PARENTAL CONSENT TO ADOPTION AND WAIVER OF PARENTAL RIGHTS
State of Rhode Island
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Dispute Resolution
- General Provisions
- Execution Block
[// GUIDANCE: Delete the Table of Contents for court-supplied “short form” filings if not required.]
1. DOCUMENT HEADER
1.1 Title & Parties
Parental Consent to Adoption and Waiver of Parental Rights (this “Consent”), executed by:
(a) Birth/Legal Parent: [BIRTH PARENT FULL NAME], (“Parent”); and
(b) Prospective Adoptive Parent(s): [ADOPTIVE PARENT FULL NAME(S)] (“Petitioner(s)”).
1.2 Child Identification
Name: [CHILD FULL NAME] Date of Birth: [DOB] Place of Birth: [PLACE].
1.3 Effective Date & Jurisdiction
This Consent is effective on the later of the signing date below or acceptance by the [COURT NAME] sitting in [COUNTY] County, Rhode Island (the “Court”), and is governed exclusively by the laws of the State of Rhode Island relating to adoption (the “Governing Law”).
1.4 Recitals
A. Parent is the child’s legal parent and holds full authority to consent to adoption.
B. Petitioner(s) seek to adopt the Child and have filed or will file a Petition for Adoption with the Court.
C. Parent desires, after required counseling and independent legal advice, voluntarily and irrevocably (subject only to the statutory revocation period) to surrender all parental rights and consent to adoption in the Child’s best interests.
D. Adequate consideration exists, consisting of the mutual promises herein and the benefits conferred upon the Child.
2. DEFINITIONS
For ease of reference, capitalized terms carry the following meanings.
2.1 “Child” – the minor identified in Section 1.2.
2.2 “Consent Revocation Period” – the statutory period during which Parent may revoke this Consent, currently [REVOCATION_PERIOD_DAYS] calendar days from execution, or such other period as Rhode Island law may prescribe at the time of execution.
2.3 “Counseling Provider” – the licensed social worker, counselor, or adoption agency representative who provided the mandatory pre-consent counseling described in Section 3.3.
2.4 “Final Decree” – the final order of adoption entered by the Court pursuant to Governing Law.
2.5 “Parent” – the individual(s) executing this Consent as the child’s legal or biological parent(s).
2.6 “Petitioner(s)” – the individual(s) seeking to adopt the Child.
[// GUIDANCE: Add or delete defined terms to align with the facts of each matter.]
3. OPERATIVE PROVISIONS
3.1 Grant of Consent. Parent hereby freely and voluntarily:
a. Consents to the adoption of the Child by Petitioner(s);
b. Surrenders to Petitioner(s) and, upon entry of the Final Decree, to the Child, all parental rights, duties, and obligations, including but not limited to custody, control, and the right to make decisions concerning the Child; and
c. Requests that the Court enter all orders necessary to effectuate such adoption.
3.2 Timing of Execution. Parent affirms that this Consent is executed no earlier than the earliest time permitted by Rhode Island law and after completion of all mandatory waiting periods.
3.3 Counseling Requirement. Parent certifies that:
a. Mandatory counseling was completed on [COUNSELING DATE] with [COUNSELING_PROVIDER_NAME];
b. The Counseling Provider explained the legal consequences of relinquishment and adoption; and
c. A written Counseling Certificate is attached hereto as Exhibit A.
3.4 Voluntariness & Independent Advice. Parent acknowledges having:
a. Received independent legal advice or knowingly waived the same;
b. Been advised of the right to separate counsel at Petitioner(s)’ expense if requested; and
c. Signed this Consent without duress, coercion, or undue influence.
3.5 Revocation.
a. Parent may revoke this Consent only by delivering a written, notarized revocation to the Court within the Consent Revocation Period.
b. Upon expiration of the Consent Revocation Period, this Consent becomes irrevocable absent a showing required by statute (e.g., fraud, duress).
c. If revoked, the Court shall determine custodial arrangements consistent with Governing Law.
3.6 No Consideration for Surrender. Parent affirms that no money or thing of value, other than lawful expenses allowed under Governing Law, was given or promised in exchange for this Consent.
3.7 Post-Adoption Communication. Any agreement for post-adoption contact is set forth in a separate Post-Adoption Contact Agreement (“PACA”), which must be approved by the Court and is enforceable only as permitted by Governing Law. This Consent is effective regardless of enforcement of any PACA.
