Adoption Consent Form - Arizona

CONSENT TO ADOPTION — ARIZONA

1. PERSON GIVING CONSENT

I, [FULL LEGAL NAME], residing at [FULL ADDRESS], give this consent in the following capacity (select one):

☐ Birth or adoptive mother of the child.
☐ Father of the child whose consent is required under A.R.S. § 8-106(A)(2); basis: [________________________________].
☐ Court-appointed guardian of the person of the child, authorized by the appointing court to consent to adoption; court and case number: [________________________________].
☐ Agency or Arizona Department of Child Safety with legal authority to place the child; basis and case number: [________________________________].
☐ Guardian of an adult parent for whom a guardian is appointed; authority and case number: [________________________________].

My authority to give this consent is described in the attached order or record, if applicable: [________________________________]. Other persons whose consent may be required are identified in the attached schedule: [________________________________].

2. CHILD AND TIMING

Child's full name: [________________________________]

Date and time of birth: [__/__/____] [____:____]

Place of birth: [________________________________]

Date and time this consent is signed: [__/__/____] [____:____]

I understand that a consent given before 72 hours after the child's birth is invalid under A.R.S. § 8-107(B). If the child is age 12 or older, the child's separate consent must be given in open court under A.R.S. § 8-106(A)(3); this document does not replace that consent.

3. PLACEMENT DESIGNATION

I consent to adoption of the identified child and designate one of the following under A.R.S. § 8-107(D):

☐ Particular adoptive person or persons: [FULL TRUE NAME(S)] of [FULL ADDRESS(ES)] are authorized to adopt the child.

☐ Agency or Arizona Department of Child Safety: [NAME AND ADDRESS] is authorized to place the child for adoption.

If fictitious adoptive names are used, I additionally state that the adopting person or persons are currently certified as acceptable to adopt the child; I know these names are fictitious, do not wish to know the true names, and have been furnished all information I wish to know about them. Description of information furnished: [________________________________].

I understand that a consent to a person other than an agency or the division is invalid if it neither identifies particular adoptive persons nor instead purports to let a third person locate or nominate them (A.R.S. § 8-107(G)).

4. REQUIRED ACKNOWLEDGMENTS

Effect of adoption decree. I understand that, on entry of a decree of adoption, the parent-child relationship and its legal rights and duties arise between the adoptive parent and child. The prior parent-child relationship and its legal consequences are severed, including inheritance rights, subject to the statutory exceptions for communication rights and adoption by a parent's spouse (A.R.S. § 8-117). This consent alone is not an adoption decree.

Irrevocability. I understand that this consent is irrevocable unless it was obtained by fraud, duress, or undue influence (A.R.S. § 8-106(D)).

Compensation. I understand that direct or indirect compensation for giving or obtaining consent to place a child for adoption is prohibited except for expenses permitted under A.R.S. § 8-114. Payments or promised payments, if any: [________________________________].

I have read this consent or had it read to me. I understand it and give it voluntarily.

5. SIGNATURE

Signature of person giving consent: ______________________________________

Printed name: [________________________________]

Date and time: [__/__/____] [____:____]

Complete one of the following signing methods under A.R.S. § 8-107(A).

Option A — Two adult witnesses

We are each at least 18 years old, witnessed the signing of this consent, and subscribed our names in the presence of the person giving consent.

Option B — Notarial acknowledgment

State of Arizona, County of [________________]

The person named above acknowledged this consent before me on [__/__/____]. Identity was established by [________________________________].

Notary signature: ______________________________________

Printed name and title: [________________________________]

Commission expiration: [__/__/____]

[NOTARIAL SEAL]

6. FILING ITEMS

For a birth parent in an agency, division, or attorney-assisted direct placement, complete the separate notarized original-birth-certificate acknowledgment and contact preference form required by A.R.S. § 8-106(E). For a mother, the notarized potential-fathers affidavit required by § 8-106(F) is a separate filing. Attach court authority or other supporting records as applicable.

SOURCES

A.R.S. § 8-106 · A.R.S. § 8-107 · A.R.S. § 8-117 · A.R.S. § 8-114