Adoption Consent Form - Washington

CONSENT OF PARENT TO ADOPTION

(Washington State — Court-Submission Draft)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Dispute Resolution
8. General Provisions
9. Execution Block
10. Notarial Acknowledgment

1. DOCUMENT HEADER

1.1 Title.
CONSENT OF [CONSENTING PARENT NAME] TO THE ADOPTION OF [CHILD LEGAL NAME] AND RELINQUISHMENT OF PARENTAL RIGHTS

1.2 Parties.
• “[Consenting Parent]”: [CONSENTING PARENT FULL LEGAL NAME], currently residing at [ADDRESS].
• “[Child]”: [CHILD LEGAL NAME], born [DATE OF BIRTH] in [CITY/COUNTY], Washington.
• “[Prospective Adoptive Parent(s)]”: [ADOPTIVE PARENT NAME(S)], residing at [ADDRESS(ES)].
• “[Agency]” (if applicable): [LICENSED CHILD-PLACEMENT AGENCY NAME], a Washington-licensed child-placing agency, License No. ☐.

1.3 Recitals.
A. Consenting Parent is the [biological/legal] parent of the Child and possesses the legal capacity to execute this Consent.
B. Consenting Parent desires permanently to relinquish all parental rights 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, and shall be governed by, the Washington Adoption Act, RCW ch. 26.33 (“WA Adoption Act”).
1.4 Effective Date.
This Consent has no force or effect until approved by the court. The date of court approval is the “Effective Date.”

2. DEFINITIONS

“Approval-Presentation Date” means the first date on which this Consent may be presented to the court: forty-eight hours after it is signed or forty-eight hours after the Child’s birth, whichever occurs later. RCW 26.33.160 does not state that the Consent itself may not be signed during that period.

“Agency” has the meaning set forth in Section 1.2.

“Child,” “Consenting Parent,” and “Prospective Adoptive Parent(s)” have the meanings set forth in Section 1.2.

“Court” means the Superior Court of Washington for [COUNTY] (Family & Juvenile Court).

“Revocation Rules” means the procedures in RCW 26.33.160(2)-(4). Before court approval, the consenting party may revoke by written notice delivered or mailed to the clerk. The statute also provides a narrow birth-related notice procedure, post-approval relief within one year for fraud, duress, or lack of mental competency, and separate rules for an Indian child.

3. OPERATIVE PROVISIONS

3.1 Consent to Adoption.
Subject to court approval and the Revocation Rules, Consenting Parent consents to the adoption of the Child by the Prospective Adoptive Parent(s) and requests court approval of this Consent.

3.2 Timing Compliance.
Consenting Parent records:

a. The Child was born on [DATE AND TIME OF BIRTH];

b. This Consent was signed on [DATE AND TIME SIGNED]; and

c. This Consent will not be presented to the court before [APPROVAL-PRESENTATION DATE AND TIME], which is forty-eight hours after signing or forty-eight hours after birth, whichever occurs later.

3.3 Court Order Required.
Consenting Parent understands that the court will determine whether to approve this Consent and that an order permanently terminating parental rights will be entered as part of the lawful adoption process. This signed form does not by itself terminate parental rights.

3.4 Required Statutory Information.

☐ The birth parent is ☐ of ☐ not of Native American or Alaska Native ancestry.

☐ Clerk of court where this Consent will be presented:

Name of court: [________________________________]

Mailing / delivery address: [________________________________]

☐ Consenting Parent has read the following statement required by RCW 26.33.160(4)(i):

I understand that my decision to relinquish the child is an extremely important one, that the legal effect of this relinquishment will be to take from me all legal rights and obligations with respect to the child, and that an order permanently terminating all of my parental rights to the child will be entered. I also understand that there are social services and counseling services available in the community, and that there may be financial assistance available through state and local governmental agencies.

3.5 Consideration.
No payment or inducement of any kind, other than statutorily permitted pregnancy-related expenses and Court-approved adoption costs, has been offered or accepted in exchange for this Consent.

4. REPRESENTATIONS & WARRANTIES

Consenting Parent represents and warrants, as of the Execution Date and reaffirmed as of Court approval, that:

4.1 Capacity & Authority. Consenting Parent is over eighteen (18) years of age, has not been adjudicated incompetent, and holds sole legal authority to execute this Consent.

4.2 No Prior Relinquishment. No prior relinquishment or consent to adoption concerning the Child has been executed or remains in force.

4.3 Voluntariness. This Consent is executed voluntarily, without fraud, duress, or undue influence.

4.4 Advice. Consenting Parent has had the opportunity to consult independent legal counsel before signing.

4.5 Accuracy of Information. All information provided herein and in any supporting affidavits is true, correct, and complete to the best of Consenting Parent’s knowledge.

5. COVENANTS & RESTRICTIONS

5.1 Cooperation. Consenting Parent shall execute all additional documents and perform all acts reasonably necessary to effectuate the adoption.

5.2 No Contact/Interference. Consenting Parent shall not interfere with the placement of the Child or initiate contact with the Child contrary to any post-adoption contact agreement or Court order.

5.3 Confidentiality. Consenting Parent shall keep confidential any identifying information about the Prospective Adoptive Parent(s) except as required by law.

6. STATUTORY REVOCATION AND COURT CONTROL

Approval and revocation of this Consent are governed by RCW 26.33.160. Any termination of parental rights remains subject to court order and applicable law. This Consent does not create a private default, specific-performance remedy, fee award, penalty, or shortened revocation period.

7. DISPUTE RESOLUTION

7.1 Governing Law. This Consent shall be governed by and construed in accordance with the laws of the State of Washington, including RCW ch. 26.33.

7.2 Court Submission. This Consent is intended for submission to the Superior Court identified in Section 3.4. Counsel must confirm venue and any related termination or adoption proceeding before filing.

7.3 Arbitration. Arbitration is not available for matters arising under this Consent.

7.4 Jury Provision. This Consent contains no contractual jury waiver.

7.5 Injunctive Relief. Nothing herein limits the Court’s equitable power to grant injunctive or other relief necessary to protect the Child’s best interests and placement stability.

8. GENERAL PROVISIONS

8.1 Entire Agreement. This Consent constitutes the entire agreement of the parties with respect to the subject matter and supersedes all prior agreements or understandings.

8.2 Amendments & Waivers. No amendment or waiver of any provision shall be effective unless in writing and signed by the Consenting Parent and approved by the Court.

8.3 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect to the maximum extent permitted by law.

8.4 Successors & Assigns. This Consent binds and benefits the parties and their respective heirs, representatives, successors, and assigns.

8.5 Signature Method. RCW 26.33.160 requires a written consent signed under penalty of perjury and a qualifying witness. Use the signature method and filing format accepted by the court; an optional acknowledgment does not replace the statutory witness.

9. EXECUTION BLOCK

I declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

Signed on [__/__/____] at [CITY], [STATE / COUNTRY].

______________________________________
[CONSENTING PARENT NAME]
Consenting Parent

______________________________________
Witness Signature
Name: _________________________________
Address: _______________________________
Relationship to Consenting Parent: _______________________________

10. OPTIONAL NOTARIAL ACKNOWLEDGMENT

This acknowledgment is not a substitute for the witness required by RCW 26.33.160(6). Confirm whether the receiving court requests notarization.

State of Washington )
County of ______________ ) ss.

On this ____ day of __________, 20____, before me, the undersigned Notary Public, personally appeared ______________________________, 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.

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

______________________________________
Notary Public in and for the State of Washington
My commission expires: __________________

Sources and References

• RCW 26.33.160 — Consent to adoption; when revocable; procedure (official Washington Legislature)