PARENTAL CONSENT TO ADOPTION AND WAIVER OF PARENTAL RIGHTS

State of Nevada

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation (Intentionally Omitted)
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1. Parties
   1.1 “[Birth Parent]” means [FULL LEGAL NAME OF BIRTH PARENT], residing at [ADDRESS].
   1.2 “[Child]” means [CHILD’S FULL LEGAL NAME], born [DATE OF BIRTH] in [CITY/COUNTY], Nevada.
   1.3 “[Prospective Adoptive Parent(s)]” means [FULL LEGAL NAME(S)], residing at [ADDRESS].
   1.4 “[Placement Agency]” (if applicable) means [AGENCY NAME], a Nevada-licensed child-placing agency.

2. Recitals
   A. Birth Parent is the legal parent of Child and has full authority to consent to adoption.
   B. Prospective Adoptive Parent(s) desire to adopt Child pursuant to Nevada adoption law.
   C. Birth Parent wishes to voluntarily and irrevocably relinquish all parental rights in favor of Prospective Adoptive Parent(s), subject to statutory revocation rights.
   D. Consideration for this Consent includes counseling services, statutory disclosures, and other good and valuable consideration, the sufficiency of which is acknowledged.

3. Effective Date
   This Consent is effective on the date of execution by Birth Parent (“Effective Date”), provided the statutory waiting period below has elapsed.

4. Governing Law & Jurisdiction
   This document is governed by the adoption laws of the State of Nevada and is subject to the exclusive jurisdiction of the [NAME OF COUNTY] Family Court, State of Nevada.

II. DEFINITIONS

For ease of reference, capitalized terms are defined alphabetically:

“Acknowledgment” – The notarial acknowledgment attached hereto as Exhibit A.
“Counseling” – Statutorily-required counseling provided to Birth Parent concerning relinquishment and adoption.
“Consent” – This Parental Consent to Adoption and Waiver of Parental Rights.
“Court” – The Family Division of the District Court of the State of Nevada for [NAME OF COUNTY].
“Revocation Period” – The statutory period, currently [NUMBER] hours/days, during which Birth Parent may revoke this Consent as provided in Section 3.4.
“Waiting Period” – The minimum period after Child’s birth that must expire before this Consent can be validly executed (currently seventy-two (72) hours).

[// GUIDANCE: Confirm current Waiting Period and Revocation Period under NRS Chapter 127 before finalizing.]

III. OPERATIVE PROVISIONS

3.1 Voluntary Relinquishment. Subject to the terms herein, Birth Parent hereby voluntarily, knowingly, and intentionally relinquishes all legal and physical custodial rights to Child, including but not limited to the rights of custody, visitation, inheritance, and decision-making.

3.2 Timing of Consent. Birth Parent affirms that:
a. The Waiting Period has fully elapsed; and
b. Birth Parent was not under duress, undue influence, or impairment at the time of execution.

3.3 Transfer of Custody. Birth Parent authorizes Placement Agency or Prospective Adoptive Parent(s), as applicable, to take immediate physical custody of Child upon execution of this Consent or at such other time as the Court may direct.

3.4 Revocation. Birth Parent may revoke this Consent only by delivering a written, notarized Statement of Revocation to [PLACEMENT AGENCY/COURT CLERK] within the Revocation Period. Absent timely revocation, this Consent becomes final and irrevocable except upon order of the Court for fraud or duress proven by clear and convincing evidence.

3.5 Conditions Subsequent. If the Court denies the petition for adoption or fails to enter a final decree within [X] months of filing, this Consent shall, at Birth Parent’s election, either (i) remain in effect for an additional [Y] months, or (ii) be deemed withdrawn with no further action required.

IV. REPRESENTATIONS & WARRANTIES

4.1 By Birth Parent
a. Legal Capacity. Birth Parent is at least eighteen (18) years old, of sound mind, and not the subject of any guardianship or conservatorship.
b. Exclusive Parental Rights. No other person holds parental rights to Child except as expressly disclosed in Schedule 1 (Other Legal Parents).
c. Counseling. Birth Parent received Counseling from [COUNSELOR NAME/LICENSE NO.] on [DATE], at least [24] hours before signing this Consent.
d. No Consideration Prohibited by Law. Birth Parent has received no compensation or inducement contrary to Nevada law.

