PARENTAL CONSENT TO ADOPTION
State of Minnesota
[// GUIDANCE: This template is drafted for use in all Minnesota adoptions (agency, direct-placement, relative, or step-parent). Counsel must tailor bracketed items, choose the correct placement type, and attach any required statutory exhibits (e.g., agency disclosure, ICWA consent).]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants
- Revocation; Default & Remedies
- Dispute Resolution
- General Provisions
- Execution Block
- Notarial Acknowledgment
- Agency / Independent Counselor Certification (if applicable)
- ICWA Addendum (if applicable)
1. DOCUMENT HEADER
1.1 Title. Parental Consent to Adoption and Transfer of Parental Rights.
1.2 Parties.
(a) Consenting Parent(s): [FULL LEGAL NAME(S)], hereinafter “Parent.”
(b) Child: [FULL LEGAL NAME], born [DATE OF BIRTH] in [PLACE OF BIRTH], hereinafter “Child.”
(c) Prospective Adoptive Parent(s): [FULL LEGAL NAME(S)], hereinafter “Adoptive Parent(s).”
(d) Placement Agency (if any): [AGENCY NAME], a Minnesota-licensed child-placing agency (“Agency”).
1.3 Effective Date. This Consent becomes effective on the date it is executed and notarized (“Execution Date”), subject to Section 6 (Revocation).
1.4 Governing Law & Venue. This document is governed by Minn. Stat. § 259.24 et seq. and all other applicable Minnesota adoption laws (“Adoption Act”). Exclusive venue lies in the [NAME OF COUNTY] District Court, Family Division (“Family Court”).
2. DEFINITIONS
For ease of reference, capitalized terms have the meanings set forth below:
“Adoption Act” – Minnesota Statutes chapter 259, including § 259.24.
“Agency Placement” – a placement arranged and supervised by a licensed Agency pursuant to Minn. Stat. § 259.47.
“Direct Placement” – a placement made directly with the Adoptive Parent(s) under Minn. Stat. § 259.47, subd. 2.
“Execution Date” – the calendar date on which Parent signs this Consent before a notary.
“Revocation Period” – the statutory period during which Parent may withdraw Consent under Section 6.
“Working Day” – any day other than a Saturday, Sunday, or Minnesota state holiday.
3. OPERATIVE PROVISIONS
3.1 Grant of Consent. Parent irrevocably grants (subject only to Section 6) consent to the adoption of Child by the Adoptive Parent(s) and transfers all parental rights pursuant to Minn. Stat. § 259.24.
3.2 Nature of Placement. This adoption is:
☐ Agency Placement ☐ Direct Placement ☐ Step-Parent/Relative Adoption
[// GUIDANCE: Check one. Statutory timing and revocation differ.]
3.3 Timing Compliance. Parent affirms that:
(a) Parent is executing this Consent not earlier than seventy-two (72) hours after Child’s birth; and
(b) For Direct Placements, Parent executes within sixty (60) days of Child’s placement with Adoptive Parent(s).
(Minn. Stat. § 259.24, subd. 2.)
3.4 Counseling Acknowledgment.
(a) Parent received at least three (3) hours of pre-consent counseling by a licensed social worker or Agency representative, as required by Minn. Stat. § 259.24, subd. 6.
(b) Parent received the written “Minnesota Adoption Information Sheet” and statutory notice of rights, and had the opportunity to ask questions.
(c) For Direct Placements, the independent licensed counselor’s certificate is attached as Exhibit A.
3.5 No Consideration. Parent affirms no money or thing of value, other than statutorily allowed expenses, was promised or accepted in exchange for Consent.
3.6 Further Assurances. Parent will execute any additional documents reasonably necessary to effectuate the adoption and will appear in court as requested.
4. REPRESENTATIONS & WARRANTIES
Parent represents and warrants to the Adoptive Parent(s) and the Court that, as of the Execution Date:
4.1 Legal Parentage. Parent is the Child’s legal [mother/father] and has sole legal authority to consent, or any non-signing legal parent’s rights have been properly terminated.
4.2 Capacity & Voluntariness. Parent is at least 18 years of age, is of sound mind, not under duress, undue influence, or the effect of controlled substances, and voluntarily executes this Consent.
4.3 Truthfulness. All information supplied to the Agency, Court, and Adoptive Parent(s) is true, complete, and accurate to the best of Parent’s knowledge.
4.4 ICWA Status. ☐ Child is not an “Indian child” under 25 U.S.C. § 1903.
☐ Child may be an “Indian child”; see ICWA Addendum.
4.5 No Conflicting Orders. No court has entered any order that would conflict with this Consent.
[// GUIDANCE: Insert disclosure schedule if any exceptions.]
