HB4641 EnrolledLRB099 18531 SMS 42910 b

1    AN ACT concerning regulation.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Child Care Act of 1969 is amended by
5changing Sections 2.08, 2.17, 2.23, 2.25, 7.4, and 7.6 and by
6adding Sections 3.2 and 3.3 as follows:
 
7    (225 ILCS 10/2.08)  (from Ch. 23, par. 2212.08)
8    Sec. 2.08. "Child welfare agency" means a public or private
9child care facility, receiving any child or children for the
10purpose of placing or arranging for the placement or free care
11of the child or children in foster family homes, unlicensed
12pre-adoptive and adoptive homes, adoption-only homes, or other
13facilities for child care, apart from the custody of the
14child's or children's parents. The term "child welfare agency"
15includes all agencies established and maintained by a
16municipality or other political subdivision of the State of
17Illinois to protect, guard, train or care for children outside
18their own homes and all agencies, persons, groups of persons,
19associations, organizations, corporations, institutions,
20centers, or groups providing adoption services, but does not
21include any circuit court or duly appointed juvenile probation
22officer or youth counselor of the court who receives and places
23children under an order of the court.

 

 

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1(Source: P.A. 94-586, eff. 8-15-05.)
 
2    (225 ILCS 10/2.17)  (from Ch. 23, par. 2212.17)
3    Sec. 2.17. "Foster family home" means a facility for child
4care in residences of families who receive no more than 8
5children unrelated to them, unless all the children are of
6common parentage, or residences of relatives who receive no
7more than 8 related children placed by the Department, unless
8the children are of common parentage, for the purpose of
9providing family care and training for the children on a
10full-time basis, except the Director of Children and Family
11Services, pursuant to Department regulations, may waive the
12limit of 8 children unrelated to an adoptive family for good
13cause and only to facilitate an adoptive placement. The
14family's or relative's own children, under 18 years of age,
15shall be included in determining the maximum number of children
16served. For purposes of this Section, a "relative" includes any
17person, 21 years of age or over, other than the parent, who (i)
18is currently related to the child in any of the following ways
19by blood or adoption: grandparent, sibling, great-grandparent,
20uncle, aunt, nephew, niece, first cousin, great-uncle, or
21great-aunt; or (ii) is the spouse of such a relative; or (iii)
22is a child's step-father, step-mother, or adult step-brother or
23step-sister; or (iv) is a fictive kin; "relative" also includes
24a person related in any of the foregoing ways to a sibling of a
25child, even though the person is not related to the child, when

 

 

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1the child and its sibling are placed together with that person.
2For purposes of placement of children pursuant to Section 7 of
3the Children and Family Services Act and for purposes of
4licensing requirements set forth in Section 4 of this Act, for
5children under the custody or guardianship of the Department
6pursuant to the Juvenile Court Act of 1987, after a parent
7signs a consent, surrender, or waiver or after a parent's
8rights are otherwise terminated, and while the child remains in
9the custody or guardianship of the Department, the child is
10considered to be related to those to whom the child was related
11under this Section prior to the signing of the consent,
12surrender, or waiver or the order of termination of parental
13rights. The term "foster family home" includes homes receiving
14children from any State-operated institution for child care; or
15from any agency established by a municipality or other
16political subdivision of the State of Illinois authorized to
17provide care for children outside their own homes. The term
18"foster family home" does not include an "adoption-only home"
19as defined in Section 2.23 of this Act. The types of foster
20family homes are defined as follows:
21        (a) "Boarding home" means a foster family home which
22    receives payment for regular full-time care of a child or
23    children.
24        (b) "Free home" means a foster family home other than
25    an adoptive home which does not receive payments for the
26    care of a child or children.

