Adoption Consent Form - Virginia
PARENTAL CONSENT TO ADOPTION — VIRGINIA PARENTAL PLACEMENT
Before you use this: This form is for a birth parent personally consenting to a direct parental placement under Va. Code § 63.2-1233. The ordinary consent is executed under oath before the juvenile and domestic relations district court, in the presence of the prospective adoptive parents, after the court makes the required § 63.2-1232 findings and the child is at least in the third calendar day of life. Confirm the court's required form and procedure before the hearing. Agency, stepparent, relative, adult, interstate, and birth-father exception routes require separate review. Do not sign this form privately in place of the court process.
| Person or case | Information |
|---|---|
| Juvenile and domestic relations district court | [COURT AND CITY OR COUNTY] |
| Case number, if assigned | [CASE NUMBER] |
| Child's legal name and date of birth | [NAME; DATE AND TIME OF BIRTH] |
| Consenting birth parent | [FULL LEGAL NAME; CONTACT ADDRESS] |
| Parent's relationship to child | [BIRTH MOTHER / BIRTH FATHER] |
| Prospective adoptive parent(s) | [FULL LEGAL NAME(S); CONTACT ADDRESS(ES)] |
| Other birth parent and consent/notice status | [NAME; STATUS; COURT RECORD REFERENCE] |
Consent
I, [CONSENTING BIRTH PARENT], am a birth parent of [CHILD]. I consent to the proposed adoption of this child by [PROSPECTIVE ADOPTIVE PARENT(S)], subject to the court's acceptance of my consent and orders under Virginia law. I give this consent voluntarily and without coercion.
I have been informed of alternatives to adoption, the adoption procedure, opportunities for placement with other adoptive families, and my opportunity to be represented by legal counsel. My counsel is [NAME AND CONTACT / NONE; OPPORTUNITY EXPLAINED]. The information and counseling considered by the court under § 63.2-1232 are identified in [COURT RECORD OR ATTACHMENT].
Financial agreements, exchanges of property, and fees relating to this placement or adoption have been disclosed to the court as [COURT RECORD OR NONE]. I understand that this consent is not a binding contract for placement or adoption. The court determines whether to accept consent and what custody order to enter. This document does not itself transfer custody or end parental rights.
Revocation information
For a parental placement consent, Va. Code § 63.2-1234 permits either consenting birth parent to revoke for any reason for up to seven days from execution, unless that parent makes a valid separate written waiver at the time of consent after the child is at least 10 days old and after receiving independent legal counsel about the waiver. This form does not waive revocation.
A revocation must be written, signed by the revoking parent or counsel of record, and filed with the clerk of the juvenile and domestic relations district court where the petition was filed during the court's business day within the statutory period. If the period ends while the clerk's office is closed on a Saturday, Sunday, legal holiday, or other authorized closure, it extends to the next day the clerk's office is open. Before a final adoption order, § 63.2-1234 also permits revocation on proof of fraud or duress, or, after placement, by written mutual consent of the birth and prospective adoptive parents.
Court where a revocation would be filed: [JUVENILE AND DOMESTIC RELATIONS DISTRICT COURT; CLERK CONTACT]
I have read this form, had the opportunity to ask questions, and understand the consent and revocation information above.
Consenting birth parent's signature (execute under oath before the court): __________________________
Printed name: [NAME] Date and time of execution: [DATE AND TIME]
Oath and acknowledgment
Subscribed and sworn to, and acknowledged before me, by [PARENT NAME] on [DATE] at [LOCATION].
Authorized officer's signature: __________________________
Printed name and official capacity: [NAME AND TITLE]
Commission expiration, if applicable: [DATE / NOT APPLICABLE]
Court use
Court finding and acceptance of consent: [ORDER OR DOCKET REFERENCE; DATE]
Custody order or other court disposition: [ORDER REFERENCE; DATE]
Copy furnished to consenting parent: ☐ Yes, on [DATE] ☐ Pending
Sources and references
About this template
- Last updated
- September 30, 2026
- Citations checked
- September 30, 2026
- Jurisdiction
- Virginia
- Category
- Family Law
Legal authority
- Va. Code § 63.2-1202 (persons whose consent is required; form of consent)
- Va. Code § 63.2-1232 (parental-placement findings before consent)
- Va. Code § 63.2-1233 (parental-placement consent in court)
- Va. Code § 63.2-1234 (revocation of parental-placement consent)
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 September 30, 2026.
Va. Code § 63.2-1202(A) (checked September 30, 2026): "Such consent shall be in writing, signed under oath and acknowledged before an officer authorized by law to take acknowledgments. The consent of a birth parent for the adoption of his child placed directly by the birth parent shall be executed as provided in § 63.2-1233"
Va. Code § 63.2-1232(A)(4) (checked September 30, 2026): "Any financial agreement or exchange of property among the parties and any fees charged or paid for services related to the placement or adoption of the child have been disclosed to the court and that all parties understand that no binding contract regarding placement or adoption of the child exists."
Va. Code § 63.2-1233 (checked September 30, 2026): "When the juvenile and domestic relations district court is satisfied that all requirements of § 63.2-1232 have been met with respect to at least one birth parent and the adoptive child is at least in the third calendar day of life, that birth parent or both birth parents, as the case may be, shall execute consent to the proposed adoption in compliance with the provisions of § 63.2-1202 while before the juvenile and domestic relations district court in person and in the presence of the prospective adoptive parents."
Va. Code § 63.2-1234(1) (checked September 30, 2026): "By either consenting birth parent for any reason for up to seven days from its execution; however, such seven-day revocation period may be waived in writing at the time of consent provided that the child is at least 10 days old and the consenting birth parent acknowledges having received independent legal counsel regarding the effect of such waiver."
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