Adoption Consent Form - New Hampshire
PARENTAL SURRENDER OF RIGHTS FOR ADOPTION — NEW HAMPSHIRE
| Court | Matter |
|---|---|
| New Hampshire Probate Court, [COUNTY] County | In the Adoption of [CHILD'S BIRTH NAME] |
| Docket number | [__________] |
Parent and child
I, [PARENT'S FULL LEGAL NAME], residing at [ADDRESS, COUNTY, STATE], am the child's [birth mother / legal father / birth father found entitled to surrender under RSA 170-B:6]. The child, [CHILD'S BIRTH NAME], was born on [DATE] at [TIME] in [PLACE]. This surrender is signed on [DATE] at [TIME], at least 72 hours after the child's birth (RSA 170-B:8, I).
The proposed adoption is [pending / contemplated through the department or licensed child-placing agency]. The intended adoptive parent(s) are [NAMES / not disclosed to me]. If an adoption petition is pending, its docket number is [NUMBER].
Voluntary surrender and acknowledgments
I voluntarily surrender my parental rights to this child for the adoption described above. I understand that my parental rights over the child will cease upon the court's approval of this surrender. The surrender will extinguish my parental obligations except accrued unpaid child support; inheritance rights and privileges are governed by RSA 170-B:25, II. Upon a surrender executed under RSA 170-B:9 and approved by the court, my right to notice of future hearings is waived (RSA 170-B:10–:11).
I acknowledge each of the following:
- ☐ I have been informed that child-placing agencies licensed under RSA 170-E offer counseling about the decision to place a child for adoption. [AGENCY / PERSON WHO INFORMED ME] informed me on [DATE]. My decision to use counseling was [DESCRIBE / none].
- ☐ I have been provided independent legal counsel, [COUNSEL NAME], who does not represent the intended adoptive parent or agency; or ☐ the court has approved waiver of counsel for good cause shown, by order dated [DATE].
- ☐ I have received or been promised no money or thing of value for this surrender except payments permissible under RSA 170-B:13. Any such permitted payments are [DESCRIBE / none].
- ☐ The identity of the intended adoptive parent(s) [has / has not] been disclosed to me.
- ☐ To the best of my knowledge, the child [is / is not / may be] an Indian child as defined in the Indian Child Welfare Act. Relevant tribal or ancestry information is [DETAILS].
- ☐ I [do / do not] wish to be notified when a final decree of adoption is entered.
- ☐ I have supplied the court with information on the age and medical and personal backgrounds of the birth parents and child, or the court has waived that requirement for good cause (RSA 170-B:9, III).
I understand that after this surrender is executed in substantial compliance with RSA 170-B:9 it is final except as RSA 170-B:12 permits; a failure to follow any arrangement for later exchange of information or contact does not itself permit withdrawal. A parent seeking withdrawal must notify the court where the surrender was taken in writing before the final decree. The court then holds an evidentiary hearing. Withdrawal requires the court to find both that the surrender was obtained by fraud or duress, proved by a preponderance of the evidence, and that withdrawal is in the child's best interests. No surrender may be withdrawn after the final adoption decree (RSA 170-B:12).
I have read and understand this document. The court or its designee has answered my questions, and I wish this surrender to take effect subject to the court's approval.
Execution in the court's presence
Signed at [PLACE], on [DATE], at [TIME].
Parent: [SIGNATURE]
Printed name: [PARENT'S FULL LEGAL NAME]
Parent's counsel, if represented: [SIGNATURE / NAME / BAR NUMBER]
Assent if the surrendering parent is under 18
The court [does / does not] require the assent of the minor parent's parent(s) or legal guardian under RSA 170-B:9, IV. If required, complete the signatures below.
Assenting parent or guardian: [SIGNATURE / PRINTED NAME / RELATIONSHIP / DATE]
Second assenting parent or guardian, if required: [SIGNATURE / PRINTED NAME / RELATIONSHIP / DATE]
Court approval
This parent signed the surrender in my presence or in the presence of the person or court I designated for good cause under RSA 170-B:9, II. The parent's questions were answered. I [approve / decline to approve] the surrender.
Court or authorized designee: [SIGNATURE / TITLE]
Date and time: [DATE / TIME]
Designation order, if applicable: [DATE / DOCKET REFERENCE]
Sources and references
About this template
- Last updated
- October 6, 2026
- Citations checked
- October 6, 2026
- Jurisdiction
- New Hampshire
- Category
- Family Law
Legal authority
- RSA 170-B:5 (persons required to surrender)
- RSA 170-B:8 (72 hours after birth; counseling availability)
- RSA 170-B:9 (counsel and court-supervised execution)
- RSA 170-B:10 (required contents of surrender)
- RSA 170-B:11 (consequences of approved surrender)
- RSA 170-B:12 (withdrawal of surrender)
Family law covers the paperwork that shapes divorce, custody, child support, adoption, guardianship, and other family matters. These filings are emotional and high-stakes, and they also have to meet strict procedural rules for service, financial disclosure, and parenting plans. Clean, accurate paperwork keeps the focus on getting a workable outcome for the family instead of getting derailed by technical problems that delay hearings or force amended filings.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 6, 2026.
RSA 170-B:5, I (checked October 6, 2026): "Unless excused pursuant to RSA 170-B:7, a surrender of parental rights shall be obtained from: (a) The birth mother"
RSA 170-B:8 (checked October 6, 2026): "No surrender shall be taken until a passage of a minimum of 72 hours after the birth of the child."
RSA 170-B:9, I-II (checked October 6, 2026): "Any parent surrendering parental rights shall be represented by legal counsel who is not representing an intended adoptive parent or the agency, unless such representation is waived with approval of the court for good cause shown."
RSA 170-B:9, II (checked October 6, 2026): "A surrender of parental rights by a parent or guardian shall be executed by an instrument in writing, signed by the parent, in the presence and with the approval of the court of the county in which the parent resides."
Draft your Adoption Consent Form in the editor
Answer a few questions, let the AI editor draft each section from your answers, review it, and download Word and PDF. $99 one time, or $249 per month for every document and every Ezel app.