Adoption Consent Form

PARENTAL CONSENT TO ADOPTION

State of Hawaiʻi

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Revocation; Default & Remedies
7. Dispute Resolution & Governing Law
8. General Provisions
9. Execution Block & Notarial Certificate

1. DOCUMENT HEADER

1.1 Title and Parties

This Parental Consent to Adoption (“Consent”) is executed by [NAME OF CONSENTING PARENT] (“Consenting Parent”) in favor of [NAME(S) OF PROSPECTIVE ADOPTIVE PARENT(S)] (“Prospective Adoptive Parent(s)”) regarding [NAME OF MINOR CHILD], born [DATE OF BIRTH] in [PLACE OF BIRTH] (“Child”).

1.2 Recitals

A. Consenting Parent is the [mother/father/legal guardian] of Child and possesses legal authority to consent to adoption pursuant to Hawaiʻi Revised Statutes § 578-2.
B. Prospective Adoptive Parent(s) desire to adopt Child, and placement is scheduled through [NAME OF LICENSED CHILD-PLACING AGENCY/DEPARTMENT] (“Placement Agency”).
C. Consenting Parent, having received all statutorily required counseling and disclosures, now desires to execute this Consent.

1.3 Effective Date & Jurisdiction

This Consent is effective upon the date of notarized signature below (“Effective Date”) and is governed exclusively by the laws of the State of Hawaiʻi. Venue for all proceedings shall lie with the Family Court of the [First/Second/Third/Fifth] Circuit, State of Hawaiʻi (“Family Court”).

2. DEFINITIONS

For purposes of this Consent, the following capitalized terms have the meanings set forth below (terms listed alphabetically):

“Agency” means the licensed child-placing agency or the State of Hawaiʻi Department of Human Services responsible for placement of Child.

“Counseling” means the pre-consent counseling required under Hawaiʻi adoption law, including discussion of alternatives, consequences, and the irrevocable nature of this Consent.

“Placement” means the physical transfer of Child to Prospective Adoptive Parent(s) for purposes of adoption.

“Revocation Period” means the limited period, if any, during which Consenting Parent may revoke this Consent as provided in Section 6.1.

3. OPERATIVE PROVISIONS

3.1 Voluntary Consent

Consenting Parent hereby irrevocably (subject only to Section 6) consents to the adoption of Child by Prospective Adoptive Parent(s) and authorizes Agency and the Family Court to take all actions necessary to effectuate the adoption.

3.2 Timing of Execution

Consenting Parent affirms that:
a. Child has been born; and
b. At least [72] hours have elapsed since Child’s birth.*

3.3 Counseling Certification

Consenting Parent certifies that:
a. Counseling was made available by Agency and conducted on [DATE(S)];
b. All questions were answered to Consenting Parent’s satisfaction; and
c. Execution of this Consent is informed and voluntary.

3.4 Waiver of Further Notice

Consenting Parent waives all further notice of adoption hearings or proceedings regarding Child, except as required by the Family Court.

3.5 Surrender of Parental Rights

Upon the later of Placement or expiration of the Revocation Period (if any), all parental rights, duties, and obligations of Consenting Parent with respect to Child shall be permanently terminated, subject only to entry of a final decree of adoption by the Family Court.

4. REPRESENTATIONS & WARRANTIES

Consenting Parent represents and warrants to Prospective Adoptive Parent(s) and Agency that, as of the Effective Date:

4.1 Legal Authority – Consenting Parent is the sole individual whose consent is required under HRS § 578-2 or has obtained the written consent of all other individuals whose consent is required.
4.2 Absence of Duress – Consent is given freely, knowingly, and voluntarily, without fraud, coercion, or duress.
4.3 No Pending Litigation – No court action or administrative proceeding is pending that would affect the legal status of Child or Consenting Parent’s authority to consent.
4.4 Truthfulness – All statements contained herein and in any related disclosures are accurate and complete.

The foregoing representations survive execution and remain effective until entry of the final decree of adoption.

5. COVENANTS & RESTRICTIONS

5.1 Cooperation – Consenting Parent shall execute such additional instruments and provide testimony as the Family Court may require.

5.2 Confidentiality – Consenting Parent shall keep confidential all identifying information concerning Prospective Adoptive Parent(s), except as permitted by HRS § 578-15 or court order.

5.3 Non-Interference – Consenting Parent shall not interfere with Placement or the adoption process and shall refrain from contacting Child unless expressly authorized in writing by Prospective Adoptive Parent(s) or the Court.

6. REVOCATION; DEFAULT & REMEDIES

6.1 Limited Right of Revocation

Consenting Parent may revoke this Consent only as follows:
a. Written revocation delivered to Agency and filed with the Family Court within [___] days of the Effective Date; or
b. Upon judicial finding of fraud, duress, or material misrepresentation.
After the earlier of Placement or expiration of the Revocation Period, this Consent becomes final and irrevocable except as provided by law.

6.2 Effect of Revocation

If validly revoked, parental rights revert to Consenting Parent, and Prospective Adoptive Parent(s) shall immediately surrender physical custody of Child to Agency unless otherwise ordered by the Court.

6.3 Remedies for Breach

In addition to injunctive relief to enforce permanent placement, any breach of Sections 5.2 or 5.3 entitles Prospective Adoptive Parent(s) and/or Agency to seek:
a. Specific performance;
b. Protective orders; and
c. Recovery of reasonable attorneys’ fees and costs as determined by the Court.

7. DISPUTE RESOLUTION & GOVERNING LAW

7.1 Governing Law – This Consent is governed by, and construed in accordance with, the laws of the State of Hawaiʻi without regard to conflict-of-law principles.

7.2 Forum Selection – The Family Court of the appropriate circuit shall have exclusive jurisdiction over all matters arising from or relating to this Consent.

7.3 Arbitration – Arbitration is not available for adoption matters under Hawaiʻi law; all disputes shall be resolved judicially.

7.4 Jury Waiver – Jury trial is inapplicable to Family Court adoption proceedings; therefore, no jury waiver is required.

7.5 Injunctive Relief – Nothing in this Consent limits the Court’s authority to enter orders ensuring the permanent placement and welfare of Child.

8. GENERAL PROVISIONS

8.1 Entire Agreement – This Consent constitutes the entire agreement of the parties with respect to the subject matter hereof and supersedes all prior or contemporaneous oral or written statements.

8.2 Amendment – Any amendment must be in writing and executed with the same formalities as this Consent.

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 Successors & Assigns – This Consent binds and inures to the benefit of the parties and their respective heirs, legal representatives, and permitted assigns.

8.5 Counterparts & Electronic Signatures – This Consent may be executed in counterparts, each of which is deemed an original, and signatures transmitted electronically or by facsimile are deemed originals for all purposes.

9. EXECUTION BLOCK & NOTARIAL CERTIFICATE

9.1 Signatures

______________________________
[NAME OF CONSENTING PARENT]
Consenting Parent
Date: _________________________

______________________________
[NAME, TITLE]
Authorized Representative, [Placement Agency]
Date: _________________________

9.2 Notary Acknowledgment (State of Hawaiʻi)

State of Hawaiʻi )
____________________ ) SS.
City & County of __________ )

On this ______ day of ______________, 20____, before me appeared __________________________, personally known to me or proved on the basis of satisfactory evidence to be the individual whose name is subscribed to this instrument, and acknowledged that he/she executed the same freely and voluntarily for the purposes herein stated.

________________________________
Notary Public, State of Hawaiʻi
My commission expires: __________