 

 

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1        (c) "Adoptive home" means a foster family home which
2    receives a child or children for the purpose of adopting
3    the child or children, but does not include an
4    adoption-only home.
5        (d) "Work-wage home" means a foster family home which
6    receives a child or children who pay part or all of their
7    board by rendering some services to the family not
8    prohibited by the Child Labor Law or by standards or
9    regulations of the Department prescribed under this Act.
10    The child or children may receive a wage in connection with
11    the services rendered the foster family.
12        (e) "Agency-supervised home" means a foster family
13    home under the direct and regular supervision of a licensed
14    child welfare agency, of the Department of Children and
15    Family Services, of a circuit court, or of any other State
16    agency which has authority to place children in child care
17    facilities, and which receives no more than 8 children,
18    unless of common parentage, who are placed and are
19    regularly supervised by one of the specified agencies.
20        (f) "Independent home" means a foster family home,
21    other than an adoptive home, which receives no more than 4
22    children, unless of common parentage, directly from
23    parents, or other legally responsible persons, by
24    independent arrangement and which is not subject to direct
25    and regular supervision of a specified agency except as
26    such supervision pertains to licensing by the Department.

 

 

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1(Source: P.A. 98-804, eff. 1-1-15; 98-846, eff. 1-1-15; 99-78,
2eff. 7-20-15.)
 
3    (225 ILCS 10/2.23)
4    Sec. 2.23. "Adoption-only home" means a home that receives
5a child placed by an Illinois licensed child welfare agency
6providing adoption services for the sole purpose of adoption.
7The child shall not be under the custody or guardianship of the
8Department pursuant to the Juvenile Court Act of 1987. Such
9adoption-only home shall not be required to be licensed as a
10child care facility under this Act, but shall be required to
11meet the requirements set forth in Section 3.2 of this Act
12family home that receives only children whose parents' parental
13rights have been terminated or surrendered for the purpose of
14adoption only.
15(Source: P.A. 92-318, eff. 1-1-02.)
 
16    (225 ILCS 10/2.25)
17    Sec. 2.25. "Unlicensed pre-adoptive and adoptive home"
18means any home that is not licensed by the Department as a
19foster family home and that receives a child or children for
20the purpose of adopting the child or children, but does not
21include an adoption-only home.
22(Source: P.A. 94-586, eff. 8-15-05.)
 
23    (225 ILCS 10/3.2 new)

 

 

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1    Sec. 3.2. Requirements for adoption-only homes. In
2addition to the other requirements contained in this Act, in
3order to approve an adoption-only home, a licensed child
4welfare agency shall:
5        (1) conduct a home study, which shall consist of a
6    thorough assessment of any prospective adoptive parent's
7    physical, mental, financial, and emotional ability to
8    successfully parent a child through adoption;
9        (2) obtain a criminal background check of all adult
10    residents in the home pursuant to Section 3.3 of this Act;
11        (3) obtain child abuse background checks of all
12    residents in the home who are 13 years of age or over;
13        (4) assess the health of all prospective adoptive
14    parents and family members living in the home, as well as
15    any residents of the home;
16        (5) assess the finances of the prospective adoptive
17    parent or parents;
18        (6) obtain character references for the prospective
19    adoptive parent or parents;
20        (7) assess the safety of the adoptive home;
21        (8) provide adoption education and training to the
22    prospective adoptive parent or parents; and
23        (9) conduct a pre-placement home visit and
24    post-placement supervision.
25    The licensed child welfare agency may impose any other
26reasonable requirements that the agency deems appropriate in

 

 

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1approving an adoption-only home. The Department shall adopt
2procedures necessary for the implementation of this Section no
3later than 30 days after the effective date of this amendatory
4Act of the 99th General Assembly.
 
5    (225 ILCS 10/3.3 new)
6    Sec. 3.3. Requirements for criminal background checks for
7adoption-only homes. In approving an adoption-only home
8pursuant to Section 3.2 of this Act, if an adult resident has
9an arrest or conviction record, the licensed child welfare
10agency:
11        (1) shall thoroughly investigate and evaluate the
12    criminal history of the resident and, in so doing, include
13    an assessment of the applicant's character and, in the case
14    of the prospective adoptive parent, the impact that the
15    criminal history has on his or her ability to parent the
16    child; the investigation should consider the type of crime,
17    the number of crimes, the nature of the offense, the age at
18    time of crime, the length of time that has elapsed since
19    the last conviction, the relationship of the crime to the
20    ability to care for children, and any evidence of
21    rehabilitation;
22        (2) shall not approve the home if the record reveals a
23    felony conviction for crimes against a child, including,
24    but not limited to, child abuse or neglect, child
25    pornography, rape, sexual assault, or homicide;

 

 

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1        (3) shall not approve the home if the record reveals a
2    felony conviction within the last 5 years, including, but
3    not limited to, for physical assault, battery,
4    drug-related offenses, or spousal abuse; and
5        (4) shall not approve the home if the record reveals a
6    felony conviction for homicide, rape, or sexual assault.
 
