FINAL AND IRREVOCABLE CONSENT TO ADOPTION
(Illinois Adoption Act, 750 ILCS 50/1 et seq.)
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title.
Final and Irrevocable Consent to Adoption (the “Consent”).
1.2 Parties.
(a) “[CONSENTING PARENT NAME]”, an individual residing at [ADDRESS] (the “Consenting Parent”);
(b) “[ADOPTIVE PARENT(S) NAME(S)]”, an individual/married couple residing at [ADDRESS] (the “Adoptive Parent(s)”); and
(c) “[CHILD’S NAME]”, born [DATE OF BIRTH] in [PLACE OF BIRTH] (the “Minor Child”).
1.3 Effective Date.
This Consent is effective as of the date it is executed and acknowledged before a legally authorized person (the “Effective Date”), provided the timing requirements of Section 3.1 are satisfied.
1.4 Governing Law & Forum.
This Consent shall be governed by, and construed in accordance with, the Illinois Adoption Act, 750 ILCS 50/1 et seq., and any applicable Illinois regulations. Exclusive jurisdiction for any proceeding arising under or relating to this Consent lies in the [COUNTY] Circuit Court, Family Division of the State of Illinois (the “Family Court”).
1.5 Recitals.
WHEREAS, the Consenting Parent is the [biological/legal] parent of the Minor Child and desires to relinquish all parental rights to facilitate the adoption of the Minor Child by the Adoptive Parent(s); and
WHEREAS, the Adoptive Parent(s) desire to adopt the Minor Child; and
WHEREAS, the Consenting Parent has received the statutorily-required counseling and disclosures and now wishes to give final and irrevocable consent as permitted by Illinois law;
NOW, THEREFORE, in consideration of the mutual promises and undertakings herein, the parties agree as follows:
2. DEFINITIONS
For purposes of this Consent, capitalized terms have the meanings set forth below. Terms used in the singular include the plural and vice-versa as the context requires.
“Agency” – The Illinois-licensed child welfare agency or adoption intermediary identified in Section 10.3, if any, facilitating placement of the Minor Child.
“Counseling” – The pre-consent counseling provided to the Consenting Parent in compliance with Section 6(D) of the Illinois Adoption Act and referenced in Section 3.4 below.
“Revocation Period” – The limited statutory period, if any, during which this Consent may be withdrawn under Illinois law, as described in Section 3.3.
“Waiting Period” – The minimum 72-hour period (or any longer period prescribed by law) after the birth of the Minor Child that must elapse before a birth mother may execute this Consent, as described in Section 3.1.
3. OPERATIVE PROVISIONS
3.1 Timing of Execution (Waiting Period Compliance).
(a) If the Consenting Parent is the birth mother, she affirms that (i) the Minor Child was born on [DATE], and (ii) at least 72 hours have elapsed between the time of birth and the execution of this Consent, satisfying 750 ILCS 50/10.
(b) If the Consenting Parent is not the birth mother, he/she confirms that Illinois law permits execution of this Consent at any time after the birth of the Minor Child.
3.2 Grant of Consent.
Subject to the terms herein, the Consenting Parent hereby unconditionally:
(i) surrenders the Minor Child to the Adoptive Parent(s) for purposes of adoption;
(ii) consents to the entry of a Judgment of Adoption in favor of the Adoptive Parent(s); and
(iii) relinquishes and terminates all parental rights, privileges, duties, and obligations with respect to the Minor Child, including the right of inheritance, effective upon entry of the Judgment of Adoption.
3.3 Revocation.
(a) This Consent is intended to be final and irrevocable. Under 750 ILCS 50/11(a), it may be challenged only by clear and convincing evidence of fraud or duress and only if a petition is filed within twelve (12) months after the execution of this Consent.
(b) The Consenting Parent expressly waives any statutory revocation period that may apply to revocable surrenders and acknowledges the narrow grounds for withdrawal described in subsection (a).
[// GUIDANCE: Counsel should confirm whether any agency-specific revocation period or Safe Haven Act surrender applies in addition to Section 11(a).]
3.4 Counseling Acknowledgment.
The Consenting Parent affirms that:
(i) he/she has been offered no fewer than three (3) counseling sessions by a counselor meeting the qualifications set forth in 750 ILCS 50/6, at no charge;
(ii) at least one counseling session was completed prior to signing, or a written waiver of counseling was voluntarily executed; and
(iii) the counselor furnished the required written statement of completion or waiver, a copy of which is attached hereto as Exhibit A.
3.5 Consideration.
No financial consideration other than reasonable medical, legal, and counseling expenses authorized by Illinois law has been or will be paid to the Consenting Parent in exchange for this Consent.
3.6 Conditions Precedent.
The effectiveness of this Consent is expressly conditioned upon:
(a) compliance with the Waiting Period (Section 3.1);
(b) completion of Counseling (Section 3.4); and
(c) execution before a judge, clerk, or other statutorily authorized officer.
