Adoption Consent Form

PARENTAL CONSENT TO ADOPTION

AND RELINQUISHMENT OF PARENTAL RIGHTS

(State of Indiana)

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; Parties.
Parental Consent to Adoption and Relinquishment of Parental Rights (this “Consent”), executed by:

(a) [Full Legal Name of Birth Mother] (“Birth Mother”); and, if applicable,
(b) [Full Legal Name of Birth Father / Legal Father / Putative Father] (“Birth Father,” and together with Birth Mother, the “Consenting Parent(s)”).

1.2 Child.
This Consent concerns the minor child: [Child’s Full Legal Name] (the “Child”), born on [Date of Birth] in [City, County], Indiana.

1.3 Adoptive Placement.
The Child is to be adopted by [Full Legal Names of Prospective Adoptive Parent(s)] (the “Prospective Adoptive Parent(s)”).

1.4 Effective Date; Governing Law.
This Consent is effective on the date signed below (the “Effective Date”) and is governed by the Indiana Adoption Statute and related Indiana family-law provisions (“Governing Law”).

2. DEFINITIONS

For clarity, capitalized terms used herein have the meanings set forth below. Terms defined in a section shall have the same meaning throughout this Consent unless otherwise stated.

“Court” – the [Name of Indiana Superior/Circuit Court – Family Division] having jurisdiction over the adoption proceeding.

“Counseling” – the pre-consent counseling by a qualified professional made available under Ind. Code §§ 31-19-9-3 & 31-19-16-2.

“Placement” – the physical and legal placement of the Child with the Prospective Adoptive Parent(s) for adoption pursuant to Court order.

“Revocation Event” – a judicial determination of fraud, duress, or lack of capacity as described in Section 6.2.

3. OPERATIVE PROVISIONS

3.1 Consent to Adoption and Relinquishment.
Each Consenting Parent hereby:
(a) irrevocably consents to the adoption of the Child by the Prospective Adoptive Parent(s);
(b) relinquishes forever all parental rights and obligations with respect to the Child, including without limitation rights of custody, visitation, inheritance, and consent to future adoption; and
(c) requests that the Court enter any and all orders necessary to effectuate permanent Placement and adoption of the Child.

3.2 Timing of Execution.
(a) Birth Mother affirms that she is executing this Consent after the Child’s live birth, in compliance with Ind. Code § 31-19-9-2.
(b) Any Birth Father executing this Consent affirms that he is executing on or after the Child’s birth, or if executed earlier, acknowledges that it becomes effective only upon the Child’s birth.

3.3 Consideration.
The consideration for this Consent is the opportunity for the Child to be adopted into a permanent, stable home, together with any authorized expenses paid under Ind. Code § 35-46-1-9.

4. REPRESENTATIONS & WARRANTIES

Each Consenting Parent represents and warrants to the Court and all interested parties that:

4.1 Capacity. He or she is at least eighteen (18) years old, of sound mind, and not under guardianship.

4.2 Voluntariness. This Consent is executed voluntarily, without fraud, duress, coercion, or undue influence.

4.3 Counseling. He or she (i) has received Counseling, or (ii) knowingly and voluntarily waives further Counseling, having been advised of the right thereto.

4.4 No Prior Relinquishment. No previous consent or relinquishment regarding the Child remains outstanding or in effect.

4.5 Accuracy of Information. All information supplied herein and in any accompanying affidavit is true, complete, and correct to the best of his or her knowledge.

4.6 Survival. The representations and warranties in this Section survive the Effective Date and the Child’s adoption.

5. COVENANTS & RESTRICTIONS

5.1 Non-Interference. Each Consenting Parent covenants that he or she will not:
(a) seek to disturb Placement of the Child;
(b) file any proceeding inconsistent with this Consent, except as permitted under Section 6; or
(c) communicate with the Child or Prospective Adoptive Parent(s) except as may be provided in a post-adoption contact agreement approved by the Court.

5.2 Cooperation. Each Consenting Parent shall execute such additional documents and take such further actions as the Court may reasonably require to finalize the adoption.

6. DEFAULT & REMEDIES

6.1 Events of Default.
(a) A Consenting Parent’s breach of Section 5 constitutes an Event of Default.
(b) The discovery of a material false statement in Section 4 constitutes an Event of Default.

6.2 Limited Revocation.
(a) Under Ind. Code ch. 31-19-10, this Consent is irrevocable upon execution except that a Consenting Parent may petition the Court to withdraw consent within thirty (30) days of execution only on grounds of fraud, duress, or lack of capacity (“Revocation Petition”).
(b) Filing a Revocation Petition does not automatically stay Placement; relief is at the Court’s discretion, subject to the Child’s best interests.

6.3 Remedies.
Upon an Event of Default, the Court may grant any remedy available under Governing Law, including but not limited to:
(a) injunctive relief to preserve permanent Placement;
(b) dismissal of any inconsistent filing; and
(c) assessment of attorney fees and costs against the defaulting party.

7. RISK ALLOCATION

7.1 Indemnification. Not applicable.

7.2 Limitation of Liability. Not applicable.

7.3 Force Majeure. Not applicable.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Consent and any dispute arising hereunder are governed by the laws of the State of Indiana, without regard to conflict-of-laws principles.

8.2 Forum Selection. Exclusive jurisdiction and venue lie with the Indiana state family court identified in the adoption proceeding.

8.3 Arbitration. Not available.

8.4 Jury Trial. Family-law matters are heard without a jury pursuant to Indiana trial practice; jury waiver provisions are therefore inapplicable.

8.5 Injunctive Relief. The parties acknowledge that permanent Placement of the Child is paramount and agree that injunctive relief maintaining such Placement is appropriate and does not require posting of a bond.

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Consent constitutes the entire understanding of the parties regarding the subject matter hereof and supersedes any prior agreements or understandings.

9.2 Amendment; Waiver. No amendment or waiver shall be effective unless in writing and approved by the Court.

9.3 Assignment. Rights and obligations hereunder are personal to the Consenting Parent(s) and may not be assigned.

9.4 Severability. If any provision is held invalid, the remainder shall be enforced to the fullest extent permitted.

9.5 Counterparts; Electronic Signatures. This Consent may be executed in counterparts, each of which is deemed an original, and signatures may be exchanged by facsimile, PDF, or any method permitted under Ind. Code § 26-2-8-102 et seq. (Uniform Electronic Transactions Act).

10. EXECUTION BLOCK

10.1 Birth Mother

______________________________________
[Birth Mother Printed Name]

Signature: __________________________________
Date: ______________________________________

State of Indiana )
County of ________) SS:

Subscribed and sworn to before me this ___ day of __________, 20__, by [Birth Mother Name].

______________________________________
Notary Public, State of Indiana
My Commission Expires: ___________________

10.2 Birth Father / Legal Father / Putative Father (if applicable)

______________________________________
[Birth Father Printed Name]

Signature: __________________________________
Date: ______________________________________

State of Indiana )
County of ________) SS:

Subscribed and sworn to before me this ___ day of __________, 20__, by [Birth Father Name].

______________________________________
Notary Public, State of Indiana
My Commission Expires: ___________________

10.3 Acceptance by Prospective Adoptive Parent(s) (Optional but Recommended)

We, [Prospective Adoptive Parent(s)], acknowledge receipt of this Consent and agree to proceed with the adoption in accordance with its terms.

______________________________________ ______________________________________
[Adoptive Parent #1 Printed Name] [Adoptive Parent #2 Printed Name]

Signatures: _________________________ ________________________________
Date: _______________________________ Date: _____________________________