Adoption Consent Form - Oregon

CONSENT TO ADOPTION OF A MINOR CHILD

Oregon — Non-Indian Child Route

Do not use this form if there is reason to know the child is an Indian child. A parent's consent to adoption of an Indian child is governed by ORS § 109.302, may not be executed until at least 10 days after birth, must be executed in person before the court, and may be withdrawn before entry of the adoption judgment. The certificate of irrevocability in Part 7 is not valid for an Indian child.

1. ADOPTION PROCEEDING

Court: Circuit Court of the State of Oregon for [________________] County

Case number, if assigned: [________________________________]

Petitioner / prospective adoptive parent(s): [________________________________]

Child's current full name: [________________________________]

Child's date and place of birth: [__/__/____], [________________________________]

2. CONSENTING PERSON

Full legal name: [________________________________]

Address: [________________________________]

Telephone / email: [________________________________]

Capacity under ORS § 109.301(1):

☐ Parent of the child whose parentage is established under ORS § 109.065

☐ Surviving parent of the child

☐ Guardian of the child, who has no living parent

☐ Next of kin in Oregon, because the child has no living parent and no guardian

☐ Suitable person appointed by the court as the child's next friend, because the child has no living parent and no guardian or qualified next of kin

If signing under a court appointment, identify the order: [________________________________]

3. INDIAN CHILD STATEMENTS

As required by ORS § 109.301(3), I state:

☐ I do not have reason to know that the child is an Indian child.

I will inform the court immediately if, before entry of the adoption judgment, I receive information that provides reason to know the child is an Indian child.

Information considered in making this statement: [________________________________]

4. CONSENT

I voluntarily consent to the adoption of the child identified above by the petitioner(s) identified above.

I understand that:

1. This written consent affects parental or custodial rights and will be filed in an adoption proceeding under ORS § 109.276.
2. Signing this consent does not, by itself, make the consent irrevocable.
3. A consent may be or become irrevocable only through a duly signed and attested certificate and completion of every condition in ORS § 109.301(2). Part 7 is an optional certificate for that purpose.
4. I may consult an independent Oregon attorney before signing.

Additional conditions expressly attached to this consent, if any: [________________________________]

5. BIRTH-PARENT COUNSELING NOTICE

5.1 Applicability

Select one:

☐ ORS § 109.346 applies. I am a consenting birth parent and received the written notice in Part 5.2 on [__/__/____].

☐ ORS § 109.346 does not apply because the birth parent is relinquishing parental rights to the Oregon Department of Human Services.

☐ ORS § 109.346 does not apply because one parent will retain parental rights.

☐ ORS § 109.346 does not apply because the child was born in a foreign country and was adopted there or will be readopted in Oregon.

☐ ORS § 109.346 does not apply because the child was born in a foreign country, will be adopted in Oregon, and the identity or whereabouts of the birth parents are unknown.

☐ ORS § 109.346 does not apply because this is an adult adoption.

5.2 Written Notice to Consenting Birth Parent

You have the right to payment for:

• three adoption-related counseling sessions before surrender or relinquishment of the child for adoption; and
• three adoption-related counseling sessions after surrender or relinquishment.

The prospective adoptive parent must pay all uninsured costs for counseling covered by ORS § 109.346 if the counseling is received within one year after surrender or relinquishment. The statute identifies qualified providers and permits the prospective adoptive parent and consenting birth parent to agree to a different provider.

Failure to provide this notice or pay covered uninsured counseling costs is not grounds to set aside an adoption judgment or revoke a written consent or certificate of irrevocability.

5.3 Provider Verification for Court Filing

I verify that I provided the written notice above to the consenting birth parent before entry of the adoption judgment.

Provider name: [________________________________]

Provider role:

☐ Attorney for the birth parent

☐ Agency representative taking the birth parent's consent

☐ Attorney for the prospective adoptive parent

Provider Signature: [________________________________] Date: [__/__/____]

6. SIGNATURE ON CONSENT

I have read this consent, or it has been read to me. I understand it and sign it voluntarily. The information I supplied is true to the best of my knowledge.

Consenting Person Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

Optional witness to the consent:

Witness Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

7. OPTIONAL CERTIFICATE OF IRREVOCABILITY AND WAIVER

Complete only after Oregon counsel confirms that every condition below has occurred. This certificate is not valid for an Indian child.

I agree that my consent shall be or become irrevocable, and I waive my right to a personal appearance in court. I certify that:

☐ The child has been placed for adoption in the physical custody of the person(s) to whom I gave consent.

☐ The person(s) to whom I gave consent have filed a petition to adopt the child in a court of competent jurisdiction.

☐ The court has entered an order under ORS § 109.335 appointing the petitioner or another suitable person as guardian of the child pending further order or judgment.

☐ DHS, an Oregon licensed adoption agency, or an attorney representing the adoptive parent(s) has filed with the court a DHS or Oregon licensed adoption agency home study approving the petitioner(s), or DHS has notified the court that filing the study was waived.

☐ I provided the child's social, medical, and genetic history information required by ORS § 109.342 to an attorney, DHS, or an Oregon licensed adoption agency.

☐ An attorney who represents me and does not also represent the adoptive family, DHS, or an Oregon licensed adoption agency explained the consequences of signing this certificate.

Person who gave the explanation: [________________________________]

Role / organization: [________________________________]

I understand that, upon fulfillment of all conditions above, my consent may not be revoked unless fraud or duress is proved with respect to a material fact.

Signer Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

Attestation

I attest that the signer signed or acknowledged this certificate in my presence.

Attesting Witness Signature: [________________________________]

Printed Name: [________________________________]

Date: [__/__/____]

8. MEDICAL-HISTORY FILING CHECKLIST

☐ Before judgment, the court was provided a medical history of the child and genetic parents as complete as possible under the circumstances, using the form prescribed by DHS.

☐ The medical history does not include the names of the genetic parents.

☐ The ORS § 109.342 medical-history requirement does not apply because the petitioner is the child's stepparent.

9. INTERPRETER'S DECLARATION (if applicable)

I, [________________________________], declare that I am fluent in English and [LANGUAGE], accurately interpreted this document for the consenting person, and was informed that the consenting person understood the document before signing.

Interpreter Signature: [________________________________] Date: [__/__/____]

Printed Name: [________________________________]

Address: [________________________________]

SOURCES AND REFERENCES

• Oregon Legislature — ORS Chapter 109, 2025 Edition — §§ 109.301, 109.302, 109.335, 109.342, and 109.346
• Oregon Legislature — 2025 Senate Bill 163 overview — Chapter 592, effective September 26, 2025
• Oregon Legislature — 2025 Senate Bill 163 enrolled text