Agency Adoption Agreement

AGENCY ADOPTION AGREEMENT

AGREEMENT INFORMATION

PARTIES TO THIS AGREEMENT

Licensed Adoption Agency

Prospective Adoptive Parent(s)

Adoptive Parent 1:

Adoptive Parent 2 (if applicable):

Marital Status:

☐ Married (Date of Marriage: _____________)

☐ Domestic Partnership (Date: _____________)

☐ Single

SECTION I: TYPE OF ADOPTION

1.1 Adoption Program

☐ Domestic Infant Adoption

☐ Domestic Older Child Adoption

☐ Foster Care Adoption

☐ Intercountry Adoption (Hague Convention Country)

☐ Intercountry Adoption (Non-Hague Country)

☐ Special Needs Adoption

☐ Other: _____________

1.2 Child Preferences (if applicable)

1.3 Required Jurisdiction and Case Screening

Before signing, Agency counsel must identify and attach the current controlling requirements:

The parties must not treat a proposed federal bill as enacted authority. H.R. 6170 and S. 3285, styled the “ADOPT Act of 2025,” were introduced in the 119th Congress but had not become law as of August 8, 2026.

SECTION II: AGENCY SERVICES AND OBLIGATIONS

2.1 Services Provided by Agency

The Agency agrees to provide the following services:

☐ Pre-adoption education and training

☐ Home study preparation and completion

☐ Criminal background checks coordination

☐ Child abuse registry clearances

☐ Matching services with birth parents/children

☐ Birth parent counseling (if applicable)

☐ Legal services coordination

☐ Medical and social history compilation

☐ Placement services

☐ Post-placement supervision and reports

☐ Court report preparation for finalization

☐ Interstate Compact (ICPC) processing (if applicable)

☐ Intercountry adoption services (if applicable)

☐ Post-adoption support services

☐ Other: _____________

2.2 Agency Obligations

The Agency agrees to:

☐ Maintain every license, accreditation, approval, supervision arrangement, or exemption required for the selected services and jurisdictions

☐ Comply with all applicable state and federal adoption laws

☐ Act in the best interests of the child at all times

☐ Provide child information accurately and completely to the extent required and permitted by applicable disclosure and confidentiality law

☐ Disclose known medical, social, and family history as required and permitted by applicable law

☐ Process applications in a timely manner

☐ Maintain confidentiality of all parties

☐ Provide written policies and procedures

☐ Comply with the Interstate Compact on the Placement of Children (ICPC) when applicable

☐ For an intercountry adoption, determine and use the provider status authorized for the case under 42 U.S.C. § 14921 and 22 C.F.R. part 96, and satisfy applicable Convention, federal, foreign, and state requirements

☐ Provide 24-hour emergency contact during placement

SECTION III: ADOPTIVE PARENT OBLIGATIONS

3.1 Pre-Placement Requirements

Prospective Adoptive Parent(s) agree to:

☐ Complete all required application forms truthfully and completely

☐ Participate in pre-adoption education/training programs

☐ Cooperate fully with home study process

☐ Submit to criminal background checks (state and federal)

☐ Authorize child abuse or neglect registry checks for the jurisdictions and lookback periods required by applicable law

☐ Provide medical examinations or screening required by applicable law or a disclosed, lawful Agency policy

☐ Submit financial documentation as requested

☐ Provide personal and professional references

☐ Notify Agency immediately of any material changes in circumstances

☐ Attend all scheduled appointments and meetings

3.2 Placement and Post-Placement Requirements

Prospective Adoptive Parent(s) agree to:

☐ Provide a safe, loving, and nurturing home for the child

☐ Meet all of the child's physical, emotional, educational, and medical needs

☐ Cooperate with post-placement supervision visits

☐ Allow Agency access to child and home during supervisory period

☐ Not change residence without prior notice to Agency

☐ Notify Agency of any significant changes affecting the child

☐ Complete all legal requirements for adoption finalization

☐ Maintain health insurance coverage for the child

☐ Do not transfer custody or return the child except in compliance with controlling consent, revocation, court-order, safety, and placement requirements; promptly contact Agency and counsel

☐ Contact Agency immediately if unable to care for child

SECTION IV: HOME STUDY REQUIREMENTS

4.1 Home Study Components

The home study will include:

☐ Personal interviews with each prospective adoptive parent

☐ Joint interviews (if applicable)