7    (225 ILCS 10/7.4)
8    Sec. 7.4. Disclosures.
9    (a) Every licensed child welfare agency providing adoption
10services and licensed by the Department shall provide to all
11prospective clients and to the public written disclosures with
12respect to its adoption services, policies, and practices,
13including general eligibility criteria, fees, and the mutual
14rights and responsibilities of clients, including biological
15parents and adoptive parents. The written disclosure shall be
16posted on any website maintained by the child welfare agency
17that relates to adoption services. The Department shall adopt
18rules relating to the contents of the written disclosures.
19Eligible agencies may be deemed compliant with this subsection
20(a).
21    (b) Every licensed child welfare agency providing adoption
22services shall provide to all applicants, prior to application,
23a written schedule of estimated fees, expenses, and refund
24policies. Every child welfare agency providing adoption
25services shall have a written policy that shall be part of its

 

 

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1standard adoption contract and state that it will not charge
2additional fees and expenses beyond those disclosed in the
3adoption contract unless additional fees are reasonably
4required by the circumstances and are disclosed to the adoptive
5parents or parent before they are incurred. The Department
6shall adopt rules relating to the contents of the written
7schedule and policy. Eligible agencies may be deemed compliant
8with this subsection (b).
9    (c) Every licensed child welfare agency providing adoption
10services must make full and fair disclosure to its clients,
11including biological parents and adoptive parents, of all
12circumstances material to the placement of a child for
13adoption. The Department shall adopt rules necessary for the
14implementation and regulation of the requirements of this
15subsection (c).
16    (c-5) Whenever a licensed child welfare agency places a
17child in a licensed foster family home or an adoption-only
18home, the agency shall provide the following to the caretaker
19or prospective adoptive parent:
20        (1) Available detailed information concerning the
21    child's educational and health history, copies of
22    immunization records (including insurance and medical card
23    information), a history of the child's previous
24    placements, if any, and reasons for placement changes,
25    excluding any information that identifies or reveals the
26    location of any previous caretaker.

 

 

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1        (2) A copy of the child's portion of the client service
2    plan, including any visitation arrangement, and all
3    amendments or revisions to it as related to the child.
4        (3) Information containing details of the child's
5    individualized educational plan when the child is
6    receiving special education services.
7        (4) Any known social or behavioral information
8    (including, but not limited to, criminal background, fire
9    setting, perpetration of sexual abuse, destructive
10    behavior, and substance abuse) necessary to care for and
11    safeguard the child.
12    The agency may prepare a written summary of the information
13required by this subsection, which may be provided to the
14foster or prospective adoptive parent in advance of a
15placement. The foster or prospective adoptive parent may review
16the supporting documents in the child's file in the presence of
17casework staff. In the case of an emergency placement, casework
18staff shall at least provide information verbally, if
19necessary, and must subsequently provide the information in
20writing as required by this subsection. In the case of
21emergency placements when time does not allow prior review,
22preparation, and collection of written information, the agency
23shall provide such information as it becomes available.
24    The Department shall adopt rules necessary for the
25implementation and regulation of the requirements of this
26subsection (c-5).

 

 

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1    (d) Every licensed child welfare agency providing adoption
2services shall meet minimum standards set forth by the
3Department concerning the taking or acknowledging of a consent
4prior to taking or acknowledging a consent from a prospective
5biological parent. The Department shall adopt rules concerning
6the minimum standards required by agencies under this Section.
7(Source: P.A. 94-586, eff. 8-15-05; 94-1010, eff. 10-1-06.)
 
