Parental Consent and Relinquishment of Parental Rights for Adoption
(New Hampshire)
[// GUIDANCE: This template is drafted for a voluntary parental consent to adoption under New Hampshire law (RSA 170-B). Customize bracketed fields, remove guidance comments prior to execution, and confirm all statutory citations against the most current official sources before filing.]
TABLE OF CONTENTS
I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block
I. DOCUMENT HEADER
1.1 Title.
Parental Consent and Relinquishment of Parental Rights for Adoption (the “Consent”).
1.2 Parties.
(a) “[BIRTH PARENT NAME]” (“Consenting Parent”);
(b) “[ADOPTION AGENCY/PROSPECTIVE ADOPTIVE PARENTS]” (“Agency/Prospective Parents”); and
(c) “[MINOR CHILD FULL LEGAL NAME], born [DOB] in [CITY, STATE]” (the “Child”).
1.3 Recitals.
A. Consenting Parent is the [biological/legal] parent of the Child.
B. Consenting Parent desires to voluntarily relinquish all parental rights to facilitate the Child’s adoption pursuant to N.H. Rev. Stat. Ann. § 170-B:5 et seq.
C. Agency/Prospective Parents desire to accept such relinquishment subject to the terms herein and subsequent approval by the [NAME OF FAMILY DIVISION OF NH CIRCUIT COURT] (the “Court”).
1.4 Effective Date.
This Consent becomes effective on the date on which it is executed, notarized, and delivered to the Court in accordance with Section III.
1.5 Governing Law.
This Consent shall be governed by and construed in accordance with the laws of the State of New Hampshire, without regard to conflicts-of-law principles.
II. DEFINITIONS
For purposes of this Consent, the following terms shall have the meanings set forth below. Capitalized terms used and not defined herein have the meanings ascribed in applicable statutes.
“Counseling Session” – The pre-consent counseling with a licensed professional or agency authorized under RSA 170-B conducted in accordance with Section III.3.
“Court” – The New Hampshire Circuit Court – Family Division having jurisdiction over the adoption proceeding.
“Revocation Period” – The statutory period during which Consenting Parent may revoke this Consent, ending seventy-two (72) hours after the later of (a) execution of this Consent, or (b) the Child’s birth, as provided in N.H. Rev. Stat. Ann. § 170-B:12.
“Timely Consent Window” – The earliest time at which this Consent may be executed: not earlier than seventy-two (72) hours after the Child’s birth, pursuant to N.H. Rev. Stat. Ann. § 170-B:5, I(a).
III. OPERATIVE PROVISIONS
3.1 Voluntary Relinquishment.
Subject to Section 3.2, Consenting Parent hereby voluntarily and unconditionally:
(a) relinquishes all parental rights, obligations, and privileges with respect to the Child;
(b) consents to the Child’s adoption by the Prospective Parents or such other adoptive parent(s) as the Court may approve; and
(c) waives all further notice of any adoption proceeding regarding the Child, except as mandated by law.
3.2 Timing of Execution.
Consenting Parent affirms that this Consent is executed no earlier than the Timely Consent Window.
3.3 Mandatory Counseling.
Prior to execution, Consenting Parent has participated in at least one Counseling Session conducted on [DATE] by [COUNSELOR NAME/AGENCY] and has received the statutory advisements set forth in N.H. Rev. Stat. Ann. § 170-B:5, V.
3.4 Revocation.
(a) Consenting Parent may revoke this Consent only by delivering a written, notarized revocation to the Court and Agency/Prospective Parents within the Revocation Period.
(b) Absent timely revocation, this Consent becomes final and irrevocable upon expiration of the Revocation Period except upon a judicial finding of fraud or duress.
3.5 Delivery to Court.
Agency/Prospective Parents shall file the original executed Consent with the Court within [5] business days after execution.
IV. REPRESENTATIONS & WARRANTIES
4.1 By Consenting Parent.
(a) Capacity. Consenting Parent is at least eighteen (18) years old or otherwise legally competent to execute this Consent.
(b) Sole Authority. Consenting Parent possesses sole legal authority to consent, or all individuals with legal authority have joined herein.
(c) Voluntariness. This Consent is executed freely, knowingly, and voluntarily, without fraud, duress, or undue influence.
