Adoption Consent Form

CONSENT TO TERMINATION OF PARENTAL RIGHTS AND ADOPTION

(State of Wisconsin – Wis. Stat. ch. 48)

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
4. Representations & Warranties
5. Covenants & Restrictions
6. Withdrawal of Consent & Revocation Parameters
7. Dispute Resolution
8. General Provisions
9. Acknowledgments & Certifications
10. Execution Block

1. DOCUMENT HEADER

1.1 Title. Consent to Termination of Parental Rights and Adoption (“Consent”).

1.2 Parties.
(a) “[FULL LEGAL NAME]” (“Consenting Parent”).
(b) “[FULL LEGAL NAME]” (“Child”), born on [DATE OF BIRTH] at [HOSPITAL/CITY], Wisconsin.
(c) “[FULL LEGAL NAME(S)]” (“Prospective Adoptive Parent(s)”) [optional].
(d) “[NAME OF LICENSED CHILD-PLACING AGENCY]” (“Agency”) [if applicable].

1.3 Effective Date. This Consent is effective on the date it is executed before the Court as required by Wis. Stat. § 48.41(2).

1.4 Governing Law & Venue. This Consent is governed by the laws of the State of Wisconsin. Exclusive venue lies in the [COUNTY] Circuit Court, Family Division (the “Court”).

2. DEFINITIONS

For purposes of this Consent:

“Agency” means the licensed Wisconsin child-placing agency identified above or any successor entity approved by the Court.

“Child” has the meaning set forth in Section 1.2(b).

“Court” has the meaning set forth in Section 1.4.

“Counselor” means a qualified adoption counselor or social worker who provides any counseling the Consenting Parent elects to receive, as referenced in Section 3.4. Wisconsin does not require a minimum number of counseling sessions as a condition of a valid consent.

“Consenting Parent” has the meaning set forth in Section 1.2(a).

“Prospective Adoptive Parent(s)” has the meaning set forth in Section 1.2(c).

3. OPERATIVE PROVISIONS

3.1 Voluntary Consent. Consenting Parent hereby voluntarily, knowingly, and irrevocably (subject to Section 6) consents to:
(a) the termination of all parental rights to the Child; and
(b) the placement of the Child for adoption by the Agency or directly with the Prospective Adoptive Parent(s).

3.2 Timing Requirement. Consent to a voluntary termination of parental rights is given by the Consenting Parent’s personal appearance before the Court at a hearing (Wis. Stat. § 48.41(2)(a)). Where the Child is placed for adoption with nonrelatives, the Court holds the hearing within 30 days after the petitions are filed, except that the hearing may not be held before the birth of the Child (Wis. Stat. § 48.837(4)(a)). Wisconsin law imposes no fixed post-birth waiting period (e.g., 72 hours) as a condition of a voluntary consent; the 72-hour reference in Wisconsin law is a ground for involuntary termination under Wis. Stat. § 48.415, not a waiting period for voluntary consent. Date and time of the Child’s birth: ______________.

3.3 Court Appearance. Consenting Parent acknowledges that:
(a) this Consent must be reaffirmed personally before the Court; and
(b) the Court will determine whether the Consent is informed and voluntary, and may accept it only after the judge has explained the effect of termination and questioned the Consenting Parent, as required by Wis. Stat. § 48.41(2)(a).

3.4 Counseling (Optional).
(a) Wisconsin does not require the Consenting Parent to complete or be offered any minimum number of counseling sessions as a condition of a valid consent. Any pre-adoptive or post-adoptive counseling the Consenting Parent elects to receive is among the expenses the Prospective Adoptive Parent(s) may lawfully pay under Wis. Stat. § 48.913(1).
(b) If counseling was received, session date(s): ____________________________.
(c) If a Counselor Certificate is provided, it is attached at Section 9.2; no such certificate is required for this Consent to be valid.

3.5 Consideration. No monetary consideration, material promise, or inducement has been offered or accepted by the Consenting Parent other than permissible adoption-related expenses authorized by Wis. Stat. § 48.913.

4. REPRESENTATIONS & WARRANTIES

Consenting Parent represents and warrants to the Court and the Agency that:

a. Parentage & Authority. Consenting Parent is the Child’s legal [mother/father] and has full legal capacity to execute this Consent.
b. Absence of Coercion. No fraud, duress, or undue influence has been exerted.
c. Exclusive Rights. No other person holds custodial or parental rights to the Child, except as disclosed in Schedule 1 (Other Potential Parents) attached hereto.
d. Substance Capacity. Consenting Parent is not under the influence of any impairing substance.
e. Independent Advice. Consenting Parent has been advised of the right to consult independent counsel and either: (i) has had adequate opportunity to do so, or (ii) knowingly waives that right.

5. COVENANTS & RESTRICTIONS

a. Future Cooperation. Consenting Parent shall execute any further documents reasonably required to effectuate the adoption.
b. Contact Provisions. Entry of the TPR Order severs all parental rights, including any right to contact or visitation (Wis. Stat. § 48.40(2)). Wisconsin does not provide a generally enforceable open-adoption/post-adoption-contact statute; any future contact with the Child shall occur only as permitted by subsequent court order or as otherwise authorized by law.
c. Confidentiality. Consenting Parent shall maintain confidentiality of identifying information concerning Prospective Adoptive Parent(s) unless disclosure is authorized by law or court order.

