Adoption Consent Form

PARENTAL CONSENT TO ADOPTION

(State of North Carolina – N.C. Gen. Stat. Chapter 48 Compliant)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Revocation & Remedies
7. Risk Allocation (Intentionally Omitted)
8. Dispute Resolution
9. General Provisions
10. Execution Block & Notarial Certificate

1. DOCUMENT HEADER

Parental Consent to Adoption
Effective Date: [DATE OF EXECUTION]
County of Filing: [COUNTY, NC]

This Parental Consent to Adoption (this “Consent”) is executed by [FULL LEGAL NAME OF CONSENTING PARENT] (“Consenting Parent”) in favor of [FULL LEGAL NAME(S) OF PROSPECTIVE ADOPTIVE PARENT(S), if known] (the “Prospective Adoptive Parent(s)”) with reference to the following facts:

A. The Consenting Parent is the [biological/legal] parent of [CHILD’S FULL LEGAL NAME], born on [DOB] in [PLACE OF BIRTH, COUNTY/STATE] (the “Child”).
B. The Consenting Parent desires to irrevocably* consent to the Child’s adoption in accordance with North Carolina General Statutes Chapter 48.
C. The Consenting Parent acknowledges having been advised of (i) the right to independent legal counsel, (ii) the availability of licensed adoption counseling services, and (iii) the statutory seven-day revocation period.

2. DEFINITIONS

For ease of reference, capitalized terms have the meanings set out below; terms defined in one section have the same meaning throughout:

“Child” – The minor identified in Recital A.
“Consent” – This Parental Consent to Adoption document.
“Consenting Parent” – The parent executing this Consent.
“Effective Date” – The calendar date on which the Consenting Parent signs this Consent.
“Prospective Adoptive Parent(s)” – The individual(s) identified in the header (or “UNKNOWN” if not yet identified at execution).
“Revocation Period” – The statutory seven (7) day period following the Effective Date, excluding the day of execution, during which the Consenting Parent may revoke this Consent pursuant to N.C. Gen. Stat. § 48-3-608(b).

3. OPERATIVE PROVISIONS

3.1 Consent to Adoption.
The Consenting Parent hereby unconditionally and voluntarily consents to the permanent adoption of the Child by the Prospective Adoptive Parent(s), with full knowledge that upon entry of a final decree of adoption all parental rights of the Consenting Parent with respect to the Child will be terminated.

3.2 Identification of Prospective Adoptive Parent(s).
(The Consenting Parent checks one)
☐ The Prospective Adoptive Parent(s) are identified above.
☐ The Prospective Adoptive Parent(s) are UNKNOWN at the time of execution, and placement will be made through [LICENSED AGENCY NAME].

3.3 Consideration.
No monetary consideration or other thing of value, other than payment of pregnancy-related expenses permitted by law, has been promised to or received by the Consenting Parent in exchange for this Consent.

3.4 Timing of Execution.
The Child was born prior to the Effective Date, and this Consent is executed not earlier than the day of birth, as required by N.C. Gen. Stat. § 48-3-603(a).

3.5 Conditions Precedent.
This Consent is conditioned solely upon the entry of a final decree of adoption in the [COUNTY] County District Court, State of North Carolina. No other condition or contingency shall affect its validity.

4. REPRESENTATIONS & WARRANTIES

The Consenting Parent represents and warrants as of the Effective Date that:

4.1 Capacity. The Consenting Parent is at least eighteen (18) years of age and has the legal capacity to execute this Consent.

4.2 Voluntariness. This Consent is executed voluntarily, without coercion, duress, or undue influence.

4.3 Understanding. The Consenting Parent has read or had read to him/her this entire Consent, understands its legal effect, and has been informed of the right to receive legal and counseling services before signing.

4.4 Accurate Information. All information provided herein regarding the Consenting Parent and the Child is true and correct to the best of the Consenting Parent’s knowledge.

4.5 No Conflicting Orders. No court order currently prohibits or restricts the Consenting Parent’s ability to execute this Consent.

5. COVENANTS & RESTRICTIONS

5.1 Future Cooperation. The Consenting Parent shall execute and deliver any additional documents reasonably required to effectuate the adoption.