(d) Complete Disclosure. Consenting Parent has disclosed all material information relevant to the Child’s identity, health, and legal status.
4.2 Survival.
The representations and warranties of Consenting Parent survive execution and remain enforceable.
V. COVENANTS & RESTRICTIONS
5.1 Non-Interference.
Consenting Parent shall not initiate or support any action to contest the adoption after the Revocation Period, except as permitted by law for fraud or duress.
5.2 Cooperation.
Consenting Parent shall execute all further instruments and provide testimony reasonably requested to consummate the adoption.
5.3 Confidentiality.
Consenting Parent agrees to maintain confidentiality of identifying information in accordance with RSA 170-B:19.
VI. DEFAULT & REMEDIES
6.1 Events of Default.
Any attempt by Consenting Parent to revoke or challenge this Consent after the Revocation Period, absent statutory grounds, constitutes a default.
6.2 Remedies.
(a) Specific Performance. Agency/Prospective Parents may seek Court enforcement of this Consent.
(b) Injunctive Relief. The Court may grant injunctive relief to preserve the Child’s permanent placement.
(c) Attorneys’ Fees. In any action to enforce this Consent, the prevailing party may recover reasonable attorneys’ fees and costs.
[// GUIDANCE: Attorneys’ fees in NH family matters are discretionary. Omit or tailor Section 6.2(c) to the specific case.]
VII. RISK ALLOCATION
7.1 Indemnification.
Not applicable per Section VII of the metadata; no party assumes indemnity obligations herein.
7.2 Limitation of Liability.
Not applicable.
7.3 Force Majeure.
Performance deadlines herein are extended for events beyond a party’s reasonable control, excluding payment or filing obligations.
VIII. DISPUTE RESOLUTION
8.1 Exclusive Forum.
The parties submit exclusively to the jurisdiction of the Court for all matters arising under this Consent.
8.2 Arbitration.
Arbitration is unavailable for adoption matters under New Hampshire law; any dispute shall be resolved solely by the Court.
8.3 Jury Waiver.
Not applicable—jury trials are not available in the Court for adoption proceedings.
8.4 Injunctive Relief.
Nothing herein limits the Court’s authority to issue orders necessary to ensure the Child’s permanent placement and best interests.
IX. GENERAL PROVISIONS
9.1 Amendments.
This Consent may be amended only by a written instrument signed by all parties and approved by the Court.
9.2 Assignment.
Rights and obligations hereunder are personal and may not be assigned except as ordered or approved by the Court.
9.3 Severability.
If any provision is held invalid, the remaining provisions shall continue in full force to the maximum extent permitted.
9.4 Entire Agreement.
This Consent constitutes the entire agreement among the parties regarding the subject matter and supersedes all prior understandings.
9.5 Counterparts; Electronic Signatures.
This Consent may be executed in counterparts, each deemed an original. Signatures transmitted electronically (e.g., PDF) shall be deemed originals under N.H. RSA ch. 294-E.
X. EXECUTION BLOCK
IN WITNESS WHEREOF, the undersigned have executed this Consent as of the dates written below.
A. Consenting Parent
[BIRTH PARENT NAME]
Date: _____
STATE OF NEW HAMPSHIRE
COUNTY OF _______
On this _ day of _, 20__, before me, the undersigned, personally appeared [BIRTH PARENT NAME], satisfactorily proven to be the person whose name appears above, and acknowledged that he/she executed this Consent as his/her free act and deed.
Notary Public/Justice of the Peace
My Commission Expires: _______
B. Agency / Prospective Adoptive Parent(s)
[If Agency]
[AGENCY NAME]
By: _____
Name: ____
Title: ____
Date: ______
[If Individuals]
_____ _____
[PROSPECTIVE PARENT #1] [PROSPECTIVE PARENT #2]
Date: __ Date: __
C. Court Acceptance
The foregoing Consent is hereby accepted and filed this ___ day of ____, 20__.
Clerk, [NAME OF COURT]
[// GUIDANCE: Attach any required disclosure schedules (e.g., medical history of the Child) as Exhibits. Confirm compliance with RSA 170-B:11 regarding notice to putative fathers, if applicable. Retain originals for court filing and provide certified copies to all parties.]