Fill and Sign the California Child Parental Form

a.       b.       Related to child (specify): Members of child's tribe       Indian parents meet do not meet the placement       Indian child (name):       Date of birth                   Enrollment       Check here if you do not know the enrollment #.       Your name       Mother Father (Check only one. Each parent fills out a separate form.)       City :                   Phone #:             Enrollment #:       Check here if you do not know the enrollment #.                       ADOPT-225 Parent of Indian Child Agrees to End Parental Rights Clerk stamps below when form is filed. I want my child to be adopted by (name(s)) Their relationship to Indian child: (Check all that apply) None of the above Court name and street address The parent(s) in  . Superior Court of California, County of preference requirements of the Indian Child Welfare Act. Age: Child's tribe(s): Case Number: Your address (skip this if you have a lawyer): State: Zip: Your tribe(s): Your lawyer (if you have one): (Name, address, phone #, and State Bar #): I am the parent in  and I understand and say: a. I agree to give up my parental rights. b. I agree to the adoption of my child by the parent(s) listed in  . c. I understand what will happen when I sign this form. d. No one has threatened me or made promises to me to get me to sign this form. e. I understand that until the judge signs an Adoption Order (ADOPT-215) or an order to end my parental f. I want the court to let me know if the adoption is canceled so I can ask the court to give custody of my child back to me The court will give the custody of my child back to me if the judge decides it is in my child's best interest. g. I do not give up any of my rights under the Indian Child Welfare Act by signing this form. h. My child was at least 10 days old when I signed this form. i. I understand that notice of the adoption request will be sent to any Indian tribe of which my child may be a Judicial Council of California, Rev. January 1, 2005, Mandatory Form 25 U.S.C. § 1913 Parent of Indian Child Agrees to End Parental Rights ADOPT-225, Page 1 of 2 elec troni c form  2005 WWW.LawCA.com L a w P u b l i s h e r s Your name       Date:             I, Judge       Superior Court of California, County of       • I fully explained the terms and consequences to (name of parent):       Date            Case Number: At the time of signing this form, I do not live and am not domiciled on an Indian reservation. Type or print your name Signature of Indian parent Judge's Cettification , , certify: • This form was completed in writing and recorded before me. • The parent fully understood the terms and consequences • The parent speaks English or used an interpreter at the hearing. Certified: Judge (or Judicial Officer) Parent of Indian Child Agrees to End Parental Rights ADOPT-225, Page 2 of 2 elec troni c form  2005 WWW.LawCA.com L a w P u b l i s h e r s