Adoption Consent Form

PARENTAL CONSENT TO ADOPTION

State of Maine
Family Division of the Maine District Court
Court Docket No.: ___________________

TABLE OF CONTENTS

1. Document Header ............................................... 2
2. Definitions ....................................................... 3
3. Operative Provisions ........................................ 4
4. Representations & Warranties .......................... 6
5. Covenants & Continuing Obligations .................. 7
6. Default & Remedies ......................................... 8
7. Dispute Resolution ............................................ 9
8. General Provisions ............................................ 9
9. Execution & Acknowledgments .......................... 11

1. DOCUMENT HEADER

Parental Consent to Adoption (the “Consent”) made effective as of [EFFECTIVE DATE] (the “Effective Date”) by the undersigned natural parent(s) of the minor child identified below.

A. Child: [CHILD’S FULL LEGAL NAME], born [DOB] at [PLACE OF BIRTH] (the “Child”).
B. Birth Parent(s):

1. [BIRTH MOTHER FULL LEGAL NAME], residing at [ADDRESS] (“Birth Mother”);
 2. [BIRTH FATHER FULL LEGAL NAME] (if applicable), residing at [ADDRESS] (“Birth Father”).
C. Prospective Adoptive Parent(s): [ADOPTIVE PARENT(S) FULL LEGAL NAME(S)], residing at [ADDRESS] (“Prospective Adoptive Parent(s)”).

Recitals
WHEREAS, the Birth Parent(s) are the legal parent(s) of the Child;
WHEREAS, the Prospective Adoptive Parent(s) desire to adopt the Child pursuant to 18-C M.R.S.A. art. 9 (the “Maine Adoption Act”);
WHEREAS, the Maine Adoption Act requires written parental consent executed not sooner than seventy-two (72) hours after the Child’s birth and provides a limited period during which such consent may be revoked; and
WHEREAS, the Birth Parent(s) have been advised of their statutory right to receive adoption counseling and have either received or knowingly waived such counseling in accordance with Section [2.04] below;

NOW, THEREFORE, the Birth Parent(s) hereby consent as follows.

2. DEFINITIONS

For purposes of this Consent, capitalized terms have the meanings set forth below:

“Adoption Act” means Title 18-C of the Maine Revised Statutes, Article 9, as amended.

“Child” has the meaning stated in Section 1(A).

“Consent Effective Date” means the calendar date on which the last Birth Parent executes this Consent before a duly authorized officer described in Section 9(A).

“Counseling” means the statutorily-recognized adoption counseling offered or provided to the Birth Parent(s) in accordance with 18-C M.R.S.A. § 9-[verify current section].

“Court” means the Maine District Court, Family Division, designated in the caption above.

“Revocation Period” means the [5-DAY] period beginning on the Consent Effective Date, during which a Birth Parent may revoke this Consent as set forth in Section 3.03(b).

3. OPERATIVE PROVISIONS

3.01 Grant of Parental Consent

(a) Subject to the terms of this Consent and the Maine Adoption Act, each Birth Parent irrevocably consents to the adoption of the Child by the Prospective Adoptive Parent(s) and to the entry of a Final Decree of Adoption by the Court.
(b) This Consent includes the voluntary relinquishment of all parental rights and duties with respect to the Child, except as may be expressly reserved herein or required by law.

3.02 Timing of Execution

(a) Each Birth Parent affirms that he or she is executing this Consent no earlier than seventy-two (72) hours after the Child’s birth, in compliance with 18-C M.R.S.A. § 9-302(3).
(b) Any execution before the statutory waiting period is void and of no effect.

3.03 Revocation

(a) Each Birth Parent understands that this Consent becomes final and irrevocable upon expiration of the Revocation Period, except as provided by law.
(b) A Birth Parent may revoke this Consent only by delivering a written, dated, and notarized Revocation Notice to the Court before the close of the Revocation Period.
(c) If a timely Revocation Notice is filed, this Consent is null and void ab initio, and the parties shall be restored, insofar as practicable, to their pre-Consent legal positions.

3.04 Counseling

(a) Each Birth Parent acknowledges that he or she:
 (i) has been informed of the right to receive at least three (3) hours of adoption counseling from a duly qualified professional at no cost; and
 (ii) has [RECEIVED / WAIVED] such Counseling.
(b) Evidence of Counseling (or written waiver) shall be attached hereto as Exhibit A and incorporated by reference.

3.05 Conditions Subsequent

This Consent is conditioned on:
(a) the filing of a petition for adoption by the Prospective Adoptive Parent(s) within [X] days after the expiration of the Revocation Period; and
(b) the Court’s finding that the adoption is in the Child’s best interests.

Failure to satisfy the foregoing conditions may be grounds for the Court to set aside this Consent.

