Adoption Consent Form

STATE OF MICHIGAN

PARENTAL CONSENT AND RELEASE OF PARENTAL RIGHTS FOR ADOPTION

(Michigan Adoption Code, MCL 710.21 et seq.)

TABLE OF CONTENTS

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

1. DOCUMENT HEADER

1.1 Effective Date: [DATE]

1.2 Parties:
 (a) “Consenting Parent” – [FULL LEGAL NAME, ADDRESS, DATE OF BIRTH]
 (b) “Child” – [FULL LEGAL NAME (if known), DATE OF BIRTH, PLACE OF BIRTH]
 (c) “Prospective Adoptive Parent(s)” – [NAME(S), ADDRESS]
 (d) “Adoption Agency” (if applicable) – [NAME, LICENSE #]

1.3 Governing Law: State of Michigan Adoption Code (MCL 710.21 et seq.)

1.4 Forum Selection: Exclusive jurisdiction and venue in the [COUNTY] Probate/Family Division of the Michigan Circuit Court (“Family Court”).

1.5 Recitals
 A. Consenting Parent is the biological/legal parent of the Child.
 B. Consenting Parent desires to permanently relinquish all parental rights and place the Child for adoption, subject to Michigan law.
 C. Prospective Adoptive Parent(s) desire to adopt the Child, and the Adoption Agency (if any) consents to facilitate the placement.
 D. Adequate consideration exists in the form of counseling, statutory disclosures, and the opportunity for judicial review.

2. DEFINITIONS

“Consent” means this executed instrument by which the Consenting Parent voluntarily relinquishes all parental rights to the Child under the Michigan Adoption Code.

“Court” means the Family Court identified in §1.4.

“Counseling” means the statutorily-required pre-execution and post-execution counseling provided to the Consenting Parent in accordance with §3.4.

“Revocation Period” means the statutory period during which the Consenting Parent may, under limited circumstances, revoke this Consent, as set forth in §3.6.

“Placement” means the physical transfer of the Child to the Prospective Adoptive Parent(s) pursuant to an Order of the Court.

3. OPERATIVE PROVISIONS

3.1 Grant of Consent and Release
 (a) Consenting Parent irrevocably (subject only to §3.6) releases, relinquishes, and surrenders to the Adoption Agency and/or Prospective Adoptive Parent(s) all parental rights, including but not limited to legal and physical custody, decision-making authority, and the right to inherit.
 (b) Consenting Parent requests that the Court enter an order terminating Consenting Parent’s rights and approving the Placement and subsequent adoption of the Child.

3.2 Timing of Execution
 (a) This Consent shall not be executed until AFTER the birth of the Child.
 (b) Execution shall occur no sooner than [MINIMUM HOURS] after birth, if the Court or agency imposes a waiting period in its discretion.

3.3 Form of Execution
 Execution must occur in person before a judge or a judge’s designee in accordance with MCL 710.24-710.28, or before an out-of-state equivalent under a duly authenticated procedure if the Consenting Parent is not present in Michigan.

3.4 Mandatory Counseling
 (a) Pre-Execution Counseling: Consenting Parent affirms receiving counseling regarding alternatives to adoption, the legal effect of Consent, and the availability of financial, medical, and other assistance.
 (b) Post-Execution Counseling: Consenting Parent understands that additional counseling services remain available during the Revocation Period.

3.5 Conditions Precedent
 (a) Completion of counseling (§3.4).
 (b) Provision of all required medical and social history forms.
 (c) Judicial determination that Consent is voluntary, informed, and in the Child’s best interests.

3.6 Revocation of Consent
(a) Revocation Window (Out-of-Court Consent): Consenting Parent may revoke this Consent by filing a written, verified revocation with the Court within 5 business days after execution ("Revocation Period") pursuant to MCL 710.29.
(b) Separate TPR Order Challenge: Note that a separate 21-day period applies to filing a motion to set aside a Termination of Parental Rights (TPR) order under MCL 710.64(1). That mechanism is distinct from revocation of an out-of-court consent.
(c) Waiver: Consenting Parent may, after the Child has been placed with Prospective Adoptive Parent(s), execute a separate waiver of the remaining Revocation Period before the Court.
(d) Effect of Revocation: If the Court grants revocation, all parental rights revert to the Consenting Parent subject to any prior abuse/neglect findings.
(e) Finality: Unless revoked under §3.6(a), or set aside for fraud or duress, this Consent becomes permanent and irrevocable upon expiration of the Revocation Period or entry of a final adoption order, whichever occurs first.

3.7 Consideration / Expenses
 Consenting Parent acknowledges receipt of, or entitlement to, reimbursement of reasonable pregnancy-related and adoption expenses as permitted by Michigan law, and that no unlawful payment or inducement has been offered or accepted.

