PARENTAL CONSENT TO ADOPTION
Vermont Adoption Act, 15A V.S.A. § 2-401 et seq.
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Dispute Resolution
- General Provisions
- Execution Block
[// GUIDANCE: Bracketed text in ALL-CAPS is intended for attorney customization.]
1. DOCUMENT HEADER
1.1 Title
Parental Consent to Adoption and Voluntary Relinquishment of Parental Rights (“Consent”).
1.2 Parties
(a) “[CONSENTING PARENT]” – the biological or legal parent executing this Consent.
(b) “[CHILD]” – the minor child identified below.
(c) “[PROSPECTIVE ADOPTIVE PARENT(S)]” – individual(s) seeking to adopt the Child (optional for identification).
(d) “Department” – the Vermont Department for Children and Families (“DCF”), if applicable.
1.3 Recitals
A. Consenting Parent is the [mother/father/parent] of the Child and possesses full legal authority to consent to adoption under the Vermont Adoption Act, 15A V.S.A. § 2-401 et seq.
B. Consenting Parent desires permanently to relinquish all parental rights and obligations with respect to the Child and to consent to the Child’s adoption by the Prospective Adoptive Parent(s).
C. This Consent is executed in compliance with:
• Timing requirements of 15A V.S.A. § 2-405 (execution ≥ 36 hours post-birth).
• Revocation provisions of 15A V.S.A. § 2-406 (21-day revocation period).
• Counseling provisions of 15A V.S.A. § 2-408 (offer of counseling).
1.4 Effective Date
The “Execution Date” is the date on which this Consent is signed and notarized as provided herein.
1.5 Governing Law & Forum
This Consent is governed by Vermont law. Jurisdiction and venue for all matters arising hereunder lie exclusively in the [COUNTY] Unit of the Vermont Family Division of the Superior Court (“Family Court”).
2. DEFINITIONS
Unless the context otherwise requires, the following terms shall have the meanings set forth below:
“Act” – the Vermont Adoption Act, 15A V.S.A. § 1-101 et seq.
“Child” – the minor identified in Section 3.1.
“Court” – the Vermont Family Division of the Superior Court exercising jurisdiction over the adoption proceeding.
“Execution Date” – defined in Section 1.4.
“Revocation Period” – the twenty-one (21) consecutive calendar days commencing on the Execution Date, as prescribed by 15A V.S.A. § 2-406.
3. OPERATIVE PROVISIONS
3.1 Identification of Child
Full Name: [CHILD FULL LEGAL NAME]
Date of Birth: [DOB]
Place of Birth: [CITY, COUNTY, VT]
3.2 Grant of Consent and Relinquishment
(a) Consenting Parent hereby irrevocably consents to the adoption of the Child by the Prospective Adoptive Parent(s) pursuant to the Act.
(b) Consenting Parent voluntarily and permanently relinquishes all parental rights, custodial claims, duties of support, and any other legal incidents of the parent-child relationship effective upon expiration of the Revocation Period or earlier confirmation by the Court, whichever occurs later.
3.3 Timing Compliance
Consenting Parent affirms that this Consent is executed no earlier than thirty-six (36) hours after the Child’s birth, in accordance with 15A V.S.A. § 2-405.
3.4 Counseling Confirmation
(a) Consenting Parent acknowledges that the availability of at-least three (3) hours of pre-consent counseling by a qualified counselor has been explained and offered.
(b) Consenting Parent [HAS/HAS NOT] elected to receive such counseling.
[// GUIDANCE: Attach counselor’s certificate if counseling occurred.]
3.5 Revocation Rights
(a) Consenting Parent may revoke this Consent by delivering a written, notarized revocation to the Court (and, if applicable, to DCF) at any time within the Revocation Period.
(b) Revocation is ineffective if filed after the Revocation Period except as provided by the Act for fraud, duress, or lack of mental competency.
3.6 Waiver of Further Notice
Consenting Parent waives service of process and any further notice of the adoption proceeding except as mandated by the Act.
