Adoption Consent Form - Preparation Worksheet - New York
PREPARATION WORKSHEET — NOT A CONSENT FOR SIGNATURE OR FILING
New York uses different official consent forms and execution rules for judicial, extrajudicial, agency, private-placement, and stepparent matters. Use this worksheet to select and prepare the current court form. Do not sign a draft consent until New York adoption counsel and the filing court confirm the route, form, and execution procedure.
New York Adoption Consent Preparation Worksheet
1. Matter identification
- Filing court: ☐ Family Court ☐ Surrogate's Court
- County: [________________________________]
- Existing docket or file number: [________________________________]
- Child's first name used in the caption: [________________________________]
- Child's full legal name for protected filing fields: [________________________________]
- Child's date of birth: [__/__/____]
- Proposed adoptive parent or parents: [________________________________]
- Consenting person's name and legal relationship to the child: [________________________________]
- Consenting person is in foster care: ☐ No ☐ Yes — stop and obtain counsel-directed Family Court execution
2. Select the statutory route before drafting
| Route | Execution control | Withdrawal control |
|---|---|---|
| Judicial consent | Executed or acknowledged before a New York judge or surrogate with adoption jurisdiction. The judicial officer supplies the statutory rights explanation. | The consent states that it is irrevocable upon judicial execution or acknowledgment. |
| Extrajudicial consent | Not executed before a judge or surrogate. It must use the statutory disclosures, identify the intended court, be acknowledged before a notary or other officer authorized to take proof of deeds, and include written receipt of a copy. | Written revocation must be received by the identified court within the statutory period. A timely revocation does not guarantee return of custody if the adoptive parents oppose it; the court applies the statutory hearing process. |
| Stepparent consent | Use the form and route directed by the court for consent to adoption by the named stepparent. | Apply the judicial or extrajudicial rule selected for the actual execution. |
Selected route: ☐ Judicial ☐ Extrajudicial ☐ Stepparent ☐ Other: [________________]
Reason this route applies: [____________________________________________________________]
3. Official-form control
- Current official form number and title: [________________________________]
- Form URL: [________________________________]
- Form revision or download date: [__/__/____]
- Court clerk or counsel confirmed this form for the selected route: ☐ Yes ☐ No
- The private-placement checklist was reviewed for all required companion papers: ☐ Yes ☐ No
- Any adoption information registry form required with the consent is included: ☐ Yes ☐ No ☐ Counsel to determine
Do not replace the official form's statutory warning text, type size, court address, receipt language, or signature blocks with shortened language from this worksheet.
4. Information to transfer to the official form
- Consenting person's residence: [________________________________]
- Other birth or legal parent's name and last known address, if requested: [________________________________]
- Child's required identifying information: [________________________________]
- Named adoptive parent or parents: [________________________________]
- Attorney for consenting person, if any: [________________________________]
- Attorney address and telephone: [________________________________]
- Court name and complete address for a possible written revocation: [________________________________]
- Additional facts or attachments required by the selected form: [________________________________]
5. Independent-choice record
- Right to counsel discussed by: [________________________________] on [__/__/____]
- Independent counsel retained: ☐ Yes ☐ No ☐ Appointment eligibility being evaluated
- Supportive counseling information provided: ☐ Yes ☐ No
- Interpreter or accommodation needed: ☐ No ☐ Yes: [________________________________]
- Questions remaining before execution: [________________________________]
6. Execution checklist
Judicial route
☐ Execution or acknowledgment is scheduled before the correct judge or surrogate.
☐ The signer will receive the statutory explanation and a copy of the consent.
Extrajudicial route
☐ The official form contains every disclosure required by N.Y. Domestic Relations Law § 115-b, including the required conspicuous-print provisions.
☐ The correct court name and address appear in the consent.
☐ The signer will execute or acknowledge before an authorized officer.
☐ The signer will receive a copy and complete the written receipt and delivery date on the consent.
7. Revocation-delivery planning for an extrajudicial consent
This section does not revoke a consent. It records the information counsel should confirm with the signer.
- Execution date: [__/__/____]
- Counsel-calculated last day for the court to receive written notice: [__/__/____]
- Court that must receive the notice: [________________________________]
- Court address and confirmed delivery method: [________________________________]
- Proof-of-receipt plan: [________________________________]
The statute measures whether the court receives the written notice; do not assume that mailing alone is timely. Any revocation or challenge based on fraud, duress, or coercion requires immediate advice from New York adoption counsel.
8. Final professional review
Reviewed by New York attorney: [________________________________]
Attorney confirmed route, current form, execution officer, disclosures, court address, companion forms, and timing: ☐ Yes
Review date: [__/__/____]
Signature: ____________________________________
Sources and References
About this template
- Last updated
- August 21, 2026
- Citations checked
- August 21, 2026
- Jurisdiction
- New York
- Category
- Family Law
Legal authority
- N.Y. Dom. Rel. Law § 115-b
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 August 21, 2026.
N.Y. Dom. Rel. Law § 115-b(1) (checked August 21, 2026): "A consent to adoption executed by a person who is in foster care shall only be executed before a judge of the family court."
N.Y. Dom. Rel. Law § 115-b(2) (checked August 21, 2026): "A consent to a private placement adoption may be executed or acknowledged before any judge or surrogate in this state having jurisdiction over adoption proceedings."
N.Y. Dom. Rel. Law § 115-b(3) (checked August 21, 2026): "Such consent shall become irrevocable forty-five days after the execution of the consent unless written notice of revocation thereof is received by the court in which the adoption proceeding is to be commenced within said forty-five days."
N.Y. Dom. Rel. Law § 115-b(4) (checked August 21, 2026): "Such consent shall be executed or acknowledged before a notary public or other officer authorized to take proof of deeds."
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