VOLUNTARY CONSENT TO ADOPTION AND PERMANENT RELINQUISHMENT OF PARENTAL RIGHTS

(State of Arizona)

I. DOCUMENT HEADER

1. Effective Date: [DATE]
2. Consenting Parent: [LEGAL NAME], currently residing at [ADDRESS] (“Consenting Parent”).
3. Child: [CHILD’S FULL LEGAL NAME], born on [DATE OF BIRTH] in [CITY], Arizona (“Child”).
4. Prospective Adoptive Parent(s) (optional for private placement): [ADOPTIVE PARENT(S) NAME(S)] (“Adoptive Parent(s)”).
5. Governing Law & Forum: This Consent is governed by the laws of the State of Arizona, including A.R.S. § 8-106, and exclusive jurisdiction lies with the [NAME OF COUNTY] Superior Court, Juvenile Division (“Family Court”).

II. RECITALS

A. Consenting Parent is the [MOTHER/FATHER/LEGAL GUARDIAN] of the Child and possesses full legal authority to execute this Consent.
B. Consenting Parent desires that the Child be adopted by the Adoptive Parent(s) and is willing to relinquish permanently all parental rights.
C. Arizona law requires that such consent be executed in writing, after statutory waiting periods, and with prescribed acknowledgments.

III. DEFINITIONS

The following terms, when capitalized, have the meanings set forth below:

1. “Consent” means this written, signed, and notarized instrument by which Consenting Parent voluntarily and irrevocably relinquishes parental rights, subject only to the limited grounds for withdrawal permitted under Arizona law.
2. “Counseling” means at least three (3) hours of in-person or telephonic professional counseling regarding the surrender of parental rights and the adoption process, available at no cost through licensed providers in accordance with Arizona Department of Child Safety (DCS) policy.
3. “Revocation Challenge” means a petition filed in the Family Court seeking to set aside this Consent on grounds of fraud, duress, or undue influence.

IV. OPERATIVE PROVISIONS

4.1 Grant of Consent

Consenting Parent hereby:

a. Unconditionally consents to the adoption of the Child by the Adoptive Parent(s); and
b. Permanently relinquishes all parental rights, duties, and obligations with respect to the Child, including but not limited to custody, control, visitation, and the right to receive future notices concerning the Child, except as expressly provided by law.

4.2 Effective Timing

a. For Birth Mother: Pursuant to A.R.S. § 8-106(A), this Consent shall not be signed or acknowledged earlier than seventy-two (72) hours after the Child’s birth.
b. For Birth Father / Legal Guardian: This Consent may be executed at any time after the Child’s birth, or at any time before the Child’s birth provided it is re-affirmed in writing no sooner than seventy-two (72) hours after birth.
c. Child Age Twelve (12) or Older: If the Child is twelve (12) years of age or older, the Child’s written consent is required and shall be attached as Exhibit A.

4.3 Irrevocability; Limited Withdrawal

a. Upon execution in compliance with Section 4.2, this Consent is irrevocable.
b. Withdrawal is permitted only by court order upon clear and convincing evidence that the Consent was obtained by fraud, duress, or undue influence (A.R.S. § 8-106).
c. Any Revocation Challenge must be filed within the earlier of (i) six (6) months after entry of the Decree of Adoption or (ii) thirty (30) days after discovery of the alleged fraud, duress, or undue influence.

4.4 Counseling Acknowledgment

Consenting Parent acknowledges:

i. Receipt of written notice of the right to at least three (3) hours of state-funded Counseling;
ii. Opportunity to receive such Counseling prior to execution of this Consent; and
iii. Either (check one):
☐ has completed Counseling on [DATE];   ☐ voluntarily waives Counseling.

V. REPRESENTATIONS & WARRANTIES

Consenting Parent represents and warrants that:

1. Identity, age, and parentage of the Child are as stated herein.
2. No other person’s consent is required for the Child’s adoption, except as disclosed in Schedule 1 attached hereto.
3. Consenting Parent is not under the influence of alcohol, medication, or controlled substances impairing capacity.
4. Consenting Parent has had the opportunity to consult independent legal counsel and is satisfied with such advice or has voluntarily declined it.
5. No promise, inducement, or representation of any kind (including payments or gifts) has been made to procure this Consent, except as permitted by Arizona law and fully disclosed to the Family Court.
6. Execution of this Consent does not violate any court order, guardianship, or custody decree in effect.

The above representations survive execution and are relied upon by the Adoptive Parent(s) and the Family Court.

VI. DEFAULT & REMEDIES

6.1 In the event of a Revocation Challenge, remedies shall be strictly limited to those provided under A.R.S. § 8-106 and applicable Arizona case law.

6.2 The prevailing party in any action relating to the enforcement or validity of this Consent shall be entitled to recover reasonable attorneys’ fees and costs.

VII. DISPUTE RESOLUTION

7.1 Governing Law: State of Arizona.

7.2 Forum: Exclusive jurisdiction and venue in the [NAME OF COUNTY] Superior Court, Juvenile Division.

7.3 Arbitration: Not applicable; statutory court jurisdiction is mandatory.

7.4 Injunctive Relief: Consenting Parent agrees that the Adoptive Parent(s) may seek specific performance or injunctive relief to enforce this Consent and maintain the Child’s placement pending final adjudication.

VIII. GENERAL PROVISIONS

8.1 Entire Agreement. This Consent constitutes the entire understanding with respect to the subject matter and supersedes all prior discussions or writings.

8.2 Amendments. No amendment or waiver of any term of this Consent is valid unless in a written instrument executed with the same formality as this Consent and approved by the Family Court.

8.3 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force to the maximum extent permitted by law.

8.4 Counterparts; Electronic Signatures. This Consent may be executed in counterparts, each of which is deemed an original. Signatures obtained via secure electronic means compliant with A.R.S. § 44-7001 et seq. are valid and binding.

8.5 Successors and Assigns. This Consent is binding upon Consenting Parent and inures to the benefit of the Adoptive Parent(s), their heirs, legal representatives, and assigns.

IX. ACKNOWLEDGMENT AND OATH

I, [NAME OF CONSENTING PARENT], swear or affirm under penalty of perjury under the laws of the State of Arizona that I have read (or had read to me) and understand this entire document, that the facts stated herein are true and correct to the best of my knowledge, and that I execute this Consent freely and voluntarily.

X. EXECUTION BLOCK

CONSENTING PARENT:

______________________________________
Signature of Consenting Parent     Date: ______________
Printed Name: ____________________________________________

NOTARY PUBLIC ACKNOWLEDGMENT
State of Arizona  )
County of ☐ ) ss.

On this _____ day of ____________, 20____, before me, [NAME OF NOTARY], a Notary Public in and for said State, personally appeared [CONSENTING PARENT], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument and acknowledged that (s)he executed the same for the purposes therein contained.

In witness whereof, I hereunto set my hand and official seal.

______________________________________
Notary Public
My Commission Expires: __________________

OPTIONAL: CHILD’S CONSENT (IF AGE ≥ 12)

I, [CHILD’S NAME], being twelve (12) years of age or older, hereby consent to my adoption by the Adoptive Parent(s) identified above.

______________________________________
Child’s Signature      Date

EXHIBITS & SCHEDULES

• Schedule 1: Additional Persons Whose Consent Is Required (if any)
• Exhibit A: Child’s Consent (if applicable)
• Exhibit B: Counseling Certificate (if completed)