights and Responsibilities-Private Form.
15    Dated (insert date).
16    Signature ...............
 
17    K. When the execution of a consent or a surrender is
18acknowledged before someone other than a judge, such other
19person shall have his or her signature on the certificate
20acknowledged before a notary public, in form substantially as
21follows:
 
22STATE OF ....)
23             ) SS.
24COUNTY OF ...)

 

 

10300SB1999ham001- 62 -LRB103 30669 KTG 60671 a

1    I, a Notary Public, in and for the County of ......, in the
2State of ......, certify that ...., personally known to me to
3be the same person whose name is subscribed to the foregoing
4certificate of acknowledgment, appeared before me in person
5and acknowledged that (she) (he) signed such certificate as
6(her) (his) free and voluntary act and that the statements
7made in the certificate are true.
8    Dated (insert date).
9    
Signature ...................... Notary Public
10
(official seal)

 
11    There shall be attached a certificate of magistracy, or
12other comparable proof of office of the notary public
13satisfactory to the court, to a consent signed and
14acknowledged in another state.
15    L. A surrender or consent executed and acknowledged
16outside of this State, either in accordance with the law of
17this State or in accordance with the law of the place where
18executed, is valid.
19    M. Where a consent or a surrender is signed in a foreign
20country, the execution of such consent shall be acknowledged
21or affirmed in a manner conformable to the law and procedure of
22such country.
23    N. If the person signing a consent or surrender is in the
24military service of the United States, the execution of such
25consent or surrender may be acknowledged before a commissioned

 

 

10300SB1999ham001- 63 -LRB103 30669 KTG 60671 a

1officer and the signature of such officer on such certificate
2shall be verified or acknowledged before a notary public or by
3such other procedure as is then in effect for such division or
4branch of the armed forces.
5    O. (1) The parent or parents of a child in whose interests
6a petition under Section 2-13 of the Juvenile Court Act of 1987
7is pending may, with the approval of the designated
8representative of the Department of Children and Family
9Services ("Department" or "DCFS"), execute a consent to
10adoption by a specified person or persons:
11        (a) in whose physical custody the child has resided
12    for at least 6 months; or
13        (b) in whose physical custody at least one sibling of
14    the child who is the subject of this consent has resided
15    for at least 6 months, and the child who is the subject of
16    this consent is currently residing in this foster home; or
17        (c) in whose physical custody a child under one year
18    of age has resided for at least 3 months.
19    The court may waive the time frames in subdivisions (a),
20(b), and (c) for good cause shown if the court finds it to be
21in the child's best interests.
22    A consent under this subsection O shall be acknowledged by
23a parent pursuant to subsection H and subsection K of this
24Section.
25    (2) The final and irrevocable consent to adoption by a
26specified person or persons in a Department of Children and

 

 

10300SB1999ham001- 64 -LRB103 30669 KTG 60671 a

1Family Services (DCFS) case shall be substantially as follows:
 
2
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
3
A SPECIFIED PERSON OR PERSONS: DCFS CASE

 
4    I, ......................................, the
5.................. mother or father (circle one) of a male or
6female (circle one) child, state:
7        1. My child ............................ (name of
8    child) was born on ..... (insert date) at
9    .................... Hospital in the City/Town of
10    ........., in ................ County, State of
11    ...............
12        2. I reside at ......................, County of
13    ............. and State of ..............
14        Mail may also be sent to me at this address
15    ............................, in care of
16    .................
17        My home telephone number is......................
18        My cell telephone number is......................
19        My e-mail address is.................................
20        3. I, ..........................., am .... years old.
21        4. I enter my appearance in this action for my child to
22    be adopted by the person or persons specified herein by me
23    and waive service of summons on me in this action only.
24        5. I hereby acknowledge that I have been provided a

 

 

