Adoption Consent Form - Illinois

FINAL AND IRREVOCABLE CONSENT TO ADOPTION

(Illinois Adoption Act, 750 ILCS 50/1 et seq.)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. 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 Birth Parent Rights and Responsibilities-Private Form and the disclosures required under Illinois law 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” – Counseling that the Consenting Parent has the right to request before and after signing this Consent, as described in the Birth Parent Rights and Responsibilities-Private Form referenced in Section 3.4. The Illinois Adoption Act does not condition a valid consent on completion of any minimum number of counseling sessions.

“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 72-hour period immediately following the birth of the Minor Child during which no consent or surrender may be signed under 750 ILCS 50/9(B), as described in Section 3.1.

3. OPERATIVE PROVISIONS

3.1 Timing of Execution (Waiting Period Compliance).
(a) No consent or surrender may be signed within the 72-hour period immediately following the birth of the Minor Child. A consent or surrender signed not less than 72 hours after birth is irrevocable except as provided in 750 ILCS 50/11 (750 ILCS 50/9(A)–(B)).
(b) 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 (750 ILCS 50/9(B)).
(c) If the Consenting Parent is the father, he may execute this Consent not less than 72 hours after the birth, or before the birth; a consent or surrender signed before birth is revoked only if the father gives written notice of revocation within 72 hours after the birth, and is otherwise irrevocable except as provided in Section 11 (750 ILCS 50/9(C)–(D)).

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 is irrevocable unless it was obtained by fraud or duress on the part of the person before whom it is acknowledged or on the part of the Adoptive Parent(s) or their agents, and a court of competent jurisdiction so finds. No action to void or revoke it, including one based on fraud or duress, may be commenced more than twelve (12) months after the date it was executed. Illinois courts require fraud or duress to be proved by clear and convincing evidence.
(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).

3.4 Birth Parent Rights Acknowledgment.
The Consenting Parent affirms that:
(i) he/she was provided a copy of the Birth Parent Rights and Responsibilities-Private Form before signing this Consent and had time to read it, or to have it read to him/her (750 ILCS 50/10(A)); failure to receive any right described in that Form does not constitute a basis to revoke this Consent;
(ii) he/she was advised of the right to request counseling before and after signing this Consent, and of the right to consult independent counsel of his/her own choosing at no cost to the Consenting Parent; and
(iii) a copy of the Birth Parent Rights and Responsibilities-Private Form 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); and
(b) execution and acknowledgment before an officer authorized under 750 ILCS 50/10 (Section 10.1) — for a mother, in open court before a judge or before a representative of a licensed child welfare agency; a mother’s consent may not be taken before a notary public.

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

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 Execution. This Consent may be executed in counterparts, each of which is deemed an original. Electronic transmission of a signature does not dispense with the acknowledgment requirements of 750 ILCS 50/10; the Consent must still be executed and acknowledged before an authorized officer as provided in Section 10.1 (open-court appearances may be conducted by video where the court permits).

10. EXECUTION BLOCK

10.1 Authorized Officer Acknowledgment (750 ILCS 50/9–10).
This Consent must be executed and acknowledged before an officer authorized by the Illinois Adoption Act. A mother’s consent must be taken in open court before a judge, or before a representative of a licensed Illinois child welfare agency; it may not be taken before a notary public. A father may consent in open court or, in the alternative, may sign a Consent and Waiver of Rights before a notary public under 750 ILCS 50/10S.

Executed before:
☐ Judge (in open court) ☐ Licensed child welfare agency representative ☐ Notary public (father’s Consent and Waiver of Rights under 750 ILCS 50/10S only)
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.]