Party identification
Full legal names and contact information for the parent(s) and the child, including dates of birth and any aliases to avoid ambiguity.
The affidavit provides clear evidence of a parent’s voluntary decision, helps streamline adoption or placement processes, and protects receiving parties by documenting consent. Properly completed and authenticated, it reduces later disputes about intent and timing while preserving required legal procedures.
Common participants who complete or rely on this form include biological parents, adoptive parents, social workers, and family court staff.
Each party has distinct responsibilities—parents must provide informed consent; agencies must verify voluntariness and follow state procedures.
Full legal names and contact information for the parent(s) and the child, including dates of birth and any aliases to avoid ambiguity.
Child's full legal name, date of birth, place of birth, and current placement location to uniquely identify the subject of the affidavit.
A clear, unambiguous declaration that the parent is relinquishing rights voluntarily, without coercion, specifying which rights are being relinquished.
Statements confirming the parent understands legal consequences, relinquishment is final absent court order, and referral to counsel or agency was offered.
If applicable, any stated consideration, conditions, or effective date tied to the relinquishment should be documented precisely.
Notary acknowledgment, witness signatures if required by state law, and dates for signature and notarization must be present.
| Document format | PDF | Use fillable, non-editable PDF |
|---|---|
| Role assignment | Parent | Signer |
| Authentication | Email + SMS code | Stronger KBA if required |
| Required fields | Signature, date, notary block | Mandatory |
| Delivery | Signed copy | Send to parties and agency |
Confirm the receiving agency or court accepts electronic submissions and which file formats and authentication they require.
When in doubt, prepare a notarized paper original and check agency-specific eSubmission rules or court clerk guidance.
Often the notarization date or a specified effective date in the affidavit.
Processing times vary widely by state and agency caseload.
Some jurisdictions require a hearing or judicial sign-off before termination is final.
Certain states allow limited revocation windows; check local statute.
Retain originals per retention rules and agency instructions.
Create the affidavit using accurate identifiers and required statutory language.
Confirm voluntariness and completeness before signing.
Sign in presence of notary and any required witnesses.
Deliver to agency or court; obtain filing receipt if applicable.
A birth parent signs a voluntary relinquishment to enable a private adoption placement.
A parent executes the affidavit to allow a foster family to pursue adoption.
The parent with legal custody or parental rights may sign the affidavit after receiving required counseling and confirming voluntariness; signature typically requires notarization.
A licensed child welfare worker or agency representative may accept and file the affidavit, verify accompanying documentation, and forward it for court processing as needed.
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