5. COVENANTS
5.1 Cooperation. Parent shall cooperate with the Agency, Adoptive Parent(s), and the Court to finalize the adoption.
5.2 Confidentiality. Parent shall keep confidential any non-public identifying information concerning the Adoptive Parent(s), except as allowed by Minnesota law or court order.
5.3 Post-Adoption Contact. Any agreement for post-adoption communication must be in a separate, written, court-approved “Post-Adoption Communication Agreement” and is not a condition of this Consent.
6. REVOCATION; DEFAULT & REMEDIES
6.1 Revocation Period. Pursuant to Minn. Stat. § 259.24:
(a) Direct Placement. Parent may revoke for any reason by delivering written notice to the Adoptive Parent(s) within ten (10) working days after the Execution Date.
(b) Agency Placement. Consent is final upon execution and may be withdrawn only by court order upon clear and convincing evidence that Consent was obtained by fraud, duress, or undue influence.
(c) Relative/Step-Parent Adoption. Same revocation rules as Direct Placement unless the court orders otherwise.
6.2 Manner of Revocation. Notice must: (i) be in writing, (ii) identify Child and Parent, (iii) state an unequivocal intent to revoke, and (iv) be delivered by certified mail, return-receipt requested, or personal service, to each party at the addresses in Section 8.4.
6.3 Effect of Revocation.
(a) Timely revocation voids this Consent and restores Parent’s full parental rights.
(b) Late revocation is of no effect absent court action under § 259.24, subd. 6a(c).
6.4 Court Action on Disputes. Any dispute regarding revocation shall be resolved exclusively by the Family Court, which may issue immediate custody or injunctive orders as equity requires.
7. DISPUTE RESOLUTION
7.1 Governing Law. Minnesota law governs all matters arising out of or relating to this Consent.
7.2 Exclusive Venue. Any action, motion, or petition shall be filed in the [NAME OF COUNTY] District Court, Family Division.
7.3 Arbitration & Jury Trial. Arbitration is not available, and jury trial is waived because family-court adoption proceedings are equitable, non-jury matters under Minnesota law.
7.4 Injunctive Relief. The Family Court retains authority to issue any injunctive orders necessary to protect Child’s best interests and effectuate permanent placement.
8. GENERAL PROVISIONS
8.1 Entire Agreement. This Consent constitutes the entire agreement regarding Parent’s consent to adoption, superseding all prior understandings.
8.2 Amendments. No amendment is effective unless in writing, signed by Parent, and approved by the Court.
8.3 Severability. If any provision is declared invalid, the remaining provisions remain enforceable to the fullest extent permitted by law.
8.4 Notices.
Parent Address: [ADDRESS]
Adoptive Parent(s): [ADDRESS]
Agency (if any): [ADDRESS]
Notice is effective upon receipt as evidenced by delivery confirmation.
8.5 Electronic Signatures. Original, facsimile, photocopy, and electronic signatures (including via Minnesota MNCIS e-signature procedures) are deemed originals.
8.6 Counterparts. This Consent may be executed in multiple counterparts, each of which is an original and all of which together constitute one instrument.
9. EXECUTION BLOCK
Executed on this ___ day of _, 20_, at ________, Minnesota.
CONSENTING PARENT
[PRINT NAME], Parent
[// GUIDANCE: If both birth parents are signing, copy block for second parent.]
10. NOTARIAL ACKNOWLEDGMENT
State of Minnesota )
County of _____) ss.
On this ___ day of ____, 20__, before me, a Notary Public in and for said county, personally appeared [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 voluntarily for the purposes therein contained.
Notary Public
My Commission Expires: ____
11. AGENCY / INDEPENDENT COUNSELOR CERTIFICATION
(Complete only if required under Minn. Stat. § 259.24, subd. 6 & 6a.)
I, [NAME], a licensed [social worker/independent counselor] (#__), hereby certify that I provided the counseling required by Minn. Stat. § 259.24 to the Parent on //____; that Parent appeared to understand the consequences of executing this Consent; and that to the best of my knowledge Parent signed voluntarily and free from duress.
Signature of Counselor Date: _____
12. ICWA ADDENDUM (if applicable)
[// GUIDANCE: If Child is or may be an “Indian child,” attach the separate ICWA-compliant consent form meeting 25 U.S.C. § 1913 and Minn. Stat. § 260.765, subd. * et seq. Execution must occur before a judge and meet heightened standards (including 10-day revocation period, recorded colloquy, etc.).]
[// GUIDANCE: Counsel should file the executed Consent, counseling certificate, any ICWA documents, and proof of service with the adoption petition per Minn. R. Adoption P. 7.01. Verify no additional county-specific forms (e.g., social/medical history) are required before submission.]