PARENTAL CONSENT AND RELINQUISHMENT FOR ADOPTION
State of Nebraska
[// GUIDANCE: This template is drafted for use in the State of Nebraska (“NE”). Practitioners must review the current version of the Nebraska Revised Statutes, Chap. 43, Art. 1, and all applicable court rules before finalizing. Nebraska’s adoption statutes are highly specific; failure to comply exactly will jeopardize the validity of the consent.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Recitals
- Operative Provisions
- Representations & Warranties
- Covenants
- Revocation & Withdrawal of Consent
- Default & Remedies
- Dispute Resolution
- General Provisions
- Execution Block
- Acknowledgment & Notarization
1. DOCUMENT HEADER
1.1 Title
Parental Consent and Relinquishment of Parental Rights for Adoption
1.2 Parties
a. “[FULL LEGAL NAME OF CONSENTING PARENT]”, an individual (“Consenting Parent”).
b. “[FULL LEGAL NAME(S) OF PROSPECTIVE ADOPTIVE PARENT(S)]” (collectively, “Prospective Adoptive Parent(s)”).
c. “[ADOPTION AGENCY / ATTORNEY / GUARDIAN AD LITEM]” (“Placement Entity”), if applicable.
d. “[FULL LEGAL NAME OF CHILD]”, a minor born on [DATE OF BIRTH] in [CITY/COUNTY], Nebraska (the “Child”).
1.3 Effective Date
This Consent becomes effective on the date it is signed and notarized in accordance with Section 11, provided that such date is not earlier than forty-eight (48) hours after the Child’s birth.
[// GUIDANCE: NE law prohibits execution of a parental relinquishment prior to 48 hours after birth.]
1.4 Governing Law & Venue
This Consent is governed by the laws of the State of Nebraska. Exclusive jurisdiction and venue lie with the [NAME OF COUNTY] County Court, Juvenile Division (the “Court”).
2. DEFINITIONS
The following terms have the meanings set forth below. Capitalized terms used but not defined have the meanings assigned elsewhere in this Consent.
“Agency Placement” – A placement facilitated by a licensed child-placing agency.
“Independent Placement” – A placement arranged directly between the Consenting Parent and the Prospective Adoptive Parent(s), with or without an attorney or intermediary.
“Counseling” – Pre-consent counseling by a qualified professional covering legal, emotional, and financial implications of relinquishment, and confirming voluntariness of consent.
“Consent” – This Parental Consent and Relinquishment for Adoption, as executed and acknowledged.
“Revocation Period” – The limited period, if any, during which the Consenting Parent may revoke this Consent, as set forth in Section 7.1.
“Placement Entity” – The licensed child-placing agency or attorney facilitating the adoption, if any.
3. RECITALS
WHEREAS, the Consenting Parent is the [mother/father] and legal custodian of the Child;
WHEREAS, the Consenting Parent desires to relinquish permanently all parental rights to, and place the Child for adoption with, the Prospective Adoptive Parent(s);
WHEREAS, Nebraska law requires written, notarized parental consent executed not sooner than forty-eight (48) hours post-partum and delivered to the Court;
WHEREAS, Nebraska law mandates that the Consenting Parent receive statutorily required Counseling before executing this Consent; and
WHEREAS, the parties desire to memorialize the Consenting Parent’s voluntary relinquishment and the related terms herein.
NOW, THEREFORE, in consideration of the mutual promises and benefits contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:
4. OPERATIVE PROVISIONS
4.1 Voluntary Relinquishment. The Consenting Parent hereby absolutely and irrevocably relinquishes all parental rights, duties, and obligations with respect to the Child, including but not limited to custody, visitation, control, support, inheritance, and any other legal rights accorded to a parent under Nebraska law.
4.2 Grant of Authority to Court. The Consenting Parent authorizes the Court to (a) accept this Consent; (b) terminate the Consenting Parent’s parental rights; and (c) enter all orders necessary to finalize the adoption.
4.3 Appointment of Placement Entity (If Applicable). The Consenting Parent appoints the Placement Entity to act on his/her behalf for the limited purpose of filing this Consent and facilitating the adoption, including disclosure of medical and social history as required by NE law.
4.4 Consideration. The Consenting Parent acknowledges receipt of:
a. Statutorily permitted living expenses totaling $[AMOUNT];
b. Counseling as required by Section 6.1; and
c. No other compensation or inducement.
[// GUIDANCE: Direct or indirect payments beyond living expenses violate NE law; confirm compliance.]
4.5 Conditions Precedent. This Consent is conditioned upon:
a. Completion of Counseling (Section 6.1);
b. Execution no sooner than forty-eight (48) hours after the Child’s birth; and
c. Proper notarization and filing with the Court within [NUMBER] days of execution.
5. REPRESENTATIONS & WARRANTIES
The Consenting Parent represents and warrants that:
5.1 Legal Capacity. He/she is of legal age, sound mind, and not under the influence of drugs or alcohol impairing judgment.
5.2 Sole Parental Rights. No other individual has legal parental rights to the Child except as disclosed in Schedule A.
5.3 No Duress or Fraud. This Consent is executed voluntarily, without coercion, fraud, or undue influence.
5.4 Complete Disclosure. All medical and social history provided is true, complete, and accurate to the best of the Consenting Parent’s knowledge.