☐ Interviews with all household members

☐ Home safety inspection

☐ Verification of income and employment

☐ Review of medical reports

☐ Criminal background check clearances

☐ Child abuse/neglect registry clearances

☐ Reference checks (minimum [NUMBER] references)

☐ Autobiographical statements

☐ Parenting assessment

☐ Review of marriage/divorce records

4.2 Home Study Timeline

4.3 Home Study Updates

☐ Home study updates required every [INSERT PERIOD AND AUTHORITY] if placement not achieved

☐ Update fee: $[AMOUNT]

☐ Significant life changes require immediate notification and possible update

SECTION V: FEES AND PAYMENT SCHEDULE

5.1 Fee Schedule

5.2 Additional Possible Costs

5.3 Payment Terms

☐ Payment plans available: ☐ Yes ☐ No

☐ Accepted payment methods: ☐ Check ☐ Credit Card ☐ Wire Transfer

☐ All fees are due as indicated unless alternative arrangements approved in writing

5.4 Refund Policy

☐ Application fee: ☐ Refundable ☐ Non-refundable

☐ Home study fee: ☐ Refundable if not started ☐ Pro-rated ☐ Non-refundable

☐ Program fees: [DESCRIBE REFUND POLICY]

☐ In the event of a failed match or disrupted placement: [DESCRIBE POLICY]

SECTION VI: MATCHING AND PLACEMENT

6.1 Matching Process

☐ Agency will present potential matches based on stated preferences

☐ Prospective Adoptive Parents have [NUMBER] days to accept or decline a match

☐ Declining a match [WILL/WILL NOT] affect placement on waiting list

☐ Match acceptance requires signing of Match Agreement

6.2 Placement Process

☐ Placement will occur after:

• All consents obtained
• ICPC authorization when required by the sending and receiving jurisdictions
• Agency placement approval
• Any required waiting periods

☐ Estimated timeline from match to placement: [TIMEFRAME]

6.3 Failed Matches and Disrupted Placements

☐ If a birth parent seeks to withdraw or revoke consent, follow the controlling law and court process described here: [CITATION AND PROCESS]

☐ In the event of disrupted placement after child in home: [DESCRIBE PROCESS]

☐ Financial responsibility for failed match/disruption: [DESCRIBE]

SECTION VII: CONFIDENTIALITY

7.1 Confidentiality Obligations

☐ Agency will maintain confidentiality of all parties per state law

☐ Adoptive Parents agree to maintain confidentiality of birth parent information

☐ Information sharing governed by: [STATE STATUTE]

7.2 Information Disclosure

☐ Non-identifying information will be provided to Adoptive Parents

☐ Identifying information will be shared only: [DESCRIBE CONDITIONS]

☐ Post-adoption contact registry available: ☐ Yes ☐ No

SECTION VIII: OPEN ADOPTION PROVISIONS

8.1 Post-Adoption Contact

☐ This is a closed adoption with no post-adoption contact

☐ This is an open adoption with contact provisions (see attached Post-Adoption Contact Agreement)

☐ Level of openness to be determined at match

8.2 Agency Role in Open Adoption

☐ Agency will facilitate initial contact arrangements

☐ Agency will mediate disputes regarding contact

☐ Agency will maintain contact information updates

SECTION IX: TERMINATION OF AGREEMENT

9.1 Termination by Prospective Adoptive Parents

Prospective Adoptive Parents may terminate this Agreement by:

☐ Providing written notice to Agency

☐ Refund of fees governed by Section V

9.2 Termination by Agency

Agency may terminate this Agreement if:

☐ Prospective Adoptive Parents fail to complete required steps

☐ Home study reveals a disqualifying factor under the attached law or disclosed lawful policy

☐ Material misrepresentation discovered

☐ Prospective Adoptive Parents fail to pay required fees

☐ Prospective Adoptive Parents fail to comply with Agreement terms

☐ Significant change in circumstances makes placement inadvisable

9.3 Effects of Termination

Upon termination:

☐ All services will cease

☐ Agency will retain, control, release, transfer, or destroy records only as permitted by the attached jurisdiction-specific records policy and applicable law

☐ Refund policy in Section V applies

☐ Confidentiality obligations survive termination

SECTION X: DISPUTE RESOLUTION

10.1 Grievance Procedure

☐ Initial complaint to be submitted in writing to: [CONTACT]

☐ Response within [NUMBER] business days

☐ Appeal to Executive Director within [NUMBER] days

10.2 Mediation

☐ Parties agree to attempt mediation before litigation

☐ Mediation costs shared equally

10.3 Governing Law

This Agreement shall be governed by the laws of the State of [STATE].

