Adoption Consent Agreement

ADOPTION CONSENT AGREEMENT

This Adoption Consent Agreement (the Agreement) is made and entered into on the Effective Date by and between: Consenting Parent Name: of Address: born (hereinafter "Consenting Parent"), and Adopting Parent Name: of Address: born (hereinafter "Adopting Parent"), regarding the minor child: Name: Date of Birth: Place of Birth: . County of Execution: State of Execution: .

RECITALS

WHEREAS, the Consenting Parent is the legal parent of the minor child identified above and has the legal right and authority to consent to the adoption of the child; and

WHEREAS, the Adopting Parent seeks to adopt the minor child and has represented to the Consenting Parent that the adoption proceedings will be initiated or are pending in the appropriate court; and

WHEREAS, the Consenting Parent desires to give a legally effective consent to the adoption and to surrender all parental rights and responsibilities in favor of the Adopting Parent, subject to the terms of this Agreement.

NOW, THEREFORE

In consideration of the mutual covenants contained herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. CONSENT TO ADOPTION

The Consenting Parent hereby knowingly, voluntarily and irrevocably (subject to any limited statutory right of revocation as may exist under applicable law) consents to the adoption of the minor child by the Adopting Parent, and surrenders and relinquishes all parental rights, duties, privileges, obligations, and responsibilities with respect to the minor child, including but not limited to custody and visitation, except as otherwise provided in this Agreement. The Consenting Parent expressly authorizes the Adopting Parent to take any and all steps necessary to effect the adoption in the appropriate court, and to rely upon this consent in such proceedings.

2. REPRESENTATIONS AND WARRANTIES

The Consenting Parent represents and warrants that: (a) the Consenting Parent is the legal parent of the minor child and has full authority to execute this consent; (b) the Consenting Parent is not under duress, coercion, undue influence, or the improper promise of reward; (c) the Consenting Parent has not previously executed a binding consent to the adoption of the child except as disclosed in writing below: ; and (d) to the best of the Consenting Parent's knowledge, no other person holds a superior parental right to the child that has not been disclosed.

The Adopting Parent represents and warrants that the Adopting Parent has made reasonable inquiries into the legal status of the child and will, to the extent required by law, petition the appropriate court to finalize the adoption and seek the issuance of a new birth certificate or other equivalent documentation reflecting the adopted status.

3. COUNSEL AND VOLUNTARY NATURE

The Consenting Parent acknowledges that the Consenting Parent has been advised of the right to seek independent legal counsel and has been given an opportunity to consult with an attorney of the Consenting Parent's choosing. By executing this Agreement the Consenting Parent affirms that the decision to consent is voluntary and made with full knowledge of the legal consequences of surrendering parental rights and that the Consenting Parent has received adequate information regarding the adoption process.

4. REVOCATION AND EFFECTIVE DATE

The parties acknowledge that any right of revocation of this consent, if applicable, is governed by statute and must be exercised in strict accordance with controlling law. Except for any limited statutory revocation period, this consent is intended to be final and binding upon execution and may be presented to the court as full and complete consent to adoption. The Effective Date of this Agreement is the date on which this Agreement is signed by the Consenting Parent as set forth in the signature block below.

5. CONSIDERATION

The parties acknowledge that the execution of this consent and the cooperative completion of the adoption process constitute good and valuable consideration. No payment or transfer of funds in excess of reasonable and lawful expenses has been made in exchange for this consent except as set forth below:

6. RELEASE AND INDEMNITY

Upon the entry of an adoption decree, the Consenting Parent hereby releases and forever discharges the Adopting Parent and any successor custodians from all claims, actions, and demands with respect to custody, support, and parental rights in relation to the minor child. The Consenting Parent agrees to indemnify and hold harmless the Adopting Parent against any claims by third parties arising from misrepresentations made by the Consenting Parent in this Agreement.

7. NOTICES

All notices required or permitted under this Agreement shall be in writing and delivered to the addresses provided above by personal delivery, certified mail, or other method that provides a record of delivery and shall be deemed effective upon receipt.

8. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the State where the adoption petition is filed, without regard to conflict of law principles. The parties submit to the jurisdiction of the courts of that State for enforcement of this Agreement.

9. ENTIRE AGREEMENT; AMENDMENT; SEVERABILITY; WAIVER

This Agreement constitutes the entire understanding and agreement between the parties with respect to the subject matter hereof and supersedes any prior agreements or understandings, whether written or oral. No amendment or modification of this Agreement shall be effective unless in writing and signed by both parties. If any provision of this Agreement is held to be invalid or unenforceable, the remainder of the Agreement shall remain in full force and effect. No waiver of any provision of this Agreement shall be effective unless in writing and signed by the party against whom enforcement is sought.

10. COUNTERPARTS AND EXECUTION

This Agreement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Facsimile or electronic signatures shall have the same force and effect as original signatures, subject to applicable law.

11. ADDITIONAL DISCLOSURES

ACKNOWLEDGMENT

The Consenting Parent certifies under penalty of perjury that the information provided herein is true and correct to the best of the Consenting Parent's knowledge, that the Consenting Parent understands the legal effect of this consent, and that the Consenting Parent executes this Agreement freely and voluntarily.

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