3.7 Medical & Social Information
Consenting Parent shall provide a complete and accurate social and medical history form contemporaneously with this Consent.
4. REPRESENTATIONS & WARRANTIES
4.1 Authority and Capacity
Consenting Parent represents that:
(a) He/she is over eighteen (18) years of age or otherwise legally competent;
(b) No other individual or entity possesses superior parental rights to the Child;
(c) There is no pending litigation, guardianship, or protective proceeding that would impair this Consent.
4.2 Voluntariness
This Consent is executed freely, knowingly, and voluntarily, without duress, coercion, or undue influence.
4.3 Full Disclosure
Consenting Parent has had adequate opportunity to consult independent legal counsel and understands the legal consequences of signing this Consent.
4.4 Survival
The representations and warranties in this Section survive execution and remain enforceable by the Court until final decree of adoption.
5. COVENANTS & RESTRICTIONS
5.1 Cooperation
Consenting Parent shall execute such additional documents and appear at such hearings as the Court may reasonably require to effectuate the adoption.
5.2 Confidentiality
Consenting Parent agrees to maintain the confidentiality of identifying information concerning the Prospective Adoptive Parent(s) except as otherwise permitted by Vermont law.
5.3 Post-Adoption Contact
Any future contact between Consenting Parent and Child shall be governed exclusively by a Court-approved Post-Adoption Contact Agreement, if any.
6. DEFAULT & REMEDIES
6.1 Events of Default
(a) Any revocation within the Revocation Period as provided in Section 3.5.
(b) Material misrepresentation in this Consent.
6.2 Remedies
Upon a Court finding of default:
(a) The Court may void this Consent and dismiss or stay the adoption proceeding.
(b) The Court may impose sanctions or award attorney’s fees for bad-faith conduct.
7. DISPUTE RESOLUTION
7.1 Governing Law
This Consent and all related disputes are governed by the laws of the State of Vermont without regard to conflict-of-laws principles.
7.2 Exclusive Forum
Any proceeding arising out of or relating to this Consent shall be heard exclusively in the Family Court.
7.3 Arbitration
Arbitration is unavailable for matters governed by this Consent.
7.4 Jury Trial Waiver
All proceedings are bench matters under the Family Court’s statutory jurisdiction; jury trial is unavailable.
7.5 Injunctive Relief
The Court retains authority to issue any injunctive orders necessary to safeguard the Child’s permanent placement and best interests.
8. GENERAL PROVISIONS
8.1 Amendment & Waiver
No amendment or waiver of any provision of this Consent is effective unless made in writing, signed by the Consenting Parent, and approved by the Court.
8.2 Assignment
This Consent and the rights herein are personal to the Consenting Parent and may not be assigned.
8.3 Severability
If any provision is held unenforceable, the remaining provisions shall remain in full force to the maximum extent permitted by law.
8.4 Entire Agreement
This Consent constitutes the entire agreement of the parties with respect to the subject matter and supersedes all prior understandings.
8.5 Counterparts & Electronic Signatures
This Consent may be executed in counterparts and by electronic signature, each of which is deemed an original and all of which constitute one instrument.
9. EXECUTION BLOCK
IN WITNESS WHEREOF, Consenting Parent executes this Consent on the Execution Date.
[CONSENTING PARENT NAME]
Signature: ____
Date: ________
[// GUIDANCE: If two parents are required to consent, duplicate signature lines.]
NOTARIZATION
State of Vermont )
County of [COUNTY] ) ss.
On this ___ day of __, 20_, before me, the undersigned notary public, personally appeared [CONSENTING PARENT NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.
Notary Public
My Commission Expires: _______
ACCEPTANCE BY DCF (If Applicable)
The Department for Children and Families hereby acknowledges receipt of this Consent and agrees to present it to the Court in connection with the pending adoption petition.
By: ______
Name: [DCF REPRESENTATIVE]
Title: ____
Date: ______
[// GUIDANCE: Attachments—include (1) medical/social history, (2) counseling certificate, (3) any post-adoption contact agreement draft.]