4. REPRESENTATIONS & WARRANTIES

Each Birth Parent represents and warrants to the Court and the Prospective Adoptive Parent(s) that:

4.01 Legal Capacity. He or she is at least eighteen (18) years of age, or otherwise has statutory authority to consent, and is legally competent to execute this Consent.

4.02 Voluntariness. This Consent is given freely, knowingly, and voluntarily, without undue influence, coercion, fraud, or duress.

4.03 Full Disclosure. All material information relating to the Child’s health, background, and legal status known to the Birth Parent has been disclosed in writing to the Prospective Adoptive Parent(s).

4.04 No Conflicting Orders. No court has entered any order that would conflict with or prohibit the adoption contemplated herein.

4.05 Counsel. Each Birth Parent has had the opportunity to obtain independent legal counsel of his or her choice and either:
 (a) has consulted with such counsel; or
 (b) knowingly waives the right to counsel.

4.06 Survival

The representations and warranties in this Section 4 survive execution and remain enforceable until entry of the Final Decree of Adoption.

5. COVENANTS & CONTINUING OBLIGATIONS

5.01 Cooperation. Each Birth Parent shall execute any additional documents and shall appear at any Court proceeding reasonably requested to effectuate the adoption.

5.02 Non-Interference. Following expiration of the Revocation Period, the Birth Parent(s) shall not initiate any proceeding to contest or delay the adoption unless expressly permitted by statute.

5.03 Confidentiality. Except as required by law, the parties shall maintain the confidentiality of identifying information, social and medical histories, and Court records relating to this adoption.

6. DEFAULT & REMEDIES

6.01 Default. A “Default” occurs if any representation or covenant of a Birth Parent is materially false or breached, or if this Consent is revoked within the Revocation Period.

6.02 Remedies.
(a) Upon Default, the Court may:
 (i) dismiss or stay the adoption proceeding;
 (ii) order such other relief as justice requires to protect the Child’s best interests.
(b) Attorney Fees. The Court may award reasonable attorney fees and costs against a defaulting party as permitted by 19-A M.R.S.A. § 1501 et seq. or other applicable law.

7. DISPUTE RESOLUTION

7.01 Governing Law. This Consent is governed by, and construed in accordance with, the laws of the State of Maine, including the Maine Adoption Act.

7.02 Venue. Exclusive jurisdiction and venue lie with the Family Division of the Maine District Court identified in the caption above.

7.03 Arbitration. Arbitration is not available for adoption matters under Maine law.

7.04 Jury Waiver. Jury trial is not applicable in adoption proceedings.

7.05 Injunctive Relief. The Court retains continuing jurisdiction to enter any order necessary to secure the Child’s permanent placement and welfare.

8. GENERAL PROVISIONS

8.01 Entire Agreement. This Consent, together with any exhibits, constitutes the entire understanding of the parties with respect to its subject matter and supersedes all prior or contemporaneous oral or written agreements.

8.02 Amendment & Waiver. No amendment or waiver of any provision of this Consent is valid unless set forth in a subsequent writing executed with the same formalities as this Consent and approved by the Court.

8.03 Severability. If any provision of this Consent is held invalid or unenforceable, the remaining provisions remain in full force, and the Court is authorized to reform the document to effectuate the parties’ intent and the Child’s best interests.

8.04 Assignment. Neither this Consent nor any rights hereunder may be assigned by any party, except by operation of law through the entry of the Final Decree of Adoption.

8.05 Successors & Assigns. This Consent is binding upon and inures to the benefit of the parties and their respective heirs, legal representatives, and permitted assigns.

8.06 Counterparts; Electronic Signatures. This Consent may be executed in counterparts, each of which is deemed an original, and all of which constitute one instrument. Signatures transmitted by facsimile or secure electronic means have the same force and effect as original signatures, subject to any additional authentication required by the Court.

9. EXECUTION & ACKNOWLEDGMENTS

A. Parental Execution

I certify under penalty of perjury under the laws of the State of Maine that I have read, understand, and voluntarily sign this Consent on the date indicated below.

B. Witness / Notarial Acknowledgment

STATE OF MAINE )
COUNTY OF __________ ) ss.

On this ____ day of __________, 20__, personally appeared the above-named [BIRTH PARENT NAME(S)], known to me (or satisfactorily proven) to be the person(s) whose name(s) are subscribed to the foregoing instrument, and acknowledged that he/she/they executed the same as his/her/their free act and deed.

________________________________________
Notary Public / Attorney at Law / Judge
Printed Name: __________________________
My Commission Expires: _________________

[Seal]

C. Certificate of Counseling (attach if applicable)

Exhibit A – Counselor’s Affidavit OR Written Waiver of Counseling

End of Document