KANSAS PARENTAL CONSENT TO ADOPTION

(Court-Ready Form – Prepared for Use by Kansas-Licensed Attorneys)

[// GUIDANCE: This template is intentionally comprehensive. Practitioners should delete inapplicable provisions before filing. All bracketed text is for attorney customization.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
Exhibit A – Counseling Certificate (Optional/Recommended)

I. DOCUMENT HEADER

1. Title – Parental Consent to Adoption (Kansas).
2. Effective Date – [EFFECTIVE-DATE].
3. Parties
   3.1 “Consenting Parent(s)” – [LEGAL NAME(S)] (“Parent”).
   3.2 “Child” – [CHILD’S FULL LEGAL NAME], born [DATE OF BIRTH].
   3.3 “Prospective Adoptive Parent(s)” – [NAME(S)] (“Adoptive Parents”).
   3.4 “Agency” (if any) – [AGENCY NAME].
4. Recitals
   A. Parent is the biological/legal parent of the Child.
   B. Parent desires to irrevocably consent to adoption of the Child by the Adoptive Parents pursuant to the Kansas Adoption and Relinquishment Act, K.S.A. 59-2111 et seq.
   C. Consideration for this Consent includes, without limitation, (i) the anticipated entry of a Decree of Adoption, and (ii) the best interests of the Child.
5. Governing Law & Venue – This Consent is governed exclusively by Kansas law; exclusive venue lies in the District Court, [COUNTY], Kansas (“Court”).

II. DEFINITIONS

For ease of reference, capitalized terms used herein have the meanings set forth below:

“Act” means the Kansas Adoption and Relinquishment Act, K.S.A. 59-2111 et seq.
“Agency” has the meaning set forth in Section I.3.4.
“Child” has the meaning set forth in Section I.3.2.
“Consent” means this Parental Consent to Adoption.
“Court” has the meaning set forth in Section I.5.
“Parent” or “Consenting Parent” has the meaning set forth in Section I.3.1.
“Revocation Petition” is defined in Section III.4.
[Add additional defined terms as needed.]

III. OPERATIVE PROVISIONS

1. Grant of Consent
   Parent hereby voluntarily and unconditionally consents to the adoption of the Child by the Adoptive Parents and relinquishes all parental rights, privileges, and obligations with respect to the Child, subject only to the Court’s issuance of a final Decree of Adoption.

2. Timing of Execution
   2.1 Parent affirms that this instrument is executed after the Child’s live birth and not sooner than twelve (12) hours thereafter or such later time as may be required under any applicable statute, rule, or court order.
   [// GUIDANCE: Kansas law imposes no statutory “waiting period,” but most judges expect a reasonable post-birth interval. Twelve hours is a commonly-accepted minimum; adjust if local practice differs.]

3. Counseling Requirement
   3.1 Parent acknowledges having been offered counseling by a licensed professional concerning the adoption decision, as contemplated by K.S.A. 59-2114(c).
   3.2 Parent has (check one):
   ☐ received counseling (Certificate attached as Exhibit A)
   ☐ knowingly and voluntarily waived counseling (written Waiver attached).

4. Revocation
   4.1 Under Kansas law, this Consent becomes final, binding, and irrevocable upon execution, subject only to judicial set-aside upon clear and convincing evidence of fraud, duress, or undue influence.
   4.2 Any attempt to revoke shall be by verified motion styled a “Revocation Petition” filed in the Court within thirty (30) days of execution or such other period as the Court may allow on equitable grounds.
   [// GUIDANCE: There is no statutory revocation window in Kansas; Section 4.2 gives practitioners a procedural framework should fraud/duress be alleged.]

5. No Consideration for Consent
   Parent affirms that no money or thing of value, other than statutorily-permitted living or medical expenses, has been paid or promised in exchange for this Consent.

6. Surrender of Custody
   Parent agrees to deliver physical custody of the Child to the Adoptive Parents or Agency immediately upon execution of this Consent, unless the Court orders otherwise.

