Tennessee Consent and Permission Form

Request for Paternity Establishment

Section 1: Information about the Child

Child's Full Name:

Child's Date of Birth:

Place of Birth (City, State):

Section 2: Information about the Mother

Mother's Full Name:

Mother's Current Address:

Phone Number:

Email Address:

Marital Status at Child's Birth:

Section 3: Information about the Putative Father

Putative Father's Full Name:

Putative Father's Current Address:

Phone Number:

Email Address:

Section 4: Paternity Establishment Method

Please select how paternity is being established:

Voluntary Acknowledgment of Paternity (Both parents agree)

Court Action (Parents cannot agree or father denies paternity)

State Agency Initiative (e.g., Child Support Enforcement)

Section 5: Genetic Testing

Genetic Testing:

Genetic testing has been completed. (Attach results)

Request for genetic testing.

Decline genetic testing (if applicable, state reason below)

Reason for declining/other notes on genetic testing:

Section 6: Acknowledgment and Agreement

I understand that establishing paternity may involve responsibilities for child support, custody, and visitation.

I affirm that the information provided in this request is true and accurate to the best of my knowledge.

Section 7: Signatures