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1    copy of the Birth Parent Rights and Responsibilities in
2    Illinois for Final and Irrevocable Consents to Adoption by
3    a Specified Person or Persons for DCFS Cases before
4    signing this Consent and that I have had time to read this
5    form or have it read to me and that I understand the rights
6    and responsibilities described in this form. I understand
7    that if I do not receive any of my rights as described in
8    the form, it shall not constitute a basis to revoke this
9    Final and Irrevocable Consent to Adoption by a Specified
10    Person or Persons.
11        6. I do hereby consent and agree to the adoption of
12    such child by .......... (names of current foster
13    parent(s) or caregiver(s), hereinafter referred to as the
14    "specified person or persons") only.
15        7. I wish to sign this consent and I understand that by
16    signing this consent I irrevocably and permanently give up
17    all my parental rights I have to my child.
18        8. I understand that this consent allows my child to
19    be adopted by the specified person or persons only and
20    that I cannot under any circumstances after signing this
21    document change my mind and revoke or cancel this consent.
22        9. I understand that this consent will be void if:
23            (a) the Department places my child with someone
24        other than the specified person or persons; or
25            (b) a court denies the adoption petition for the
26        specified person or persons to adopt my child; or

 

 

10300SB1999ham001- 66 -LRB103 30669 KTG 60671 a

1            (c) the DCFS Guardianship Administrator refuses to
2        consent to my child's adoption by the specified person
3        or persons on the basis that the adoption is not in my
4        child's best interests.
5        I understand that if this consent is void I have
6    parental rights to my child, subject to any applicable
7    court orders including those entered under Article II of
8    the Juvenile Court Act of 1987, unless and until I sign a
9    new consent or surrender or my parental rights are
10    involuntarily terminated. I understand that if this
11    consent is void, my child may be adopted by someone other
12    than the specified person or persons only if I sign a new
13    consent or surrender, or my parental rights are
14    involuntarily terminated. I understand that if this
15    consent is void, the Department will notify me within 30
16    days using the addresses and telephone numbers I provided
17    in paragraph 2 of this form. I understand that if I receive
18    such a notice, it is very important that I contact the
19    Department immediately, and preferably within 30 days, to
20    have input into the plan for my child's future.
21        10. I understand that if a petition for adoption of my
22    child is filed by someone other than the specified person
23    or persons, the Department will notify me within 14 days
24    after the Department becomes aware of the petition. The
25    fact that someone other than the specified person or
26    persons files a petition to adopt my child does not make

 

 

10300SB1999ham001- 67 -LRB103 30669 KTG 60671 a

1    this consent void.
2        11. If a person other than the specified person or
3    persons files a petition to adopt my child or if the
4    consent is void under paragraph 9, the Department will
5    send written notice to me using the mailing address and
6    email address provided by me in paragraph 2 of this form.
7    The Department will also contact me using the telephone
8    numbers I provided in paragraph 2 of this form. It is very
9    important that I let the Department know if any of my
10    contact information changes. If I do not let the
11    Department know if any of my contact information changes,
12    I understand that I may not receive notification from the
13    Department if this consent is void or if someone other
14    than the specified person or persons files a petition to
15    adopt my child. If any of my contact information changes,
16    I should immediately notify:
17        Caseworker's name and telephone number:
18    ............................................................;
19        Agency name, address, zip code, and telephone number:
20    ............................................................;
21        Supervisor's name and telephone number:
22    ............................................................;
23    DCFS Advocacy Office for Children and Families:
24    800-232-3798.
25        12. I expressly acknowledge that paragraph 9 (and
26    paragraphs 8a and 8b, if applicable) do not impair the

 

 

10300SB1999ham001- 68 -LRB103 30669 KTG 60671 a

1    validity and finality of this consent under any
2    circumstances.
3        13. I have read and understand the above and I am
4    signing it as my free and voluntary act.
5        Dated (insert date).
6        .............................................
7        Signature of parent
 