SECTION XI: REPRESENTATIONS AND WARRANTIES

11.1 Agency Representations

Agency represents and warrants:

☐ Agency is duly licensed to provide adoption services in [STATE]

☐ Agency maintains all required accreditations

☐ Agency has not had its license suspended or revoked

☐ Agency maintains professional liability insurance

☐ Agency complies with all applicable laws and regulations

11.2 Prospective Adoptive Parent Representations

Prospective Adoptive Parent(s) represent and warrant:

☐ All information provided is true and accurate

☐ Neither has been convicted of a disqualifying criminal offense

☐ Neither has had parental rights terminated

☐ Neither has a substantiated child abuse/neglect finding

☐ Both are legally eligible to adopt in [STATE]

☐ Both understand the legal responsibilities of adoption

SECTION XII: ACKNOWLEDGMENTS

Prospective Adoptive Parent(s) acknowledge:

☐ We have received and reviewed the Agency's written policies and procedures

☐ We understand there is no guarantee of placement

☐ We understand adoption timelines are unpredictable

☐ We understand fees may change and additional costs may arise

☐ We understand the Agency cannot guarantee future health or development; this acknowledgment does not waive any required disclosure or remedy for fraud, concealment, or misrepresentation

☐ We have been advised to consult with independent legal counsel

☐ We have had opportunity to ask questions about this Agreement

☐ We enter into this Agreement voluntarily

JURISDICTION-SPECIFIC SCHEDULE

Do not rely on a multistate summary or default timing rule. Counsel must complete this schedule from current official law for every relevant jurisdiction.

SECTION XIII: SIGNATURES

By signing below, the parties agree to be bound by the terms of this Agreement.

ADOPTION AGENCY:

Signature: _________________________________

Print Name: _________________________________

Title: _________________________________

Date: _________________________________

PROSPECTIVE ADOPTIVE PARENT 1:

Signature: _________________________________

Print Name: _________________________________

Date: _________________________________

PROSPECTIVE ADOPTIVE PARENT 2 (if applicable):

Signature: _________________________________

Print Name: _________________________________

Date: _________________________________

OPTIONAL NOTARY ACKNOWLEDGMENT

Use only if required or appropriate under the selected jurisdiction's law and notarial form requirements.

State of [STATE]
County of [COUNTY]

On [DATE], before me, a Notary Public, personally appeared the above-named individuals, proved to me on the basis of satisfactory evidence to be the persons whose names are subscribed to this instrument and acknowledged that they executed the same.

WITNESS my hand and official seal.

Notary Signature: _________________________________

Print Name: _________________________________

Commission Expires: _________________________________

[NOTARY SEAL]

ATTACHMENTS

☐ Attachment A: Agency Policies and Procedures

☐ Attachment B: Fee Schedule Details

☐ Attachment C: Home Study Requirements Checklist

☐ Attachment D: Pre-Adoption Education Requirements

☐ Attachment E: Grievance Procedures

☐ Attachment F: Post-Adoption Contact Agreement (if applicable)

☐ Attachment G: Adoption Assistance Agreement (if applicable)

DOCUMENT CONTROL

OFFICIAL FEDERAL SOURCES

• 42 U.S.C. § 14921, accreditation or approval for Convention adoption services — https://www.govinfo.gov/app/details/USCODE-2024-title42/USCODE-2024-title42-chap143-subchapII-sec14921
• 22 C.F.R. part 96, intercountry-adoption accreditation and approval — https://www.ecfr.gov/current/title-22/chapter-I/subchapter-J/part-96
• 42 U.S.C. § 1996b, interethnic adoption nondiscrimination — https://www.govinfo.gov/app/details/USCODE-2024-title42/USCODE-2024-title42-chap21-subchapI-sec1996b
• 25 U.S.C. ch. 21, Indian Child Welfare — https://www.govinfo.gov/app/details/USCODE-2024-title25/USCODE-2024-title25-chap21
• Congress.gov, H.R. 6170 status (introduced and referred; not enacted as of August 8, 2026) — https://www.congress.gov/bill/119th-congress/house-bill/6170/all-info
• Congress.gov, S. 3285 status (introduced and referred; not enacted as of August 8, 2026) — https://www.congress.gov/bill/119th-congress/senate-bill/3285/all-info

This Agreement is provided for informational purposes only. Agency adoption agreements must comply with specific state licensing requirements. Consult with a qualified attorney and your adoption agency for guidance specific to your situation.