Adoption Consent Form - Massachusetts
Written Consent to Adoption and Voluntary Surrender
Before use: Complete this form in triplicate. Do not sign before the fourth calendar day after the child's birth. Sign before a notary in the presence of two competent witnesses; the parent selects one witness. File a copy with the Department of Children and Families. The Massachusetts Court System's official form is also available.
I, as the [RELATIONSHIP TO CHILD] of [CHILD NAME], age [CHILD AGE], of the [CHILD SEX] sex, born in [CHILD PLACE OF BIRTH], on [CHILD DATE OF BIRTH], do hereby voluntarily and unconditionally surrender [CHILD NAME] to the care and custody of [AGENCY OR PERSON RECEIVING CUSTODY] for the purpose of adoption or such other disposition as may be made by a court of competent jurisdiction. I waive notice of any legal proceeding affecting the custody, guardianship, adoption or other disposition of [CHILD NAME].
I UNDERSTAND THAT THIS SURRENDER IS FINAL AND CANNOT BE REVOKED.
Parent signature: ____________________________________
Printed name: [PARENT NAME]
On this [DAY] day of [MONTH], [YEAR], before me personally came and appeared [PARENT NAME] and in my presence duly executed the foregoing instrument, and [he/she/they] acknowledged to me that [he/she/they] executed the same as [his/her/their] free act and deed, fully cognizant of its irrevocability.
Date: [__/__/____]
State of: [STATE]
County of: [COUNTY]
Notary Public: ____________________________________
Commission expires: [__/__/____]
Signed by [PARENT NAME] as [his/her/their] freely executed consent in the presence of each of us, and of each other, who thereafter have hereunto signed our names as witnesses.
Witness 1 signature (selected by parent): ____________________________________
Printed name: [WITNESS 1 NAME]
Address: [WITNESS 1 ADDRESS]
Witness 2 signature: ____________________________________
Printed name: [WITNESS 2 NAME]
Address: [WITNESS 2 ADDRESS]
About this template
- Last updated
- November 4, 2026
- Last reviewed
- November 4, 2026
- Jurisdiction
- Massachusetts
- Category
- Family Law
Family law covers the paperwork that shapes divorce, custody, child support, adoption, guardianship, and other family matters. These filings are emotional and high-stakes, and they also have to meet strict procedural rules for service, financial disclosure, and parenting plans. Clean, accurate paperwork keeps the focus on getting a workable outcome for the family instead of getting derailed by technical problems that delay hearings or force amended filings.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on November 4, 2026.
M.G.L. c. 210, § 2 (checked October 8, 2026): "It shall be attested and subscribed before a notary public in the presence of two competent witnesses, one of whom shall be selected by said person."
M.G.L. c. 210, § 2 (finality) (checked October 8, 2026): "A consent executed in accordance with the provisions of this section shall be final and irrevocable from date of execution."
Massachusetts Court System, Written Consent Pursuant to M.G.L. c. 210, § 2 (checked November 4, 2026): "VOLUNTARY AND UNCONDITIONAL SURRENDER (type or print - complete in triplicate)"
M.G.L. c. 210, § 2 (timing and DCF filing) (checked November 4, 2026): "Such written consent shall be executed no sooner than the fourth calendar day after the date of birth of the child to be adopted."
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