Adoption Consent Form - Preparation Worksheet - West Virginia

WEST VIRGINIA ADOPTION-CONSENT AND RELINQUISHMENT PREPARATION PACKET

Do not sign this packet. West Virginia law distinguishes a consent that
transfers custody to prospective adoptive parent(s) from a relinquishment
that transfers custody to an agency. The operative instrument must match the
placement route and include every applicable statement in § 48-22-303.

There is no general number-of-days revocation window. Section 48-22-305
permits revocation only on specified grounds, with different proof and timing
rules. Do not promise that a notarized letter delivered within a placeholder
period will revoke a consent or relinquishment.

1. MATTER AND ROUTE

Select one route for each signer:

☐ Consent: voluntary and unequivocal transfer of legal and physical custody
to, and consent to adoption by, prospective adoptive parent(s). Their names may,
but need not, be specified under § 48-22-303(a)(5).

☐ Relinquishment: voluntary permanent transfer of legal and physical custody
to an agency for adoption under § 48-22-303(a)(6).

☐ Child's consent: child is age 12 or older and will consent in the presence
of a judge, unless the court finds extraordinary cause to waive that consent
under § 48-22-301(f).

☐ Stepparent route: stop for separate analysis. Under § 48-22-301(b)(3),
the birth or adoptive parent married to the petitioning adoptive parent assents
by joining the petition; do not substitute this worksheet for that joinder.

☐ Possible Indian-child status. Stop for Indian Child Welfare Act and tribal-
law review before drafting or execution.

Attorney's route conclusion:

[____________________________________________________________]

2. REQUIRED-SIGNER SCREEN UNDER § 48-22-301

For each person, record whether consent, relinquishment, joinder, a prior order,
or a court finding is required. Do not infer an exception from absence, lack of
contact, or an informal custody arrangement.

If a signer is under a disability, § 48-22-301(c) requires a separate court
analysis. If all persons entitled to parental rights are deceased or have been
deprived of custody by law, § 48-22-301(d) addresses the guardian, legal
custodian, or court-appointed next friend. Counsel's analysis:

[____________________________________________________________]

3. SIGNER AND CHILD INFORMATION

Section 48-22-303 requires the operative instrument to contain, as applicable:

Language gate:

☐ Signer understands English; the operative instrument will be in plain English.

☐ Signer does not understand English; the operative instrument will be in the
signer's primary language: [________________]. Interpreter/translator and
qualification: [__________________________________________________________].

4. SEVENTY-TWO-HOUR TIMING GATE

Section 48-22-302(a) prohibits execution before 72 hours have expired after
birth. Record actual times; do not count by calendar date alone.

☐ Counsel confirmed that proposed execution occurs after—not at an assumed
calendar-day substitute for—the statutory 72-hour period.

Attorney timing approval: [________________________________]

5. REQUIRED SUBSTANTIVE STATEMENTS UNDER § 48-22-303

The operative instrument must state each applicable item below in the form
required by current law. This checklist is not the statutory language and must
not be attached as a substitute.

☐ The document is executed more than 72 hours after the child's birth.

☐ For a consent, the signer voluntarily and unequivocally consents to transfer
of legal and physical custody to, and adoption by, the prospective adoptive
parent(s), whether named or unnamed as counsel selects.

☐ For a relinquishment, the signer voluntarily consents to permanent transfer
of legal and physical custody to the agency for adoption.

☐ The prospective adoptive parents or agency may consent to the child's medical
treatment pending the adoption proceeding.

☐ After signature and acknowledgment, the consent or relinquishment is final
and, unless revoked under § 48-22-305, cannot be revoked or set aside for another
reason.

☐ Adoption permanently terminates all parental rights, including visitation,
communication, and inheritance rights.

☐ Adoption permanently terminates all parental obligations.

☐ Termination remains permanent whether or not a later visitation or
communication agreement is performed.

☐ The signer acts freely, and the consent or relinquishment was not obtained by
fraud or duress.

☐ The signer received a copy of the consent or relinquishment.

☐ The signer received information and an opportunity to participate in the
voluntary adoption registry referenced in § 48-22-303(a)(13)(ii).

☐ The signer was advised of the availability of counseling. This is not a
certification that counseling was mandatory or completed.

☐ The signer was advised of the consequences of misidentifying the other birth
parent.

☐ If the signer is a birth mother, she received the required advice concerning
information about an unknown father.

☐ The signer has not received or been promised money or value for the consent
or relinquishment other than payments authorized by the statute cited in
§ 48-22-303(a)(14). Counsel verified any payment separately.

☐ The instrument states whether the child is an “Indian child” as defined by
the Indian Child Welfare Act.

