PARENTAL CONSENT AND RELINQUISHMENT OF PARENTAL RIGHTS FOR ADOPTION
State of West Virginia
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
- Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
This Parental Consent and Relinquishment of Parental Rights for Adoption (this “Consent”) is executed as of [EXECUTION DATE] (the “Effective Date”) by [CONSENTING PARENT NAME], residing at [ADDRESS] (“Consenting Parent”), in favor of [PETITIONER(S) NAME(S)] (the “Petitioner(s)”) and the State of West Virginia Family Court for [COUNTY] County (the “Family Court”).
Recitals
A. Consenting Parent is the lawful [mother/father] of [CHILD’S FULL LEGAL NAME], born on [DOB] in [CITY, COUNTY, STATE] (the “Child”).
B. Petitioner(s) intend to adopt the Child pursuant to the laws of the State of West Virginia.
C. West Virginia adoption statutes require the voluntary, informed, and written consent of the Child’s biological parent(s).
D. Consenting Parent desires to permanently relinquish all parental rights and obligations to facilitate the Child’s adoption and placement with the Petitioner(s).
NOW, THEREFORE, in consideration of the foregoing and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Consenting Parent states and agrees as follows:
2. DEFINITIONS
For purposes of this Consent, the following terms have the meanings set forth below:
“Act” means the West Virginia statutes governing adoption as amended from time to time.
“Child” has the meaning set forth in Recital A.
“Counseling Provider” means the individual or entity that furnished statutorily-required pre-consent counseling to Consenting Parent.
“Execution Date” means the calendar date on which Consenting Parent signs this Consent.
“Family Court” has the meaning set forth in the Document Header.
“Petitioner(s)” has the meaning set forth in the Document Header.
“Revocation Period” means the statutory period during which this Consent may be revoked, being [NUMBER OF DAYS UNDER CURRENT WV LAW] days from the Execution Date or such other period as the Act may prescribe.
[// GUIDANCE: Confirm current statutory period. Insert appropriate number before use.]
3. OPERATIVE PROVISIONS
3.1 Consent to Adoption and Relinquishment. Consenting Parent hereby:
(a) Unconditionally and irrevocably consents to the adoption of the Child by the Petitioner(s);
(b) Relinquishes, surrenders, and terminates all parental rights, duties, privileges, and obligations with respect to the Child, subject only to Section 3.4 (Revocation).
3.2 Timing of Execution. Consenting Parent affirms that this Consent is executed not earlier than the statutory waiting period following the Child’s birth and that any additional timing requirements under the Act have been satisfied.
[// GUIDANCE: WV law historically requires a minimum post-birth waiting period (e.g., 72 hours). Confirm and modify if necessary.]
3.3 Counseling Requirement. Consenting Parent acknowledges having received at least [NUMBER] hours of pre-consent counseling from the Counseling Provider on or before the Execution Date and has been advised of:
(a) The legal effect of execution and potential consequences of revocation;
(b) Available alternatives to adoption; and
(c) Support services that may be available if the Child is retained.
The Counseling Provider’s written certification is attached hereto as Exhibit A and incorporated herein.
3.4 Revocation.
(a) Right to Revoke. Consenting Parent may revoke this Consent only by delivering a written, notarized statement of revocation to the Family Court within the Revocation Period.
(b) Effect of Revocation. Upon timely and proper revocation, all rights relinquished herein shall be deemed restored as if this Consent had never been executed, subject to further order of the Family Court.
(c) Irrevocability After Revocation Period. If no timely revocation is received, this Consent becomes final, binding, and irrevocable.
3.5 Consideration. Consenting Parent acknowledges receiving [NONE / LAWFUL REIMBURSEMENT OF PREGNANCY-RELATED EXPENSES ONLY] and no other compensation for executing this Consent.
3.6 Delivery to Court. Consenting Parent authorizes Counsel for Petitioner(s) to file this Consent, together with all required exhibits, with the Family Court.
4. REPRESENTATIONS & WARRANTIES
4.1 Authority and Capacity. Consenting Parent is at least [AGE] years of age, is legally competent, and has full authority to execute this Consent.