IV. REPRESENTATIONS & WARRANTIES

1. Parental Status – Parent represents that they are the sole individual whose consent is required, or that all other individuals whose consent is required have executed or will execute similar instruments.
2. Capacity & Voluntariness – Parent is over the age of eighteen (18), is not under the influence of intoxicants, and is acting voluntarily with full understanding of legal consequences.
3. No Pending Litigation – There is no pending litigation or order that would preclude the adoption.
4. Accuracy of Information – All information provided to the Court or Agency concerning the Parent and Child is true, complete, and accurate.
5. Survival – The foregoing representations and warranties shall survive execution and remain enforceable until entry of the Decree of Adoption.

V. COVENANTS & RESTRICTIONS

1. Future Cooperation – Parent shall execute any additional documents reasonably required to effectuate the adoption.
2. Nondisparagement – Parent shall not knowingly disparage the adoption proceedings to any third party in a manner that could materially harm the best interests of the Child.
3. Confidentiality – Parent agrees to maintain confidentiality of identifying information except as required by law.

VI. DEFAULT & REMEDIES

1. Event of Default – A breach of Section V constitutes a default.
2. Remedies – Upon default, the Court may fashion such equitable relief as necessary, including injunctive relief to protect the Child’s best interests and enforcement of confidentiality obligations.
3. Attorneys’ Fees – The prevailing party in any proceeding to enforce this Consent shall be entitled to reasonable attorneys’ fees and costs as determined by the Court.

VII. RISK ALLOCATION

Indemnification provisions and liability caps are inapplicable to this family-law instrument.

VIII. DISPUTE RESOLUTION

1. Governing Law – Kansas law governs.
2. Exclusive Forum – Any dispute shall be heard exclusively by the District Court, [COUNTY], Kansas, sitting as a family court.
3. Arbitration – Arbitration is not available.
4. Jury Trial Waiver – By statute, adoption matters are heard without a jury.
5. Injunctive Relief – The Court retains inherent authority to enter any injunctive or equitable relief necessary to secure the permanent placement and welfare of the Child.

IX. GENERAL PROVISIONS

1. Entire Agreement – This Consent, together with any attachments, comprises the entire agreement of the parties regarding the subject matter hereof.
2. Amendment & Waiver – May be amended only by written instrument executed with the same formality as this Consent and approved by the Court.
3. Assignment – Non-assignable by Parent; binding upon Parent’s heirs, executors, and legal representatives.
4. Severability – Any invalid provision shall not affect remaining provisions, which shall be enforced to the fullest extent permitted by law.
5. Counterparts; Electronic Signatures – This Consent may be executed in counterparts and by electronic signature, each deemed an original.

X. EXECUTION BLOCK

Executed this ___ day of _, 20, in the County of [COUNTY], State of Kansas.

CONSENTING PARENT

[LEGAL NAME], Parent

State of Kansas )
County of ______ ) ss.

On this ___ day of _, 20, before me, a Notary Public in and for said state, personally appeared [LEGAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they executed the same as their free and voluntary act.

Notary Public
My Commission Expires: ______

[// GUIDANCE: K.S.A. 59-2114 permits execution before a district court judge, court-appointed officer, or notary. Adapt acknowledgement accordingly if executed in open court.]

PROSPECTIVE ADOPTIVE PARENT ACKNOWLEDGMENT (Optional)

The undersigned acknowledge receipt of this executed Consent.

[ADOPTIVE PARENT 1] [ADOPTIVE PARENT 2]

EXHIBIT A – COUNSELING CERTIFICATE

(To be completed by licensed counselor/therapist)

I, [COUNSELOR NAME], a licensed [professional title] in the State of Kansas, certify that I provided counseling to [PARENT NAME] concerning the decision to consent to the adoption of [CHILD NAME].
Date(s) of counseling session(s): __
Signature: ____ Date: ___

[// GUIDANCE: File the executed Consent, any Waiver or Counseling Certificate, and the adoption petition together to ensure compliance with local rule checklists.]