☐ The signer believes the adoption is in the child's best interest.

☐ The signer expressly waives notice of an adoption proceeding unless the
adoption is contested, appealed, or denied.

6. CONDITIONAL REVOCATION, CONTACT, AND INSTRUCTIONS

A. Optional express condition

Section 48-22-303(b) permits an instrument to provide expressly for conditional
revocation only when:

☐ another required person does not execute within a specified period;

☐ a court does not terminate another person's parental relationship; or

☐ in a direct placement, the petition of a prospective adoptive parent named
or described in the consent is denied or withdrawn.

Selected condition, exact deadline or event, and drafting instructions:

[____________________________________________________________]

☐ No conditional-revocation provision will be included.

B. Required contact information

For a consent, include the prospective adoptive parents' lawyer's name,
address, telephone number, and facsimile number. For a relinquishment, include
the agency's corresponding information.

C. Specific revocation instructions

Section 48-22-303(c)(3) requires specific instructions on how to revoke. The
instructions must be drafted for the selected route and the actual § 48-22-305
ground; a generic “send a notarized letter within ___ days” clause is unsafe.

Attorney-drafted instruction text, recipients, addresses, filing method, and
proof-of-delivery plan:

[____________________________________________________________]

7. REVOCATION ANALYSIS UNDER § 48-22-305

Counsel must explain that revocation is available only through one of these
routes:

1. The signer and the named or described prospective adoptive parent, that
   parent's lawyer, or the agency agree to revocation before an adoption order.

2. The signer proves fraud or duress by clear and convincing evidence in an
   action filed within six months after execution or before the adoption order
   is final, whichever date is later.

3. Before entry of an adoption order, the signer proves by a preponderance of
   the evidence that an expressly stated conditional-revocation event occurred.

4. Before entry of an adoption order, the signer proves by clear and convincing
   evidence that the instrument does not comply with Article 22.

☐ Signer received a case-specific explanation of each applicable ground,
burden, deadline, forum, filing requirement, and emergency contact.

☐ No private default, damages, attorney-fee, noninterference, confidentiality,
arbitration, jury-waiver, injunction, consideration, warranty, severability,
assignment, counterpart, or electronic-signature term was added.

8. ACKNOWLEDGMENT UNDER § 48-22-302

A parent or guardian's consent or relinquishment must be signed and
acknowledged in the presence of one authorized official:

☐ Judge of a court of record.

☐ Person designated by a judge of a court of record to take consents or
relinquishments; designation verified and retained.

☐ Notary public; commission and identity-verification requirements confirmed.

☐ Commissioned active-duty U.S. military officer, because the signer is in
military service.

☐ U.S. foreign-service or consular officer in another country, because the
signer is in that country.

Do not assume remote notarization, an e-signature platform, a PDF signature,
facsimile, or counterparts satisfy the required presence and acknowledgment.

9. PARENT UNDER 18

If the signer will be under 18 when the adoption petition is filed and is a
West Virginia resident, § 48-22-304 requires specific court review and approval
of the consent or relinquishment; the court may appoint a guardian ad litem.

☐ Not applicable; signer will be age 18 or older at filing.

☐ Applicable. Counsel will present the instrument for specific court review
and approval.

Do not state that minority alone invalidates an otherwise valid consent or
relinquishment. Do not omit the review-and-approval route.

10. FINAL ATTORNEY CONTROL

☐ Every required signer, exception, disability, prior termination, alleged
abandonment, and child-consent issue was investigated.

☐ Consent versus agency relinquishment was selected correctly.

☐ The operative document is in plain English or the signer's primary language.

☐ Every applicable item in § 48-22-303(a) and (c) appears in the instrument.

☐ Any conditional-revocation clause fits § 48-22-303(b) exactly.

☐ Birth and execution times establish compliance with the 72-hour rule.

☐ The acknowledgment official is authorized under § 48-22-302(b).

☐ Minor-parent court review under § 48-22-304 is calendared if applicable.

☐ Specific § 48-22-305 revocation instructions were checked against the actual
case, court, lawyer or agency, and current law.

☐ The signer received a copy and the required registry, counseling,
other-parent-identification, payment, Indian-child, permanency, and notice
advisements were documented.

Attorney name and West Virginia Bar number: [______________________________]

Review date: [__/__/____]

Selected operative form/version and file location: [_______________________]

OFFICIAL SOURCES

• W. Va. Code § 48-22-301 — required persons and exceptions
• W. Va. Code § 48-22-302 — timing and acknowledgment
• W. Va. Code § 48-22-303 — required contents
• W. Va. Code § 48-22-304 — parent under 18
• W. Va. Code § 48-22-305 — revocation