CONSENT OF BIRTH PARENT(S) TO ADOPTION

(Ohio Rev. Code Ann. Chapter 3107 Compliant)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Statutory Disclosures & Acknowledgments
4. Consent & Waiver of Notice
5. Counseling Certification
6. Revocation of Consent
7. Governing Law & Forum Selection
8. General Provisions
9. Execution Block
10. Notary Acknowledgment

1. DOCUMENT HEADER

Title: Consent of Birth Parent(s) to Adoption and Waiver of Notice of Further Proceedings
Effective Date: [EFFECTIVE DATE]
Birth Parent(s): [BIRTH PARENT FULL LEGAL NAME(S)]
Child: [CHILD FULL LEGAL NAME], born [DOB] in [CITY, COUNTY, STATE]
Prospective Adoptive Parent(s): [ADOPTIVE PARENT FULL LEGAL NAME(S)]
Adoption Agency / Attorney (if any): [AGENCY/COUNSEL NAME]
Court of Jurisdiction: [COURT NAME], [COUNTY], Ohio

WHEREAS, the Birth Parent(s) desire voluntarily and irrevocably (subject to statutory revocation rights described herein) to consent to the adoption of the Child by the Prospective Adoptive Parent(s) pursuant to Ohio Rev. Code Ann. § 3107.08 et seq.; and

WHEREAS, adequate consideration consists of the mutual promises herein and the fulfillment of all statutory duties imposed upon the parties and the Court;

NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

2. DEFINITIONS

For purposes of this Consent, the following terms have the meanings set forth below. Defined terms may be used in the singular or plural and shall apply equally to all genders.

“Adoption Proceeding” means the case captioned In re: Adoption of [CHILD NAME] pending before the Court.

“Best Interests Hearing” means any hearing at which the Court determines whether the proposed adoption is in the Child’s best interests.

“Consent” means this instrument titled “Consent of Birth Parent(s) to Adoption and Waiver of Notice of Further Proceedings.”

“Counseling Provider” means a professional or agency qualified under Ohio law to provide adoption-related counseling.

“Revocation Period” has the meaning set forth in Section 6.1.

3. STATUTORY DISCLOSURES & ACKNOWLEDGMENTS

3.1 Right to Independent Counsel
The Birth Parent(s) acknowledge(s) the statutory right to consult independent legal counsel at their own expense before executing this Consent and either have done so or knowingly waive such right.

3.2 Receipt of Required Written Materials
Birth Parent(s) certify receipt, prior to execution, of:
a. The Ohio Department of Job and Family Services publication “Birthparent Guide to Adoption”;
b. A written summary of adoption options, rights, and responsibilities pursuant to Ohio Rev. Code Ann. § 3107.081(A); and
c. The Medical and Social History forms required under § 3107.09(C).

3.3 Voluntariness
Birth Parent(s) affirm that this Consent is executed voluntarily, without duress, coercion, or undue influence, and that no payment or promise of value not expressly permitted by law has been offered or accepted.

3.4 Understanding of Finality
Birth Parent(s) understand that, subject only to the Revocation Period described in Section 6, this Consent becomes final and irrevocable upon entry of the Final Decree of Adoption.

3.5 Language & Comprehension
Birth Parent(s) represent that they read, write, and understand the English language or that this document has been read and explained to them in a language they understand.

4. CONSENT & WAIVER OF NOTICE

4.1 Grant of Consent
Pursuant to Ohio Rev. Code Ann. § 3107.08, the undersigned Birth Parent(s) hereby irrevocably consent(s) to the adoption of the Child by the Prospective Adoptive Parent(s) and request(s) that the Court enter the appropriate orders and decrees to effectuate such adoption.

4.2 Waiver of Further Notice
The undersigned Birth Parent(s) waive(s) notice of all further hearings or proceedings in connection with the Adoption Proceeding, including the Best Interests Hearing and entry of the Final Decree of Adoption.

5. COUNSELING CERTIFICATION

5.1 Counseling Offer
Birth Parent(s) acknowledge that they have been offered no-cost counseling services by a Counseling Provider as mandated by Ohio law.

5.2 Counseling Acceptance or Waiver
[Choose ONE and delete the other before execution.]
☐ Birth Parent(s) have received counseling on [DATE(S)] from [COUNSELING PROVIDER].
☐ Birth Parent(s) knowingly and voluntarily waive counseling.

6. REVOCATION OF CONSENT

6.1 Revocation Period
Under Ohio Rev. Code Ann. § 3107.09(E), this Consent may be withdrawn by written notice delivered to the Court at any time prior to the earlier of:
a. Entry of an interlocutory decree of adoption; or
b. Entry of the Final Decree of Adoption.
(“Revocation Period”).

6.2 Procedure for Revocation
a. Revocation must be in writing, signed by the revoking Birth Parent(s), and filed with the Clerk of the Court identified above.
b. After the Revocation Period expires, withdrawal is permitted only with leave of Court and upon a finding, by clear and convincing evidence, that revocation is in the Child’s best interests.

7. GOVERNING LAW & FORUM SELECTION

7.1 Governing Law
This Consent and any dispute arising hereunder shall be governed by the laws of the State of Ohio.

7.2 Exclusive Forum
The [COURT NAME], [COUNTY], Ohio shall retain exclusive jurisdiction over all matters relating to the adoption of the Child. Arbitration is not available. A jury trial is not available in juvenile/family court adoption proceedings.

7.3 Injunctive Relief
The Court is empowered to issue any orders necessary to protect the Child’s placement and best interests, including injunctive relief.

8. GENERAL PROVISIONS

8.1 Entire Agreement
This Consent constitutes the entire understanding between the parties regarding the subject matter hereof and supersedes all prior or contemporaneous oral or written agreements.

8.2 Amendments
No amendment or modification of this Consent shall be effective unless executed in writing by the Birth Parent(s) and approved by the Court.

8.3 Severability
If any provision of this Consent is held invalid or unenforceable, the remaining provisions shall continue in full force, provided that the essential purposes of the Consent are not thereby defeated.

8.4 Counterparts; Electronic Signatures
This Consent may be executed in counterparts, each of which shall be deemed an original. Signatures transmitted by electronic means (including via secure PDF or authenticated e-signature platform) shall be deemed original for all purposes permitted by Ohio law.

9. EXECUTION BLOCK

IN WITNESS WHEREOF, the undersigned Birth Parent(s) have executed this Consent on the date(s) indicated below.

Birth Mother

________________________________________
[BIRTH MOTHER FULL LEGAL NAME]
Date: ___________________

Birth Father

________________________________________
[BIRTH FATHER FULL LEGAL NAME]
Date: ___________________

10. NOTARY ACKNOWLEDGMENT

State of Ohio )
County of ______ ) ss:

On this _____ day of __________, 20__, before me, a Notary Public in and for said state, personally appeared ____________________________________, known to me or satisfactorily proven to be the person(s) whose name(s) is/are subscribed to the foregoing Consent, and acknowledged that he/she/they executed the same for the purposes therein contained.

IN WITNESS WHEREOF, I have hereunto set my hand and official seal.

________________________________________
Notary Public

My Commission Expires: _______________