Adoption Waiver Form

ADOPTION WAIVER FORM

This Adoption Waiver Form (the Agreement) is entered into on this , by and between Petitioner/Adopting Party Name: whose address is , and Relinquishing Party Name: whose relationship to the child is and whose address is .

The subject of this Agreement is the following minor: Name: , Date of Birth: , Place of Birth: .

RECITALS

WHEREAS, the Petitioner/Adopting Party has petitioned a court for the adoption of the minor child identified above and desires clear title to parental rights to permit the adoption to proceed; and

WHEREAS, the Relinquishing Party is the legal parent or guardian of the minor child and, after consultation and consideration, wishes to voluntarily waive and relinquish all parental rights and consents necessary to effectuate said adoption; and

WHEREAS, the parties desire to set forth their mutual understandings and the Relinquishing Party's informed waiver under the terms and conditions set forth herein.

NOW, THEREFORE

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

1. DEFINITIONS

For purposes of this Agreement, "Waiver" means the voluntary and knowing surrender by the Relinquishing Party of all parental rights, duties, claims, entitlements, and privileges with respect to the minor child, including but not limited to custody, visitation, guardianship, and inheritance, to the extent permitted by applicable law.

2. WAIVER AND CONSENT

The Relinquishing Party hereby knowingly, voluntarily and irrevocably waives, relinquishes and forever releases any and all parental rights and consents necessary for the adoption of the minor child by the Petitioner/Adopting Party. The Relinquishing Party affirms that this waiver is given free of duress, undue influence, fraud, or misrepresentation.

3. REPRESENTATIONS AND WARRANTIES

The Relinquishing Party represents and warrants that: (a) they are the lawful parent or guardian of the minor child; (b) there are no legal impediments or third-party claims known to them that would prevent or invalidate this waiver; (c) they have disclosed any known information material to the welfare or medical history of the minor child; and (d) to the best of their knowledge, there are no pending adoption-related proceedings concerning the minor child other than those contemplated by the Petitioner/Adopting Party.

4. ACKNOWLEDGMENT OF COUNSEL AND VOLUNTARY EXECUTION

The Relinquishing Party acknowledges that they have been given the opportunity to seek independent legal counsel and have been informed of the legal consequences of executing this waiver. The Relinquishing Party further acknowledges that they understand their rights and are executing this Agreement voluntarily, without promise of monetary or other consideration except as expressly set forth herein.

5. CONSIDERATION

The Relinquishing Party acknowledges receipt of consideration adequate under applicable law in exchange for this Waiver. If any monetary or non-monetary consideration was provided, describe below:

6. NO REVOCATION

The Relinquishing Party expressly acknowledges that this Waiver is intended to be final and irrevocable to the maximum extent permitted by law and that no later attempt to revoke or rescind this Waiver shall be effective without the written consent of the Petitioner/Adopting Party and any required court or administrative authority.

7. INDEMNIFICATION

The Relinquishing Party agrees to defend, indemnify, and hold harmless the Petitioner/Adopting Party from and against any claims, liabilities, losses, costs, or expenses (including reasonable attorney fees) arising out of any breach of the representations or warranties set forth in this Agreement or any claim that the Relinquishing Party did not have authority to execute this Waiver.

8. CONFIDENTIALITY

Except as required by law or by order of a court of competent jurisdiction, neither party shall disclose the terms of this Agreement or any nonpublic information concerning the parties or the minor child without the prior written consent of the other party.

9. NOTICES

All notices, requests, demands, and other communications required or permitted under this Agreement must be in writing and shall be delivered to the parties at their respective addresses set forth above or to such other address as either party may designate by notice in accordance with this section. Notices may be mailed or delivered in person.

10. GOVERNING LAW

This Agreement shall be governed by and construed in accordance with the laws of the state in which the adoption petition will be filed, without regard to principles of conflicts of law. The parties submit to the exclusive jurisdiction of the courts of that state for the resolution of any disputes arising under this Agreement.

11. ENTIRE AGREEMENT; SEVERABILITY

This Agreement contains the entire understanding of the parties with respect to its subject matter and supersedes all prior and contemporaneous agreements and understandings, whether written or oral. If any provision of this Agreement is determined to be invalid or unenforceable, such provision shall be severed and the remaining provisions shall remain in full force and effect.

12. AMENDMENT; WAIVER; COUNTERPARTS

This Agreement may be amended only by a written instrument executed by both parties. No waiver of any breach shall be effective unless in writing signed by the party granting the waiver. This Agreement may be executed in counterparts, each of which shall be an original and all of which together shall constitute one instrument.

CERTIFICATION

The undersigned Relinquishing Party certifies under penalty of perjury that the statements made in this Agreement are true and correct to the best of their knowledge and belief and that they execute this Waiver knowingly and voluntarily.

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