Adoption Consent Form - Alaska

CONSENT TO ADOPTION OF A MINOR — ALASKA

Before you use this: This consent is for a parent, spouse, or guardian of a minor child. A child age 10 or older who must consent uses a separate child consent (Alaska court form P-420). Complete a separate consent for each other person whose consent is required under AS 25.23.040(a). Determine whether the child is an “Indian child” under 25 U.S.C. § 1903(4) before signing. A minor parent, or a person consenting to adoption of an Indian child other than an agency, must sign before the court as described below. This consent does not itself grant an adoption decree.

Child and adoption

Child's current full legal name: [________________________________]

Date of birth: [__/__/____] Place of birth: [________________________________]

Proposed adoptive parent(s), if identified: [________________________________]

Adoption court (Superior Court at): [________________________________]

Court address: [________________________________] Court telephone: [________________________________]

Case number, if assigned: [________________________________]

Person obtaining this consent: [________________________________]

Address for delivery of any written notice withdrawing consent: [________________________________]

Phone or other contact for delivery coordination: [________________________________]

Consenting person's identity and authority

Full legal name: [________________________________]

Address: [________________________________]

Relationship to child / basis for consent (select one):

☐ Mother of the child.

☐ Father whose consent is required under AS 25.23.040(a)(2). Basis: [________________________________].

☐ Person lawfully entitled to custody or empowered to consent. Authority: [________________________________].

☐ Guardian, lawful custodian, or authorized agency representative. Identify role and authority: [________________________________].

☐ Spouse of the minor child, if this spouse's consent is required. Basis: [________________________________].

I am the person identified above. I voluntarily consent to the adoption of the child identified above by the proposed adoptive parent(s) identified above. If the adopting parent is not identified, I make the additional statement in the next section.

My date of birth: [__/__/____] I am under age 18: ☐ Yes ☐ No

I understand that I may consult a lawyer of my choice at my own expense before signing. Court-appointed counsel may be available in the circumstances stated in Alaska Adoption Rule 8(b). My lawyer, if any: [________________________________].

Requested privileges after adoption

Visitation or other parental privileges (select one):

☐ I seek no retained visitation or other parental privilege.

☐ I ask the adoption court to include the following visitation or other privilege in its decree: [________________________________].

Inheritance (if I am a biological parent): ☐ I request that the decree expressly continue the child's inheritance rights from me. ☐ I make no such request. ☐ Not applicable.

These selections state requests for the court to consider; they do not themselves create post-adoption rights. AS 25.23.130(a), (c).

Adoptive-parent identification

☐ The proposed adoptive parent(s) are identified above.

☐ The proposed adoptive parent(s) are not named or otherwise identified in this consent. I voluntarily execute this consent irrespective of disclosure of the name or other identification of the adopting parent.

Tribal-status statement

For AS 25.23.060(a), I state whether the child is a member of an Indian tribe or the biological child of a member of an Indian tribe:

Child is a member of an Indian tribe: ☐ Yes ☐ No

Child is the biological child of a member of an Indian tribe: ☐ Yes ☐ No

Tribe(s), if either answer is yes: [________________________________]

For the separate federal definition in 25 U.S.C. § 1903(4), after determining membership and eligibility with the relevant tribe, select one:

☐ The child is an “Indian child”: unmarried, under 18, and either a tribal member or eligible for membership and the biological child of a tribal member.

☐ The child does not meet that definition. Basis for determination: [________________________________].

Temporary delegation arising from this consent

I understand that AS 25.23.060(c) makes a consent under that section effective as a power of attorney under AS 13.26.066. Unless this form states otherwise, it delegates to the adoptive parent the powers that may be delegated under that section when the child is delivered to the adoptive parent. The power remains effective while the consent remains effective, but no longer than one year unless a court extends it for good cause.

☐ I do not change that statutory delegation.

☐ I specify the following limitation or exclusion of that delegation: [________________________________].

Withdrawal notice and copy received

Select the branch matching the child's status above:

☐ Ordinary Alaska branch: non-Indian child, or a consenting person who is not the parent of an Indian child. Before an adoption decree is entered, I may withdraw this consent within 10 days after I sign it by written notice to the adoption court at the address above or to the person obtaining this consent identified above. The notice is timely if received or postmarked by the last day. After that 10-day period and before a decree, withdrawal requires a court order after notice and opportunity to be heard and a finding that withdrawal is in the child's best interest. After entry of an adoption decree, this consent may not be withdrawn under AS 25.23.070(a)-(b) and Alaska Adoption Rule 9(g).

☐ Parent of an Indian child. Under 25 U.S.C. § 1913(c), I may withdraw consent to voluntary termination or adoptive placement for any reason at any time before a final decree of termination or adoption, by written notice to the court at the address above or the person obtaining consent. Notice is timely if received or postmarked before the decree is signed. After an adoption decree, § 1913(d) permits a parent to petition to vacate it on fraud or duress grounds, subject to that subsection's two-year limit and any other permission under state law. Alaska Adoption Rule 9(h).

I acknowledge receipt of a copy of this completed consent form. I have read the withdrawal notice above before signing.

Adoption hearing notice: ☐ I want notice of its date and time. ☐ I intend to waive notice by filing a separate written notarized waiver with the court under Alaska Adoption Rule 10(b).

Signature and acknowledgment

I sign this consent after the child's birth, voluntarily, in the presence of the court or a person authorized to take acknowledgments as required by AS 25.23.060(a). If I am a parent younger than 18 or I consent to adoption of an Indian child other than on behalf of an agency, I will leave my signature blank until I am in the physical presence of the judge or a duly appointed special master at the hearing under Alaska Adoption Rule 9. For an Indian child, I will not sign until more than 10 days after birth. I affirm the statements in this consent are true.

Consenting person's signature: ________________________________

Printed name: [________________________________]

Date and time signed: [__/__/____] at [____:____] ☐ a.m. ☐ p.m.

Location signed: [________________________________]

Acknowledgment by authorized person (when a court hearing is not required)

State of Alaska, Judicial District: [________________________________]

On [__/__/____], [CONSENTING PERSON NAME] personally appeared before me, proved identity by [IDENTIFICATION METHOD], acknowledged signing this consent voluntarily, and acknowledged receipt of a copy.

Signature of person authorized to take acknowledgments: ________________________________

Printed name and office: [________________________________]

Commission expiration, if applicable: [__/__/____]

Judicial record and certificate (Indian child or minor parent)

For a parent of an Indian child, the consent must be written and recorded before a judge of a court of competent jurisdiction; a notarial acknowledgment alone does not satisfy 25 U.S.C. § 1913(a). Consent signed before or within 10 days after birth is invalid under that subsection. Other consents involving an Indian child, unless given by an agency, must also be signed before a judge under Alaska Adoption Rule 9(b). A parent who is a minor must sign before the court under Alaska Adoption Rule 9(c)(2).

Court and case number: [________________________________]

Date of court-recorded consent: [__/__/____]

I, the judicial officer, certify that the terms and consequences of this consent were fully explained in detail to the consenting person in a language and terms appropriate to the person's age, that the person understood those terms and consequences, and signed voluntarily. For an Indian child, I further certify that the person fully understood the explanation:

☐ In English.

☐ Through an interpretation into [LANGUAGE] by [INTERPRETER NAME].

Judicial officer / duly appointed special master's signature: ________________________________

Printed name and court: [________________________________]

Date: [__/__/____]