5.5 No Prior Revocation. No prior consent concerning the Child remains outstanding or unrevoked.
Survival. The representations and warranties in this Section 5 survive execution and remain enforceable.
6. COVENANTS
6.1 Counseling Requirement. Prior to signing, the Consenting Parent shall receive Counseling by [QUALIFICATIONS OF COUNSELOR] covering:
i. Legal consequences of adoption;
ii. Irrevocability (subject to Section 7);
iii. Available alternatives, including parenting and guardianship; and
iv. Community resources for post-adoption support.
6.2 Delivery of Original Consent. The Placement Entity or counsel for Prospective Adoptive Parent(s) shall file the original Consent with the Court within [NUMBER] days after execution.
6.3 Future Contact & Communication. Except as may be provided in a separate, legally unenforceable post-adoption contact agreement, the Consenting Parent agrees not to contact the Child or Prospective Adoptive Parent(s) in a manner inconsistent with orders of the Court.
[// GUIDANCE: Nebraska treats open adoption agreements as moral, not legally binding. Insert custom language if desired.]
7. REVOCATION & WITHDRAWAL OF CONSENT
7.1 Statutory Revocation Period.
[SELECT ONE OPTION & DELETE THE OTHER PRIOR TO EXECUTION]
Option A – No Revocation: Under current Nebraska law, this Consent becomes irrevocable upon execution and filing, unless the Court later finds that it was obtained by fraud or duress.
Option B – Limited Revocation: The Consenting Parent may revoke this Consent within [NUMBER] days after execution by delivering a written, notarized revocation to the Court and each party hereto.
[// GUIDANCE: Confirm the exact statutory revocation parameters in effect at the time of signing; NE law traditionally allows revocation only for fraud or duress.]
7.2 Procedure for Revocation (if applicable). A revocation must (a) identify the Child, (b) reference this Consent, and (c) be filed with the Court before the expiration of the Revocation Period. Timely revocation voids this Consent ab initio.
7.3 Effect of Revocation. Upon effective revocation, custody of the Child shall revert to the Consenting Parent unless the Court orders otherwise in the Child’s best interest.
8. DEFAULT & REMEDIES
8.1 Events of Default. The following constitute default under this Consent:
a. False or materially misleading representations (Section 5);
b. Failure to deliver required documentation;
c. Any attempt to transfer custody of the Child contrary to Court order.
8.2 Remedies. Upon default, the Court may:
a. Void this Consent in whole or in part;
b. Issue injunctive relief to maintain or restore custody;
c. Award attorney fees and costs; and/or
d. Impose any additional remedy available under Nebraska law.
9. DISPUTE RESOLUTION
9.1 Governing Law. Nebraska law governs all disputes arising under this Consent.
9.2 Exclusive Forum. Any proceeding shall be filed in the [NAME OF COUNTY] County Court, Juvenile Division.
9.3 Arbitration. Arbitration is not available for matters concerning child custody or adoption.
9.4 Jury Waiver. Jury trials are not available in Nebraska juvenile matters.
9.5 Injunctive Relief. The Court retains authority to issue injunctive or other equitable relief to enforce permanent placement of the Child.
10. GENERAL PROVISIONS
10.1 Entire Agreement. This Consent constitutes the entire agreement among the parties regarding relinquishment and supersedes all prior communications.
10.2 Amendment & Waiver. No amendment or waiver is effective unless in writing, signed, notarized, and approved by the Court.
10.3 Severability. If any provision is held invalid, the remaining provisions remain enforceable to the fullest extent permitted by law.
10.4 Successors & Assigns. This Consent binds the Consenting Parent and inures to the benefit of the Child and Prospective Adoptive Parent(s).
10.5 Counterparts; Electronic Signatures. This Consent may be executed in counterparts, each deemed an original, and may be signed electronically if permitted by the Court.
11. EXECUTION BLOCK
IN WITNESS WHEREOF, the Consenting Parent executes this Consent on the date indicated below.
[PRINTED NAME OF CONSENTING PARENT]
Consenting Parent
Date: ___ / ___ / 20___
[PRINTED NAME OF WITNESS 1]
Witness
Date: ___ / ___ / 20___
[PRINTED NAME OF WITNESS 2]
Witness
Date: ___ / ___ / 20___
[// GUIDANCE: Nebraska generally requires the signature to be witnessed by at least one disinterested adult and notarized. Confirm local practice.]
12. ACKNOWLEDGMENT & NOTARIZATION
State of Nebraska )
County of __ ) ss.
On this ___ day of _, 20, before me, a Notary Public duly commissioned and qualified in and for said county, personally appeared _____, known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same as a free and voluntary act for the purposes therein stated.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal the day and year last above written.
Notary Public
My commission expires: ___
SCHEDULE A
(Other Persons With Potential Parental Rights)
[Describe or write “None.”]
[// GUIDANCE SUMMARY:
• 48-Hour Rule: Section 1.3 enforces statutory timing for execution.
• Counseling: Section 6.1 mandates pre-consent counseling.
• Revocation: Section 7 offers selectable language—update to reflect current statute.
• Ensure court-specific procedural rules (filing deadlines, number of witnesses) are confirmed before use.]