8    (225 ILCS 10/7.6)
9    Sec. 7.6. Annual report. Every licensed child welfare
10agency providing adoption services shall file an annual report
11with the Department and with the Attorney General on forms and
12on a date prescribed by the Department. The annual reports for
13the preceding 2 years must be made available, upon request, to
14the public by the Department and every licensed agency and must
15be included on the website of the Department. Each licensed
16agency that maintains a website shall provide the reports on
17its website. The annual report shall include all of the
18following matters and all other matters required by the
19Department:
20        (1) a balance sheet and a statement of income and
21    expenses for the year, certified by an independent public
22    accountant; for purposes of this item (1), the audit report
23    filed by an agency with the Department may be included in
24    the annual report and, if so, shall be sufficient to comply
25    with the requirement of this item (1);

 

 

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1        (2) non-identifying information concerning the
2    placements made by the agency during the year, consisting
3    of the number of adoptive families in the process of
4    obtaining approval for an adoption-only home a foster
5    family license, the number of adoptive families that are
6    approved licensed and awaiting placement, the number of
7    biological parents that the agency is actively working
8    with, the number of placements, and the number of adoptions
9    initiated during the year and the status of each matter at
10    the end of the year;
11        (3) any instance during the year in which the agency
12    lost the right to provide adoption services in any State or
13    country, had its license suspended for cause, or was the
14    subject of other sanctions by any court, governmental
15    agency, or governmental regulatory body relating to the
16    provision of adoption services;
17        (4) any actions related to licensure that were
18    initiated against the agency during the year by a licensing
19    or accrediting body;
20        (5) any pending investigations by federal or State
21    authorities;
22        (6) any criminal charges, child abuse charges,
23    malpractice complaints, or lawsuits against the agency or
24    any of its employees, officers, or directors related to the
25    provision of adoption services and the basis or disposition
26    of the actions;

 

 

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1        (7) any instance in the year where the agency was found
2    guilty of, or pled guilty to, any criminal or civil or
3    administrative violation under federal, State, or foreign
4    law that relates to the provision of adoption services;
5        (8) any instance in the year where any employee,
6    officer, or director of the agency was found guilty of any
7    crime or was determined to have violated a civil law or
8    administrative rule under federal, State, or foreign law
9    relating to the provision of adoption services; and
10        (9) any civil or administrative proceeding instituted
11    by the agency during the year and relating to adoption
12    services, excluding uncontested adoption proceedings and
13    proceedings filed pursuant to Section 12a of the Adoption
14    Act.
15    Failure to disclose information required under this
16Section may result in the suspension of the agency's license
17for a period of 90 days. Subsequent violations may result in
18revocation of the license.
19    Information disclosed in accordance with this Section
20shall be subject to the applicable confidentiality
21requirements of this Act and the Adoption Act.
22(Source: P.A. 94-586, eff. 8-15-05.)
 
23    Section 10. The Adoption Act is amended by changing Section
2410 and by adding Sections 12.2 and 12.3 as follows:
 

 

 

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1    (750 ILCS 50/10)  (from Ch. 40, par. 1512)
2    Sec. 10. Forms of consent and surrender; execution and
3acknowledgment thereof.
4    A. The form of consent required for the adoption of a born
5child shall be substantially as follows:
6
FINAL AND IRREVOCABLE CONSENT TO ADOPTION
7    I, ...., (relationship, e.g., mother, father, relative,
8guardian) of ...., a ..male child, state:
9    That such child was born on .... at ....
10    That I reside at ...., County of .... and State of ....
11    That I am of the age of .... years.
12    That I hereby enter my appearance in this proceeding and
13waive service of summons on me.
14    That I hereby acknowledge that I have been provided with a
15copy of the Birth Parent Rights and Responsibilities-Private
16Form before signing this Consent and that I have had time to
17read, or have had read to me, this Form. I understand that if I
18do not receive any of the rights as described in this Form, it
19shall not constitute a basis to revoke this Final and
20Irrevocable Consent.
21    That I do hereby consent and agree to the adoption of such
22child.
23    That I wish to and understand that by signing this consent
24I do irrevocably and permanently give up all custody and other
25parental rights I have to such child.
26    That I understand such child will be placed for adoption

 

 

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1and that I cannot under any circumstances, after signing this
2document, change my mind and revoke or cancel this consent or
3obtain or recover custody or any other rights over such child.
4That I have read and understand the above and I am signing it
5as my free and voluntary act.
6    Dated (insert date).
7.........................
 