8    (3) If the parent consents to an adoption by 2 specified
9persons, then the form shall contain 2 additional paragraphs
10in substantially the following form:
11        8a. I understand that I cannot change my mind or
12    revoke this consent or recover custody of my child on the
13    basis that the specified persons divorce or are granted a
14    dissolution of a civil union or that one of the specified
15    persons has died.
16        8b. I understand that if the specified persons get a
17    divorce or are granted a dissolution of a civil union
18    before the petition to adopt my child is granted, this
19    consent remains valid only for ............... (name only
20    one specified person) to adopt my child.
21        8c. I understand that if either of the specified
22    persons dies before the petition to adopt my child is
23    granted, this consent remains valid for the surviving
24    person to adopt my child.
25    (4) The form of the certificate of acknowledgement for a

 

 

10300SB1999ham001- 69 -LRB103 30669 KTG 60671 a

1Final and Irrevocable Consent for Adoption by a Specified
2Person or Persons: DCFS Case shall be substantially as
3follows:
 
4STATE OF ..............)
5                       ) SS.
6COUNTY OF .............)
 
7    I, .................... (Name of Judge or other person),
8..................... (official title, name, and address),
9certify that ............., personally known to me to be the
10same person whose name is subscribed to the foregoing Final
11and Irrevocable Consent for Adoption by a Specified Person or
12Persons: DCFS Case, appeared before me this day in person and
13acknowledged that (she)(he) signed and delivered the consent
14as (her)(his) free and voluntary act, for the specified
15purpose.
16    I have fully explained that by signing this consent this
17parent is irrevocably and permanently relinquishing all
18parental rights to the child so that the child may be adopted
19by a specified person or persons, and this parent has stated
20that such is (her)(his) intention and desire. I have fully
21explained that this consent is void only if:
22        (a) the placement is disrupted and the child is moved
23    to a different placement; or
24        (b) a court denies the petition for adoption; or

 

 

10300SB1999ham001- 70 -LRB103 30669 KTG 60671 a

1        (c) the Department of Children and Family Services
2    Guardianship Administrator refuses to consent to the
3    child's adoption by a specified person or persons on the
4    basis that the adoption is not in the child's best
5    interests.
6    Dated (insert date).
7    ...............................
8    Signature
 
9    (5) If a consent to adoption by a specified person or
10persons is executed in this form, the following provisions
11shall apply. The consent shall be valid only for the specified
12person or persons to adopt the child. The consent shall be void
13if:
14        (a) the placement disrupts and the child is moved to
15    another placement; or
16        (b) a court denies the petition for adoption; or
17        (c) the Department of Children and Family Services
18    Guardianship Administrator refuses to consent to the
19    child's adoption by the specified person or persons on the
20    basis that the adoption is not in the child's best
21    interests.
22    If the consent is void under this Section, the parent
23shall not need to take further action to revoke the consent. No
24proceeding for termination of parental rights shall be brought
25unless the parent who executed the consent to adoption by a

 

 

10300SB1999ham001- 71 -LRB103 30669 KTG 60671 a

1specified person or persons has been notified of the
2proceedings pursuant to Section 7 of this Act or subsection
3(4) of Section 2-13 of the Juvenile Court Act of 1987.
4    (6) The Department of Children and Family Services is
5authorized to promulgate rules necessary to implement this
6subsection O.
7    (7) (Blank).
8    (8) The Department of Children and Family Services shall
9promulgate a rule and procedures regarding Consents to
10Adoption by a Specified Person or Persons in DCFS cases. The
11rule and procedures shall provide for the development of the
12Birth Parent Rights and Responsibilities Form for DCFS Cases.
13    (9) A consent to adoption by specified persons on this
14consent form shall have no effect on a court's determination
15of custody or visitation under the Illinois Marriage and
16Dissolution of Marriage Act or the Illinois Religious Freedom
17Protection and Civil Union Act if the marriage or civil union
18of the specified persons is dissolved after the adoption is
19final.
20    P. If the person signing a consent is incarcerated or
21detained in a correctional facility, prison, jail, detention
22center, or other comparable institution, either in this State
23or any other jurisdiction, the execution of such consent may
24be acknowledged before social service personnel of such
25institution, or before a person designated by a court of
26competent jurisdiction.