4. REPRESENTATIONS & WARRANTIES

4.1 Consenting Parent represents and warrants that:
 (a) Parentage: Consenting Parent is the biological/legal parent of the Child and has authority to execute this Consent.
 (b) Voluntariness: Consent is given knowingly, voluntarily, and free from duress, fraud, or undue influence.
 (c) Status of Other Parent(s): [CHECK ONE]
  ▢ Other parent’s rights have been terminated.
  ▢ Other parent will execute a separate consent/release.
  ▢ Other parent’s identity/whereabouts are unknown after diligent search.
 (d) No Prior Transfers: No previous irrevocable transfer or consent regarding the Child exists.
 (e) Full Disclosure: Consenting Parent has disclosed all known medical, genetic, and social information truthfully and completely.

4.2 Survival
 The warranties in §4.1 survive execution and remain enforceable by the Prospective Adoptive Parent(s), the Adoption Agency, and the Child (through a guardian ad litem) until final disposition of the adoption proceeding.

5. COVENANTS & RESTRICTIONS

5.1 Cooperation
 Consenting Parent shall cooperate with all reasonable requests to facilitate the adoption, including attendance at hearings and execution of supplemental documents.

5.2 Confidentiality
 Consenting Parent shall maintain the confidentiality of all adoption-related proceedings, except as required by law or court order.

5.3 Contact / Communication
 (a) Closed Adoption (default): No direct or indirect contact with the Child or Prospective Adoptive Parent(s) is permitted unless permitted by a written Post-Adoption Contact Agreement approved by the Court.
 (b) Open Adoption (if selected): Contact terms shall be governed exclusively by the Post-Adoption Contact Agreement attached hereto as Schedule A.

6. DEFAULT & REMEDIES

6.1 Events of Default
 (a) Filing a fraudulent statement in this Consent or related documents.
 (b) Violating confidentiality (§5.2) or contact restrictions (§5.3).

6.2 Notice & Cure
 Written notice of default shall be provided to the defaulting party, who shall have 7 days to cure, unless the Court determines an immediate remedy is in the Child’s best interests.

6.3 Remedies
 (a) Specific Performance or injunctive relief to enforce confidentiality or contact provisions.
 (b) Costs and reasonable attorney fees awarded to the prevailing party in any enforcement action.

7. DISPUTE RESOLUTION

7.1 Governing Law: Michigan law, without regard to conflict-of-laws principles.

7.2 Exclusive Forum: Family Court (§1.4).

7.3 Arbitration: Not available.

7.4 Jury Waiver: Jury trials are not available in adoption proceedings.

7.5 Injunctive Relief: The Family Court retains continuing jurisdiction to impose or modify injunctive relief to safeguard the Child’s best interests, including permanent placement orders.

8. GENERAL PROVISIONS

8.1 Amendments & Waivers
 Must be in writing, signed by all relevant parties, and approved by the Court. A waiver of one provision does not waive any other.

8.2 Assignment
 Rights and obligations under this Consent are non-assignable, except that Prospective Adoptive Parent(s)’ rights transfer automatically to any successor adoptive placement ordered by the Court.

8.3 Severability
 If any provision is held unenforceable, the remainder shall be interpreted to effectuate the parties’ intent and statutory purpose.

8.4 Entire Agreement
 This document, together with any schedules and Court orders, constitutes the complete agreement concerning the relinquishment of parental rights.

8.5 Counterparts; Electronic Signatures
 May be executed in counterparts, each deemed an original. Electronic signatures or remote audio-visual notarization (where permitted) have the same legal effect as wet signatures.

9. EXECUTION BLOCK

9.1 In-Court Execution

Signed and sworn to before me, the undersigned judge/designee, in open court on the Effective Date first written above.

_______________________________
Judge/Referee/Probate Register
[NAME]
[COURT]

9.2 Notarial Execution (Out-of-State or Remote)

State of ____________
County of __________

On this ___ day of __________, 20___, before me, __________________, a Notary Public, personally appeared [CONSENTING PARENT NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument and acknowledged that (s)he executed the same for the purposes therein contained.

_______________________________
Notary Public, State of __________
My Commission Expires: __________
[SEAL]

9.3 Consenting Parent

I hereby execute this Consent and acknowledge that I have read, understand, and agree to all terms herein. I further acknowledge that I have had the opportunity to consult with independent legal counsel.

Signature: ___________________________
Printed Name: ________________________
Date: _______________________________

9.4 Agency Representative (if applicable)

The undersigned licensed child-placing agency representative affirms compliance with all statutory requirements, including counseling confirmation.

Signature: ___________________________
Name & Title: ________________________
Agency License #: ____________________
Date: _______________________________

9.5 Prospective Adoptive Parent(s) Acknowledgment

We acknowledge receipt of this executed Consent and agree to fulfill all obligations imposed herein and by Michigan law.

1. ___________________________________
   Name: _____________________________
   Date: ______________________________

2. ___________________________________
   Name: _____________________________
   Date: ______________________________