8    If under Section 8 the consent of more than one person is
9required, then each such person shall execute a separate
10consent.
11    A-1. (1) The form of the Final and Irrevocable Consent to
12Adoption by a Specified Person or Persons: Non-DCFS Case set
13forth in this subsection A-1 is to be used by legal parents
14only. This form is not to be used in cases in which there is a
15pending petition under Section 2-13 of the Juvenile Court Act
16of 1987.
17    (2) The form of the Final and Irrevocable Consent to
18Adoption by a Specified Person or Persons in a non-DCFS case
19shall have the caption of the proceeding in which it is to be
20filed and shall be substantially as follows:
21
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
22
A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE
23    I, ...., (relationship, e.g., mother, father) of ...., a
24..male child, state:
25    1. That such child was born on ...., at ....., City of ...

 

 

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1and State of ....
2    2. That I reside at ...., County of .... and State of ....
3    3. That I am of the age of .... years.
4    4. That I hereby enter my appearance in this proceeding and
5waive service of summons on me.
6    5. That I hereby acknowledge that I have been provided a
7copy of the Birth Parent Rights and Responsibilities-Private
8Form before signing this Consent and that I have had time to
9read, or have had read to me, this Form and that I understand
10the Rights and Responsibilities described in this Form. I
11understand that if I do not receive any of my rights as
12described in said Form, it shall not constitute a basis to
13revoke this Final and Irrevocable Consent to Adoption by a
14Specified Person.
15    6. That I do hereby consent and agree to the adoption of
16such child by .... (specified persons) only.
17    7. That I wish to and understand that upon signing this
18consent I do irrevocably and permanently give up all custody
19and other parental rights I have to such child if such child is
20adopted by .... (specified person or persons). I hereby
21transfer all of my rights to the custody, care and control of
22such child to ............................. (specified person
23or persons).
24    8. That I understand such child will be adopted by
25....................... (specified person or persons) and that
26I cannot under any circumstances, after signing this document,

 

 

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1change my mind and revoke or cancel this consent or obtain or
2recover custody or any other rights over such child if
3............................ (specified person or persons)
4adopt(s) such child; PROVIDED that each specified person has
5filed or shall file, within 60 days from the date hereof, a
6petition for the adoption of such child.
7    9. That if the specified person or persons designated
8herein do not file a petition for adoption within the
9time-frame specified above, or, if said petition for adoption
10is filed within the time-frame specified above but the adoption
11petition is dismissed with prejudice or the adoption proceeding
12is otherwise concluded without an order declaring the child to
13be the adopted child of the specified person or persons, then I
14understand that I will receive written notice of such
15circumstances within 10 business days of their occurrence. I
16understand that the notice will be directed to me using the
17contact information I have provided in this consent. I
18understand that I will have 10 business days from the date that
19the written notice is sent to me to respond, within which time
20I may request the Court to declare this consent voidable and
21return the child to me. I further understand that the Court
22will make the final decision of whether or not the child will
23be returned to me. If I do not make such request within 10
24business days of the date of the notice, then I expressly waive
25any other notice or service of process in any legal proceeding
26for the adoption of the child.

 

 

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1    10. That I expressly acknowledge that nothing in this
2Consent impairs the validity and absolute finality of this
3Consent under any circumstance other than those described in
4paragraph 9 of this Consent.
5    11. That I understand that I have a remaining duty and
6obligation to keep .............. (insert name and address of
7the attorney for the specified person or persons) informed of
8my current address or other preferred contact information until
9this adoption has been finalized. My failure to do so may
10result in the termination of my parental rights and the child
11being placed for adoption in another home.
12    12. That I do expressly waive any other notice or service
13of process in any of the legal proceedings for the adoption of
14the child as long as the adoption proceeding by the specified
15person or persons is pending.
16    13. That I have read and understand the above and I am
17signing it as my free and voluntary act.
18    14. That I acknowledge that this consent is valid even if
19the specified person or persons separate or divorce or one of
20the specified persons dies prior to the entry of the final
21judgment for adoption.
22    Dated (insert date).
23    .............................................
24    Signature of parent.
25    .............................................
26    Address of parent.