4. REPRESENTATIONS & WARRANTIES
The Consenting Parent represents and warrants that:
4.1 Authority. He/she is the sole individual whose consent is required or, if another parent’s rights exist, that parent’s consent or lawful termination has already occurred or will occur contemporaneously.
4.2 No Pending Litigation. No court has issued any order affecting custody of the Minor Child that would prevent adoption.
4.3 Voluntariness. This Consent is executed voluntarily, without fraud, coercion, or duress.
4.4 Full Disclosure. The Consenting Parent has (i) read and understands this Consent, or it has been read to him/her in a language he/she understands, and (ii) had the opportunity to seek independent legal advice.
4.5 Accuracy of Information. All information provided to the Agency and Adoptive Parent(s) regarding the Minor Child’s medical, social, and familial history is accurate to the best of the Consenting Parent’s knowledge.
The above representations and warranties survive execution and extend to the entry of any Judgment of Adoption.
5. COVENANTS & RESTRICTIONS
5.1 Future Cooperation. The Consenting Parent shall execute any additional documents reasonably requested by the Adoptive Parent(s) or Agency to effectuate the adoption.
5.2 Confidentiality. The Consenting Parent agrees to maintain the confidentiality of all identifying information of the Adoptive Parent(s), except as otherwise permitted by Illinois law or court order.
5.3 Non-Interference. The Consenting Parent shall not interfere with the custody or placement of the Minor Child following execution of this Consent.
6. DEFAULT & REMEDIES
6.1 Event of Default. Any material breach of the covenants in Section 5 constitutes a default.
6.2 Remedies. In addition to any remedies available at law or in equity, the non-breaching party may seek:
(a) injunctive relief preventing interference with placement;
(b) costs and reasonable attorneys’ fees incurred in enforcing this Consent; and
(c) any other relief deemed just and proper by the Family Court.
7. RISK ALLOCATION
[// GUIDANCE: The metadata indicates indemnification and liability caps are not applicable. The following section is intentionally limited.]
7.1 No Indemnification or Liability Limitation. Each party bears its own risk and liability arising from or related to this Consent, except as expressly provided in Section 6.2.
8. DISPUTE RESOLUTION
8.1 Governing Law. Illinois law governs all matters arising under this Consent.
8.2 Exclusive Forum. Any dispute shall be brought exclusively in the Family Court identified in Section 1.4.
8.3 Arbitration & Jury Trial. Adoption matters are not subject to arbitration, and jury trials are unavailable in the Family Court.
9. GENERAL PROVISIONS
9.1 Entire Agreement. This Consent, together with any attached exhibits, constitutes the entire agreement of the parties regarding its subject matter and supersedes all prior understandings.
9.2 Amendment & Waiver. No amendment or waiver is effective unless in writing and signed by the Consenting Parent and approved by the Family Court.
9.3 Assignment. None of the rights or obligations hereunder may be assigned by the Consenting Parent.
9.4 Severability. If any provision is held invalid, the remainder shall be enforced to the fullest extent permitted by law.
9.5 Counterparts & Electronic Signatures. This Consent may be executed in counterparts, each of which is deemed an original. Signatures transmitted by electronic means hold the same force as originals, subject to Illinois Supreme Court Rule 9.
10. EXECUTION BLOCK
10.1 Authorized Officer Acknowledgment.
Executed before:
☐ Judge ☐ Clerk of Court ☐ Notary Public ☐ Other Authorized Officer: [SPECIFY]
on the ___ day of _, 20, at [CITY], Illinois.
10.2 Consenting Parent
[CONSENTING PARENT NAME]
Date: ________
10.3 Agency Representative (if applicable)
[AGENCY NAME] – Authorized Representative
Title: _____
Date: _____
10.4 Adoptive Parent(s)
(a) _____
[ADOPTIVE PARENT #1 NAME]
Date: ________
(b) _____
[ADOPTIVE PARENT #2 NAME] (if applicable)
Date: ________
10.5 Acknowledgment by Authorized Officer
State of Illinois )
County of [__] ) ss.
I, ____, a duly authorized officer, certify that the Consenting Parent personally appeared before me, was identified by satisfactory evidence, acknowledged the execution of this Consent, and affirmed the representations herein.
Signature of Officer
Title: _____
Commission Expires: ____
Exhibit A – Counseling Statement / Waiver
[Attach certified statement of counselor confirming completion of or voluntary waiver from counseling.]
[// GUIDANCE:
1. Review statutory form requirements in 750 ILCS 50/10 for any mandatory language that must appear verbatim.
2. Confirm court-specific formatting rules (e.g., caption requirements) before filing.
3. Attach all required statutory notices (e.g., “Important Notice to Parent”) if adoption is facilitated through DCFS or an agency.
4. Ensure that any payments to the birth parent comply with 720 ILCS 5/12C-60 (prohibition on baby-selling) and that expense affidavits are prepared for court submission.
]