4.2 Voluntariness. Execution of this Consent is voluntary and free from duress, fraud, undue influence, or coercion.
4.3 No Pending Litigation. There is no pending litigation, custody dispute, or protective order that would prohibit, impair, or delay the adoption of the Child.
4.4 Exclusive Rights. Consenting Parent has not previously assigned or otherwise transferred any parental rights in the Child to any person or entity.
4.5 Accuracy of Information. All information provided herein and in any attachments is true, complete, and correct to the best of Consenting Parent’s knowledge.
4.6 Survival. The representations and warranties in this Section 4 survive the Effective Date and remain in effect notwithstanding any subsequent proceedings.
5. COVENANTS & RESTRICTIONS
5.1 Future Cooperation. Consenting Parent shall execute and deliver any additional documents reasonably requested by the Petitioner(s) or the Family Court to effectuate the adoption.
5.2 Non-interference. Consenting Parent shall not interfere with or contest the adoption petition after expiration of the Revocation Period, except as required by law.
5.3 Confidentiality. Consenting Parent agrees to keep confidential all non-public information obtained in connection with the adoption, except as required by law or court order.
6. DEFAULT & REMEDIES
6.1 Default. A “Default” occurs if Consenting Parent materially breaches any covenant, representation, or warranty in this Consent prior to finalization of the adoption.
6.2 Remedies. Upon Default, and subject to the Act, the Family Court may:
(a) Void this Consent;
(b) Reinstate parental rights;
(c) Grant such other relief as equity requires, including attorney’s fees and costs.
7. DISPUTE RESOLUTION
7.1 Governing Law. This Consent is governed by the laws of the State of West Virginia without regard to conflict-of-laws principles.
7.2 Exclusive Forum. The Family Court of [COUNTY] County, West Virginia, shall have exclusive jurisdiction over any dispute arising under or relating to this Consent.
7.3 Arbitration. Arbitration is not available for matters governed by the Family Court’s exclusive jurisdiction.
7.4 Jury Waiver. Jury trial is unavailable in Family Court proceedings; all determinations shall be made by the presiding judge.
7.5 Injunctive Relief. Consenting Parent acknowledges that the stability and permanency of the Child’s placement constitute good cause for the Family Court to grant permanent placement orders or other equitable relief.
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 or contemporaneous understandings.
8.2 Amendments. No amendment or waiver of any provision of this Consent is effective unless it is in writing and signed by Consenting Parent and approved by the Family Court.
8.3 Severability. If any provision of this Consent is held invalid or unenforceable, the remainder shall continue in full force to the maximum extent permissible.
8.4 Assignment. This Consent is personal to Consenting Parent and may not be assigned.
8.5 Successors and Assigns. This Consent binds Consenting Parent and inures to the benefit of the Petitioner(s) and their permitted successors and assigns.
8.6 Counterparts; Electronic Signatures. This Consent may be executed in counterparts, each of which is deemed an original, and all of which constitute one instrument. Signatures transmitted electronically or via facsimile are binding.
9. EXECUTION BLOCK
IN WITNESS WHEREOF, Consenting Parent executes this Consent as of the Effective Date.
[CONSENTING PARENT NAME]
Consenting Parent
Date: _________
[// GUIDANCE: The following notarial certificate is drafted to comply with WV acknowledgment standards. Confirm formatting with local clerk.]
State of West Virginia
County of _________
This instrument was acknowledged before me on [DATE] by [CONSENTING PARENT NAME].
Notary Public
My Commission Expires: ____
Exhibit A – Counseling Provider Certification
[Attach signed statement from Counseling Provider confirming statutory counseling completion, dates, and compliance.]
[// GUIDANCE:
1. Verify all statutory waiting periods and revocation timelines under current WV law before finalizing Sections 3.2 and 3.4.
2. Attach any additional exhibits required by local court rules (e.g., Social/Medical History, ICPC documentation, guardian ad litem report).
3. Advisable for Consenting Parent to be represented by independent counsel; include counsel’s acknowledgment certificate if required.
4. File original executed Consent with the appropriate Family Court clerk along with the adoption petition.]