Adoption Consent Form - Nevada

SPECIFIC CONSENT TO ADOPTION — NEVADA

Use only for an identified adoption naming the prospective adoptive parent(s). An agency adoption uses a relinquishment to a named child-placing agency under NRS 127C.070. Do not use this form for an Indian child; NRS 127C.330 requires an in-person, on-the-record consent before the court no sooner than 10 days after birth and permits withdrawal before the adoption order.

Complete every required field before signing. Confirm the identity and authority of every person whose consent is required under NRS 127C.230-.240. The child-placing agency should document its NRS 127C.280 disclosures and services separately.

1. Child and identified adoption

Child's name, if any: [________________________________]

Sex: [________________________________]

Date of birth: [__/__/____]

Time of birth: [____:____ ☐ a.m. ☐ p.m.]

Place of birth: [________________________________]

Prospective adoptive parent(s), full legal name(s): [________________________________]

Parent or legal guardian giving this consent, full legal name: [________________________________]

Relationship to child: [________________________________]

Mailing address: [________________________________]

2. Timing and Indian child inquiry

Date and time of signing: [__/__/____ at ____:____ ☐ a.m. ☐ p.m.]

The person signing confirms that at least 72 hours have elapsed since the child's birth. Counsel must review NRS 127C.290(1)(b) and 127C.320(2) before using this form for a parent who did not give birth to the child; this form is drafted for signing after birth.

Do you have reason to know that the child is an Indian child? ☐ Yes ☐ No ☐ Unsure

If Yes or Unsure, stop execution and obtain Nevada adoption counsel's review of NRS 127C.330 and applicable tribal and federal law. If No, the person signing agrees to inform the court immediately if, before entry of the adoption order, information arises giving reason to know that the child is an Indian child. See NRS 127C.290(1)(e).

3. Consent and understanding

I specifically consent to the adoption of the child identified above by the prospective adoptive parent(s) named above. This consent is voluntary. No person has obtained it through fraud, duress, or undue influence.

Effect on parental rights, completed by Nevada adoption counsel after reviewing NRS 127C.080 and the proposed adoption: [________________________________]

I understand that an executed specific consent cannot be revoked or nullified by me under NRS 127C.320(4). That section separately identifies circumstances in which a consent may become invalid, including a timely action based on fraud, duress, or undue influence. This form creates no contractual revocation period or automatic withdrawal option.

I confirm that I have not received money or anything of value in return for the child's placement, this consent, or cooperation in the adoption. Any allowed medical or necessary living expense payment must comply with NRS 127C.900 and may not be contingent on placement or consent.

Information about other parents and legal guardians whose consent may be required: [________________________________]

Child-placing agency and contact, if any: [________________________________]

Agency disclosure record under NRS 127C.280, if applicable: [date, person, and separate record reference: ________________________________]

Placement with prospective adoptive parents must await an approved home study and a valid consent or parental-rights termination order under NRS 127C.820. Signing this form alone does not authorize immediate placement.

4. Signature and acknowledgment

Parent or legal guardian signing:

Signature: _____________________________________

Printed name: [________________________________]

Date and time: [__/__/____ at ____:____ ☐ a.m. ☐ p.m.]

Acknowledgment before judge, court clerk with seal, notary public, or justice of the peace (NRS 127C.290(1)(c)):

State of [______________], County of [______________]. On [__/__/____], [name of signing person] personally appeared before me, proved identity by [________________], and acknowledged signing this specific consent voluntarily.

Signature of authorized acknowledging officer: _____________________________________

Printed name and official capacity: [________________________________]

Official seal, if applicable: [________________________________]

Two competent, disinterested witnesses (NRS 127C.290(1)(f)): Both witnesses subscribe their names in the presence of, or by permitted remote appearance of, the person signing and a notary public. One witness must be a social worker or caseworker employed by an agency listed in NRS 127C.290(1)(f). Counsel must verify any out-of-state remote-witness procedure under subsection (2).

Witness 1 signature: _____________________________________ Date/time: [________________________________]

Printed name: [________________________________] Agency/employer: [________________________________]

Role: ☐ Social worker ☐ Caseworker Agency qualification under NRS 127C.290(1)(f): [________________________________]

Witness 2 signature: _____________________________________ Date/time: [________________________________]

Printed name: [________________________________] Address/contact: [________________________________]

Each witness confirms competence, disinterest, and the required witnessing procedure. Notary present for witness subscriptions: [name and signature: __________________________________]

Counsel and agency completion check

• ☐ Identified adoption and named prospective adoptive parent(s) confirmed.
• ☐ All child identifiers, including sex and time of birth, completed.
• ☐ Required consents or court orders for other parents/guardians reviewed under NRS 127C.230-.240.
• ☐ Birth timing and Indian child inquiry reviewed; separate NRS 127C.330 process used if applicable.
• ☐ NRS 127C.280 agency information and services documented where required.
• ☐ Signer acknowledgment and both qualified, disinterested witness attestations completed.
• ☐ Placement prerequisites under NRS 127C.820 confirmed separately.