5.2 Confidentiality. Except as required by law or court order, the Consenting Parent shall keep confidential the identity of the Prospective Adoptive Parent(s) if requested.

6. REVOCATION & REMEDIES

6.1 Statutory Revocation Right.
The Consenting Parent may revoke this Consent within the Revocation Period by delivering written notice of revocation to:
(a) the Prospective Adoptive Parent(s) or their attorney of record; and
(b) if placement is through an agency, the agency named in Section 3.2.
Delivery must be made no later than 5:00 p.m. Eastern Time on the seventh (7th) day following the Effective Date. Notice is effective upon receipt. (N.C. Gen. Stat. § 48-3-608(b)).

6.2 Effect of Revocation.
Upon timely and proper revocation, this Consent shall be void ab initio, parental rights shall revest in the Consenting Parent, and the Child shall be returned promptly to the Consenting Parent unless otherwise ordered by the court.

6.3 Finality.
If not revoked under Section 6.1, this Consent becomes final and irrevocable on the first business day after expiration of the Revocation Period and may thereafter be challenged only on the grounds of fraud or duress as provided in N.C. Gen. Stat. § 48-3-608(d).

6.4 Remedies for Breach.
Any dispute regarding the validity or enforceability of this Consent shall be resolved exclusively by the District Court for [COUNTY] County, North Carolina, sitting as a family court. The court may grant injunctive relief to preserve the Child’s placement and act in the Child’s best interests.

7. RISK ALLOCATION

[INTENTIONALLY OMITTED – indemnification, liability caps, and insurance provisions are not applicable to an adoption consent form.]

8. DISPUTE RESOLUTION

8.1 Governing Law.
This Consent and any dispute arising herefrom shall be governed by and construed in accordance with the laws of the State of North Carolina, without regard to conflict-of-laws principles.

8.2 Forum Selection.
The parties submit to the exclusive jurisdiction of the District Court, [COUNTY] County, North Carolina, sitting as a family court.

8.3 Arbitration.
Arbitration is not available for disputes concerning the adoption of a minor child in North Carolina; therefore, all disputes shall be adjudicated by the court specified in Section 8.2.

8.4 Jury Trial.
Proceedings in North Carolina family court are heard without a jury. The parties expressly acknowledge that no right to jury trial applies.

8.5 Injunctive Relief.
Nothing in this Consent limits the court’s authority to enter injunctive or other equitable relief to secure the Child’s permanent placement.

9. GENERAL PROVISIONS

9.1 Entire Agreement. This Consent constitutes the entire understanding of the parties concerning the subject matter herein and supersedes all prior or contemporaneous agreements or statements.

9.2 Amendments. No amendment or waiver of any provision of this Consent is effective unless in writing and executed with the same formalities as this Consent.

9.3 Assignment. The Consenting Parent may not assign any rights or obligations under this Consent.

9.4 Severability. If any provision of this Consent is held invalid, illegal, or unenforceable, the remaining provisions shall remain in full force and effect to the greatest extent permitted by law.

9.5 Counterparts; Electronic Signatures. This Consent may be executed in counterparts, each of which is deemed an original, and all of which together constitute one instrument. Signatures transmitted by reliable electronic means (including facsimile or PDF) are deemed original signatures.

10. EXECUTION BLOCK & NOTARIAL CERTIFICATE

IN WITNESS WHEREOF, the Consenting Parent has executed this Consent as of the Effective Date.

_______________________________________
[PRINT NAME OF CONSENTING PARENT]
Signature of Consenting Parent

Date of Birth of Consenting Parent: [MM/DD/YYYY]
Residential Address: [STREET, CITY, STATE, ZIP]
Telephone Number: [PHONE]
Email Address (optional): [EMAIL]

NOTARY PUBLIC CERTIFICATE

State of North Carolina
County of [COUNTY]

On this ____ day of ________________, 20____, before me, the undersigned Notary Public, personally appeared [NAME OF CONSENTING PARENT], satisfactorily proven to be the person whose name is subscribed to the foregoing instrument, who acknowledged that he/she executed the same for the purposes therein contained.

Witness my hand and official seal.

_______________________________________
[Signature of Notary Public]
Notary Public, State of North Carolina
My commission expires: ______________

(SEAL)