 

 

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1    .............................................
2    Phone number(s) of parent.
3    .............................................
4    Personal email(s) of parent.
5    .............................................
6    (3) The form of the certificate of acknowledgement for a
7Final and Irrevocable Consent for Adoption by a Specified
8Person or Persons: Non-DCFS Case shall be substantially as
9follows:
 
10STATE OF ..............)
11                       ) SS.
12COUNTY OF .............)
13    I, .................... (Name of Judge or other person),
14..................... (official title, name, and address),
15certify that ............., personally known to me to be the
16same person whose name is subscribed to the foregoing Final and
17Irrevocable Consent for Adoption by a Specified Person or
18Persons; non-DCFS case, appeared before me this day in person
19and acknowledged that (she)(he) signed and delivered the
20consent as (her)(his) free and voluntary act, for the specified
21purpose. I am further satisfied that, before signing this
22Consent, ........ has read, or has had read to him or her, the
23Birth Parent Rights and Responsibilities-Private Form.
24    A-2. Birth Parent Rights and Responsibilities-Private
25Form. The Birth Parent Rights and Responsibilities-Private

 

 

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1Form must be read by, or have been read to, any person
2executing a Final and Irrevocable Consent to Adoption under
3subsection A, a Final and Irrevocable Consent to Adoption by a
4Specified Person or Persons: Non-DCFS Case under subsection
5A-1, or a Consent to Adoption of Unborn Child under subsection
6B prior to the execution of said Consent. The form of the Birth
7Parent Rights and Responsibilities-Private Form shall be
8substantially as follows:
9
Birth Parent Rights and Responsibilities-Private Form
10
THIS FORM DOES NOT CONSTITUTE LEGAL ADVICE. LEGAL ADVICE IS
11
DEPENDENT ON THE SPECIFIC CIRCUMSTANCES OF EACH SITUATION AND
12
JURISDICTION. THE INFORMATION IN THIS FORM CANNOT REPLACE THE
13
ADVICE OF AN ATTORNEY LICENSED IN YOUR STATE.
14    As a birth parent in the State of Illinois, you have the
15right:
16    1. To have your own attorney represent you. The prospective
17adoptive parents may agree to pay for the cost of your attorney
18in a manner consistent with Illinois law, but they are not
19required to do so.
20    2. To be treated with dignity and respect at all times and
21to make decisions free from coercion and pressure.
22    3. To request to receive counseling before and after
23signing a Final and Irrevocable Consent to Adoption
24("Consent"), a Final and Irrevocable Consent to Adoption by a
25Specified Person or Persons: Non-DCFS Case ("Specified
26Consent"), or a Consent to Adoption of Unborn Child ("Unborn

 

 

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1Consent"). The prospective adoptive parents may agree to pay
2for the cost of counseling in a manner consistent with Illinois
3law, but they are not required to do so.
4    4. To ask to be involved in choosing your child's
5prospective adoptive parents and to ask to meet them.
6    5. To ask your child's prospective adoptive parents any
7questions that pertain to your decision to place your child
8with them.
9    6. To see your child before signing a Consent or Specified
10Consent if you are the custodial parent, and to request to see
11your child if you are not the custodial parent.
12    7. To request contact with your child and/or the child's
13prospective adoptive parents, with the understanding that any
14promises regarding contact with your child or receipt of
15information about the child after signing a Consent, Specified
16Consent, or Unborn Consent cannot be enforced under Illinois
17law.
18    8. To receive copies of all documents that you sign and
19have those documents provided to you in your preferred
20language.
21    9. To request that your identifying information remain
22confidential, unless required otherwise by Illinois law or
23court order, and to voluntarily share your medical, background,
24and identifying information, including information on the
25original birth certificate of your child. This can be done
26through the Illinois Adoption Registry and Medical Information

 

 