4. REPRESENTATIONS & WARRANTIES
Parent represents and warrants to Petitioner(s) and the Court that:
4.1 Authority. Parent is of legal age and holds sole legal authority to execute this Consent, or, if joint consent, each signatory holds such authority.
4.2 No Pending Litigation. No guardianship, custody, or dependency actions concerning the Child are pending, except as disclosed in Schedule 1.
4.3 Accuracy of Information. All information supplied in support of the adoption petition is true, accurate, and complete to Parent’s knowledge.
4.4 Health Disclosure. Parent has provided complete medical and social history of the Child and of Parent as required by Governing Law.
[// GUIDANCE: Attach state-specific medical/social history forms as exhibits when filing.]
5. COVENANTS & RESTRICTIONS
5.1 Further Assurances. Parent shall execute any additional documents reasonably requested by the Court or Petitioner(s) to perfect the adoption, provided such documents do not impose additional obligations beyond this Consent.
5.2 Non-Interference. Except as expressly permitted under Governing Law, Parent shall not challenge or interfere with the adoption after the Consent Revocation Period has expired.
6. DEFAULT & REMEDIES
6.1 Default. A breach of any covenant herein prior to entry of the Final Decree constitutes a default.
6.2 Remedies. In the event of default:
a. The non-defaulting party may seek specific performance or injunctive relief;
b. The Court retains continuing jurisdiction to fashion equitable relief in the Child’s best interests; and
c. Reasonable attorneys’ fees and costs may be awarded to the prevailing party, in the Court’s discretion.
[// GUIDANCE: Family courts often retain broad equitable powers; tailor remedies to local practice.]
7. DISPUTE RESOLUTION
7.1 Governing Law. This Consent shall be construed in accordance with the laws of the State of Rhode Island governing adoptions.
7.2 Exclusive Forum. Any proceeding arising out of or relating to this Consent shall be brought exclusively in the [COURT NAME] or such other Rhode Island family court of competent jurisdiction.
7.3 Arbitration & Jury Trial. Arbitration is not available for adoption matters, and jury trials are not available in Rhode Island family court; the parties expressly acknowledge the same.
7.4 Injunctive Relief. Nothing in this Consent limits the Court’s inherent authority to issue orders necessary to secure the Child’s permanent placement and welfare.
8. GENERAL PROVISIONS
8.1 Entire Agreement. This Consent, together with any exhibits or schedules, constitutes the entire understanding regarding Parent’s surrender of parental rights.
8.2 Amendment. No amendment is valid unless in writing, signed by all parties, and approved by the Court.
8.3 Severability. If any provision is declared invalid, the remaining provisions remain enforceable to the fullest extent permitted by law.
8.4 Assignment. Parental rights surrendered herein are personal and non-assignable by Parent; Petitioner(s) may not assign their rights except as ordered by the Court.
8.5 Counterparts; Electronic Signatures. This Consent may be executed in counterparts, each of which is deemed an original. Signatures transmitted electronically or by facsimile are deemed originals for all purposes.
9. EXECUTION BLOCK
[// GUIDANCE: Rhode Island requires notarization; confirm whether one or two witnesses are required under current local court rule.]
9.1 Parent
[BIRTH PARENT FULL NAME], Parent
Date: ________
State of Rhode Island
County of ______
On this _ day of _, 20__, before me, the undersigned notary public, personally appeared [BIRTH PARENT FULL NAME], proved to me through satisfactory evidence of identification, and acknowledged that (s)he executed this Consent voluntarily for the purposes herein contained.
Notary Public
My Commission Expires: ______
9.2 Prospective Adoptive Parent(s) (Acknowledgment of Receipt)
_____ _____
[ADOPTIVE PARENT NAME] [ADOPTIVE PARENT NAME]
Date: ________
9.3 Counseling Provider Certification
I, [COUNSELING_PROVIDER_NAME], certify that I provided the counseling described in Section 3.3 and that Parent appeared to understand the nature and consequences of executing this Consent.
Signature / License No.____
Date: ________
9.4 Court Approval
SO ORDERED this _ day of _, 20__.
Judge, [COURT NAME]
EXHIBIT A – COUNSELING CERTIFICATE
SCHEDULE 1 – PENDING MATTERS (if any)
[// GUIDANCE: Attach additional exhibits (medical history, PACA, etc.) as required.]
END OF DOCUMENT