4.2 Survival. The representations and warranties in this Section survive execution and remain enforceable through entry of the final decree of adoption.

V. COVENANTS & RESTRICTIONS

5.1 Non-Interference. Birth Parent shall not interfere with, contest, or impede (a) the physical placement of Child, or (b) any Court proceeding to finalize the adoption, except as permitted under Section 3.4.

5.2 Cooperation. Birth Parent shall execute all additional documents reasonably requested by Prospective Adoptive Parent(s), Placement Agency, or the Court to effectuate the adoption.

5.3 Confidentiality. Birth Parent agrees to keep confidential all non-public information regarding Prospective Adoptive Parent(s) obtained through the adoption process, except as required by law.

VI. DEFAULT & REMEDIES

6.1 Default. Any breach of Sections 3, 4, or 5 constitutes a default under this Consent.

6.2 Notice and Cure. Upon default, the non-breaching party shall provide written notice specifying the breach. The breaching party shall have [5] days to cure, if curable.

6.3 Remedies. After expiration of the cure period:
a. The non-breaching party may seek specific performance, injunctive relief, or other equitable remedies in the Court.
b. Birth Parent acknowledges that post-Revocation Period attempts to withdraw Consent cause irreparable harm, entitling Prospective Adoptive Parent(s) to immediate injunctive relief to preserve permanent placement.

6.4 Attorneys’ Fees. The prevailing party in any action to enforce this Consent is entitled to reasonable attorneys’ fees and costs.

VII. RISK ALLOCATION

[This Section intentionally omitted. Per metadata, indemnification and liability caps are not applicable.]

VIII. DISPUTE RESOLUTION

8.1 Governing Law. Nevada substantive and procedural law governs this Consent.

8.2 Forum Selection. The parties submit exclusively to the jurisdiction of the [NAME OF COUNTY] Family Court, State of Nevada.

8.3 Arbitration. Arbitration is expressly waived and unavailable.

8.4 Jury Trial. Family-court proceedings are non-jury; any right to jury trial is irrevocably waived to the extent one may otherwise exist.

8.5 Injunctive Relief. The Court may enter temporary and permanent injunctive relief necessary to secure Child’s placement and best interests.

IX. GENERAL PROVISIONS

9.1 Amendment. This Consent may be amended only by a written instrument signed by Birth Parent and approved by the Court.

9.2 Waiver. No waiver of any provision is effective unless in writing and signed by the waiving party.

9.3 Assignment. Rights and obligations hereunder may not be assigned except by Court order or as provided by Nevada law.

9.4 Successors. This Consent binds and inures to the benefit of the parties and their respective successors and permitted assigns.

9.5 Severability. If any provision is held unenforceable, the remaining provisions remain in full force, and the unenforceable provision shall be reformed to the minimum extent necessary to render it enforceable and consistent with the parties’ intent.

9.6 Entire Agreement. This Consent constitutes the entire agreement regarding the subject matter and supersedes all prior or contemporaneous agreements or understandings.

9.7 Counterparts; Electronic Signatures. This Consent may be executed in multiple counterparts, each deemed an original, and may be signed electronically to the fullest extent permitted by Nevada law.

X. EXECUTION BLOCK

Executed as a sealed instrument under the laws of the State of Nevada.

BIRTH PARENT

Signature: [BIRTH PARENT NAME]
Date: [    ]

[// GUIDANCE: If a second legal parent exists, insert a separate execution block or Schedule 1 disclosure.]

ACKNOWLEDGMENT (Notary Public)

State of Nevada )
County of [   ] )

On this [ ] day of [    ], 20, before me, [NOTARY NAME], a Notary Public in and for said County and State, personally appeared [BIRTH PARENT NAME]**, 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 his/her free act and deed.

Witness my hand and official seal.

Notary Public
My Commission Expires: [   ]

SCHEDULE 1

Other Legal Parents (if any)

1. Name: [   ]
   Relationship to Child: [   ]
   Consent Attached: Yes □ No □ N/A □

[// GUIDANCE:
1. Confirm all statutory waiting and revocation periods under current Nevada law (NRS Chapter 127) before use.
2. Verify counseling credentials and timing.
3. Attach agency disclosures required by NRS and Nevada Department of Health & Human Services regulations.
4. Obtain court-approved forms if local rules require additional language.]