HB4641 Enrolled- 22 -LRB099 18531 SMS 42910 b

1Exchange or through completing the Birth Parent Preference
2Form. Please visit http://dph.illinois.gov or
3www.newillinoisadoptionlaw.com register with the Illinois
4Adoption Registry and Medical Information Exchange.
5    10. To access the Confidential Intermediary Program which
6provides a way for a court appointed person to connect and/or
7exchange information between adoptees, adoptive parents and
8birth parents, and other biological family members, provided in
9most cases that mutual consent is given. Please visit
10www.ci-illinois.org or call (800) 526-9022(x29).
11    11 10. To work with an adoption agency or attorney of your
12choice, or change said agency or attorney, provided you
13promptly inform all of the parties currently involved.
14    12 11. To receive, upon request, a written list of any
15promised support, financial or otherwise, from your attorney or
16the attorney for your child's prospective adoptive parents.
17    13 12. To delay signing a Consent, Specified Consent, or
18Unborn Consent if you are not ready to do so.
19    14 13. To decline to sign a Consent, Specified Consent, or
20Unborn Consent even if you have received financial support from
21the prospective adoptive parents.
22    If you do not receive any of the rights described in this
23Form, it shall not be a basis to revoke a Consent, Specified
24Consent, or Unborn Consent.
25    As a Birth Parent in the State of Illinois, you have the
26responsibility:

 

 

HB4641 Enrolled- 23 -LRB099 18531 SMS 42910 b

1    1. To carefully consider your reasons for choosing
2adoption.
3    2. To voluntarily provide all known medical, background,
4and family information about yourself and your immediate family
5to your child's prospective adoptive parents or their attorney.
6For the health of your child, you are strongly encouraged, but
7not required, to provide all known medical, background, and
8family history information about yourself and your family to
9your child's prospective adoptive parents or their attorney.
10    2 3. (Birth mothers only) To accurately complete an
11Affidavit of Identification, which identifies the father of the
12child when known, with the understanding that a birth mother
13has a right to decline to identify the birth father.
14    3. To provide the necessary documentation regarding
15financial need to make an appropriate determination of
16reasonable pregnancy-related expenses.
17    4. To not accept financial support or reimbursement of
18pregnancy related expenses simultaneously from more than one
19source or if you are not pregnant, as doing so is a crime.
20    5. To voluntarily provide all known medical, background,
21and family information about yourself and your immediate family
22to your child's prospective adoptive parents or their attorney.
23For the health of your child, you are strongly encouraged, but
24not required, to do so as set forth on the following form:
25
Birth Parent Medical Information
26    The purpose of this form is to gather your health history,

 

 

HB4641 Enrolled- 24 -LRB099 18531 SMS 42910 b

1genetic history, and social background information to share
2with the adoptive parents. It is important the adoptive family
3provide this information to the child's physician. It will
4become a part of the child's medical and family history. This
5form, in its entirety, will be given to the adoptive parent(s).
6    The following information is true and complete to the best
7of my knowledge and belief.
8    Birth parent name:
9.............................................................
10    Signature:
11.............................................................
12    Date:....................................................
13    YES or NO (circle one) I agree to release my full name on
14this form to the adoptive family. If NO is circled then the
15birth parent's name shall be redacted on this form.
16    MOTHER'S PHYSICAL CHARACTERISTICS:
17Eyes: ... Hair: .... Complexion: .... Height: ....
18Weight: .... Body build: ..... Race: .....
19Nationality/Descent: ....... Blood type: .... Rh factor: ....
20Eye glasses or contact lenses? Yes /.../ No /.../
21Right /.../ Left /.../ handed
22Age: .... or Date of birth: ..... Religion: .................
23    Please list your highest education level, occupation,
24hobbies, interests, and talents:
25.............................................................
26Existence of any disabilities? Yes /.../ No /.../

 

 

HB4641 Enrolled- 25 -LRB099 18531 SMS 42910 b

1If yes, explain:.............................................
2    If you have other children, list them below. Include any
3children previously placed for adoption.
4.............................................................
5    Describe your relationship with the birth father: .......
6    FATHER'S PHYSICAL CHARACTERISTICS:
7Eyes: ... Hair: .... Complexion: .... Height: ....
8Weight: .... Body build: ..... Race: .....
9Nationality/Descent: ....... Blood type: .... Rh factor: ....
10Eye glasses or contact lenses? Yes /.../ No /.../
11Right /.../ Left /.../ handed
12Age: .... or Date of birth: ..... Religion: .................
13    Please list your highest education level, occupation,
14hobbies, interests, and talents:
15.............................................................
16Existence of any disabilities? Yes /.../ No /.../
17If yes, explain:.............................................
18    If you have other children, list them below. Include any
19children previously placed for adoption.
20.............................................................
21
PREGNANCY HISTORY INVOLVING THIS CHILD
22    Month prenatal care began during this pregnancy:.........
23    Complications during pregnancy: Yes... No ... If yes,
24explain: ....................................................
25    .............................................................
26
MEDICATION AND OTHER SUBSTANCES USED DURING PREGNANCY OR YEAR

