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Consent by Birth Parent: Superior Court of California, County of Imperial 939 W. Main Street El Centro, Ca 92243

This document is a consent form for a birth parent to consent to the adoption of their child by a stepparent. The birth parent provides their name and the name of the child. They consent to the adoption of the child by the stepparent listed. By signing, the birth parent understands they are losing all rights to custody, services, and earnings of the child, and the child cannot be reclaimed. Witnesses must be present and sign to verify the birth parent's identity and consent.

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douglas jones
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268 views1 page

Consent by Birth Parent: Superior Court of California, County of Imperial 939 W. Main Street El Centro, Ca 92243

This document is a consent form for a birth parent to consent to the adoption of their child by a stepparent. The birth parent provides their name and the name of the child. They consent to the adoption of the child by the stepparent listed. By signing, the birth parent understands they are losing all rights to custody, services, and earnings of the child, and the child cannot be reclaimed. Witnesses must be present and sign to verify the birth parent's identity and consent.

Uploaded by

douglas jones
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY

TELEPHONE NO.: FAX NO. (Optional):


E-MAIL ADDRESS (Optional):
ATTORNEY FOR (Name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL


939 W. MAIN STREET
EL CENTRO, CA 92243

PETITIONER:

RESPONDENT:

CONSENT BY BIRTH PARENT CASE NUMBER:


Consent to Adoption by Birth Parent
Family Code 9003

I, _______________________, being the parent of _______________________________, do hereby


(Print Name) (Name of Child)
give my full and free consent to the adoption of said child by________________________________.
(Name of Petitioner (Stepparent))
I fully understand that with the signing of this document my consent may not be withdrawn except with

court approval, and that with the signing of the order of adoption by the court, I lose all my rights of

custody, services, and earnings of said child, and that said child cannot be reclaimed by me.

Said child was born on _________________ in ________________________________ and is the child


(Date) (City and State)
of _________________________________ and _________________________________.
(Name of Birth Parent) (Name of Birth Parent)

Executed at _____________________________ on Date ______________________ 20______ .


(County and State/Country)

______________________________________________ ________________________________________________
Signature of Parent Form of picture ID
SIGNED IN THE PRESENCE OF:
___________________________________
Name

__________________________________________ _______________________________________________
Signature Title*
*The consent of either or both birth parents shall be signed in the presence of a notary public, court clerk, probation officer,
qualified court investigator, authorized representative of a licensed adoption agency, or county welfare department staff
member of any county of this state.
NOTICE TO THE BIRTH PARENT WHO CONSENTS TO THE CHILD’S ADOPTION: If you or your child lived together
at any time as parent and child, the adoption of your child by a stepparent does not affect the child’s right to inherit your
property or the property of blood relatives. For further information regarding this right of inheritance, you should consult an
attorney.
AD-02 (Adopted 01/01/12, Revised 01/01/13, 01/01/14) CONSENT BY BIRTH PARENT

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