6. WITHDRAWAL OF CONSENT & REVOCATION PARAMETERS

6.1 Permissible Withdrawal Before TPR Order.
Consenting Parent may file a written petition with the Court to withdraw this Consent at any time before the Court enters the Order Terminating Parental Rights (“TPR Order”).

6.2 Effect of TPR Order.
Upon entry of the TPR Order, this Consent becomes final. For a parent who has consented to termination under Wis. Stat. § 48.41, the exclusive post-judgment remedies are:
a. a notice of intent to pursue relief from the judgment, which must be filed in the trial court within thirty (30) days after entry of the judgment to preserve appellate relief (Wis. Stat. §§ 48.42(4)(c)3., 808.04(7m); 809.107); and
b. a motion for relief from the judgment under Wis. Stat. § 48.46(2), limited to the grounds in Wis. Stat. § 806.07(1)(a), (b), (c), (d), or (f) (mistake, newly discovered evidence, fraud/misrepresentation/misconduct, void judgment, or reversed prior judgment), which must be filed within 30 days after entry of the judgment unless a timely notice of intent under par. (a) is filed.

6.3 Procedure.
Motions and petitions under Section 6.2 must comply with Wis. Stat. § 48.46 and be served upon all parties of record. A motion under § 48.46(2) does not suspend the operation of the TPR Order.

7. DISPUTE RESOLUTION

Because matters relating to adoption are within the exclusive jurisdiction of state courts:

a. Governing Law: State of Wisconsin.
b. Forum Selection: [COUNTY] Circuit Court, Family Division.
c. Arbitration: Not available.
d. Jury Waiver: All issues are to be decided by the Court sitting without a jury, consistent with “no_jury_family_court.”
e. Injunctive Relief: The Court retains authority to enter any orders necessary for permanent placement and the best interests of the Child.

8. GENERAL PROVISIONS

8.1 Entire Agreement. This Consent, including all attachments, constitutes the entire agreement regarding the matters herein and supersedes any prior statements.

8.2 Amendments. May be amended only in a writing executed by the Consenting Parent and approved by the Court before the TPR Order.

8.3 Severability. Any unenforceable provision shall be severed, and the remainder enforced to the fullest extent permitted by law.

8.4 Execution; No Electronic Signature. This Consent must be executed in the manner required by Wis. Stat. § 48.41(2) — by the Consenting Parent’s personal appearance before the Court, or, only where the statutory conditions are met, by one of the alternatives in § 48.41(2)(b)–(d) (written consent before a qualifying official with accompanying findings; a putative father’s notarized statement under (2)(c); or, in a stepparent/foreign-jurisdiction case, an affidavit witnessed by 2 persons under (2)(d)). Wisconsin’s Uniform Electronic Transactions Act does not apply to records governed by any law relating to adoption or other matters of family law, to court orders, or to official court documents required to be executed in connection with court proceedings (Wis. Stat. § 137.12(2m)(a), (c), (d)). An electronic signature therefore does not satisfy the execution requirements for this Consent.

9. ACKNOWLEDGMENTS & CERTIFICATIONS

9.1 Statement of Parental Rights (Wis. Stat. § 48.41(2)(a))

The Court may accept this Consent only after the judge has explained the effect of termination of parental rights, has questioned the Consenting Parent (or permitted an attorney for a party to do so), and is satisfied that the Consent is informed and voluntary (Wis. Stat. § 48.41(2)(a)). I, the Consenting Parent, acknowledge that the following has been read aloud to me by the Court (or that I have personally read and understood it):

1. I understand that signing this document may permanently end my parental rights to the Child.
2. I understand that I may withdraw my consent at any time before the Court enters a TPR Order, but not after, except as permitted by law.
3. I understand that the Child may be adopted by the Prospective Adoptive Parent(s) or another suitable adoptive parent.
4. I understand that I have the right to independent legal counsel and counseling services at no cost.
5. I have received a copy of this signed Consent.

Initials of Consenting Parent: _________

9.2 Counselor Certificate

I, [COUNSELOR NAME], certify that I am qualified under Wisconsin law and that:
☐ The Consenting Parent attended the counseling sessions listed in Section 3.4(b); OR
☐ The Consenting Parent knowingly and voluntarily declined such sessions.

Signature of Counselor: _________________________ Date: _____________

10. EXECUTION BLOCK

IN WITNESS WHEREOF, the undersigned executes this Consent as of the Effective Date.

Notary Block — putative father’s written statement under Wis. Stat. § 48.41(2)(c) only (not for a parent’s in-court consent under § 48.41(2)(a)):

State of Wisconsin )
County of [________________________________] )

Subscribed and sworn to before me on ____________, 20___, by _____________________________, who is personally known to me or who presented satisfactory evidence of identity.

________________________________________
Notary Public, State of Wisconsin
My Commission Expires: ________________

COURT APPROVAL

Presented to the Court this ____ day of ____________, 20__.

The Court finds that the Consenting Parent’s consent is informed, voluntary, and in compliance with Wis. Stat. § 48.41. The Court hereby accepts the Consent.

________________________________________
Circuit Court Judge

Case No.: _________________