 

 

10300SB1999ham001- 72 -LRB103 30669 KTG 60671 a

1    Q. A consent may be acknowledged telephonically, via
2audiovisual connection, or other electronic means, provided
3that a court of competent jurisdiction has entered an order
4approving the execution of the consent in such manner and has
5designated an individual to be physically present with the
6parent executing such consent in order to verify the identity
7of the parent.
8    R. An agency whose representative is acknowledging a
9consent pursuant to this Section shall be a public child
10welfare agency, or a child welfare agency, or a child placing
11agency that is authorized or licensed in the State or
12jurisdiction in which the consent is signed.
13    S. The form of waiver by a putative or legal father of a
14born or unborn child shall be substantially as follows:
 
15
FINAL AND IRREVOCABLE
16
WAIVER OF PARENTAL RIGHTS OF PUTATIVE OR LEGAL FATHER

 
17    I, ...................., state under oath or affirm as
18follows:
19        1. That the biological mother ............... has
20    named me as a possible biological or legal father of her
21    minor child who was born, or is expected to be born on
22    ..........., ......, in the City/Town of........., State
23    of ...........
24        2. That I understand that the biological mother

 

 

10300SB1999ham001- 73 -LRB103 30669 KTG 60671 a

1    ............. intends to or has placed the child for
2    adoption.
3        3. That I reside at ................, in the City/Town
4    of..........., State of ................
5        4. That I am ................ years of age and my date
6    of birth is ..............., .............
7        5. That I (select one):
8            ..... am married to the biological mother.
9            ..... am not married to the biological mother and
10        have not been married to the biological mother within
11        300 days before the child's birth or expected date of
12        child's birth.
13            ..... am not currently married to the biological
14        mother, but was married to the biological mother,
15        within 300 days before the child's birth or expected
16        date of child's birth.
17        6. That I (select one):
18            ..... neither admit nor deny that I am the
19        biological father of the child.
20            ..... deny that I am the biological father of the
21        child.
22        7. That I hereby agree to the termination of my
23    parental rights, if any, without further notice to me of
24    any proceeding for the adoption of the minor child, even
25    if I have taken any action to establish parental rights or
26    take any such action in the future including registering

 

 

10300SB1999ham001- 74 -LRB103 30669 KTG 60671 a

1    with any putative father registry.
2        8. That I understand that by signing this Waiver I do
3    irrevocably and permanently give up all custody and other
4    parental rights I may have to such child.
5        9. That I understand that this Waiver is FINAL AND
6    IRREVOCABLE and that I am permanently barred from
7    contesting any proceeding for the adoption of the child
8    after I sign this Waiver.
9        10. That I waive any further service of summons or
10    other pleadings in any proceeding to terminate parental
11    rights, if any to this child, or any proceeding for
12    adoption of this child.
13        11. That I understand that if a final judgment or
14    order of adoption for this child is not entered, then any
15    parental rights or responsibilities that I may have remain
16    intact.
17        12. That I have read and understand the above and that
18    I am signing it as my free and voluntary act.
 
19    Dated: ..................., ..............
20    ...........................................
21    Signature
 
22
OATH
23I have been duly sworn and I state under oath that I have read
24and understood this Final and Irrevocable Waiver of Parental

 

 

10300SB1999ham001- 75 -LRB103 30669 KTG 60671 a

1Rights of Putative or Legal Father. The facts contained in it
2are true and correct to the best of my knowledge. I have signed
3this document as my free and voluntary act in order to
4facilitate the adoption of the child.
 
5..............................
6Signature
 
7Signed and Sworn before me on
8this ............ day
9of ..........., 20....
 
10...................
11Notary Public
12(Source: P.A. 99-833, eff. 1-1-17; 100-1060, eff. 1-1-19.)".