 

 

 

HB4641 Enrolled- 26 -LRB099 18531 SMS 42910 b

1
PRIOR TO PREGNANCY
2FREQUENCY/ FREQUENCY/
3AMOUNT AMOUNT
4DURING PRIOR TO
5YES NO PREGNANCY PREGNANCY
6Alcohol/../ /../................. ...............
7Amphetamines/../ /../................................
8Barbiturates/../ /../................................
9Cocaine/../ /../................................
10Heroin/../ /../................................
11LSD/../ /../................................
12Marijuana/../ /../ ................. ...............
13Caffeine
14(Coffee,
15tea, etc)/../ /../ ................................
16Prescription
17drugs/../ /../ ................. ...............
18Non-
19prescription
20drugs /../ /../................................
21Other /../ /../ ................. ...............
22    In addition to this form, a birth parent shall also be
23provided the forms for the Illinois Adoption Registry and
24Medical Information Exchange.
25    B. The form of consent required for the adoption of an

 

 

HB4641 Enrolled- 27 -LRB099 18531 SMS 42910 b

1unborn child shall be substantially as follows:
2
CONSENT TO ADOPTION OF UNBORN CHILD
3    I, ...., state:
4    That I am the father of a child expected to be born on or
5about .... to .... (name of mother).
6    That I reside at .... County of ...., and State of .....
7    That I am of the age of .... years.
8    That I hereby enter my appearance in such adoption
9proceeding and waive service of summons on me.
10    That I hereby acknowledge that I have been provided with a
11copy of the Birth Parent Rights and Responsibilities-Private
12Form before signing this Consent, and that I have had time to
13read, or have had read to me, this Form. I understand that if I
14do not receive any of the rights as described in this Form, it
15shall not constitute a basis to revoke this Consent to Adoption
16of Unborn Child.
17    That I do hereby consent and agree to the adoption of such
18child, and that I have not previously executed a consent or
19surrender with respect to such child.
20    That I wish to and do understand that by signing this
21consent I do irrevocably and permanently give up all custody
22and other parental rights I have to such child, except that I
23have the right to revoke this consent by giving written notice
24of my revocation not later than 72 hours after the birth of the
25child.
26    That I understand such child will be placed for adoption

 

 

HB4641 Enrolled- 28 -LRB099 18531 SMS 42910 b

1and that, except as hereinabove provided, I cannot under any
2circumstances, after signing this document, change my mind and
3revoke or cancel this consent or obtain or recover custody or
4any other rights over such child.
5    That I have read and understand the above and I am signing
6it as my free and voluntary act.
7    Dated (insert date).
8........................
9    B-5. (1) The parent of a child may execute a consent to
10standby adoption by a specified person or persons. A consent
11under this subsection B-5 shall be acknowledged by a parent
12pursuant to subsection H and subsection K of this Section. The
13form of consent required for the standby adoption of a born
14child effective at a future date when the consenting parent of
15the child dies or requests that a final judgment of adoption be
16entered shall be substantially as follows:
17
FINAL AND IRREVOCABLE CONSENT
18
TO STANDBY ADOPTION
19    I, ..., (relationship, e.g. mother or father) of ...., a
20..male child, state:
21    That the child was born on .... at .....
22    That I reside at ...., County of ...., and State of .....
23    That I am of the age of .... years.
24    That I hereby enter my appearance in this proceeding and
25waive service of summons on me in this action only.
26    That I do hereby consent and agree to the standby adoption

 

 

HB4641 Enrolled- 29 -LRB099 18531 SMS 42910 b

1of the child, and that I have not previously executed a consent
2or surrender with respect to the child.
3    That I wish to and understand that by signing this consent
4I do irrevocably and permanently give up all custody and other
5parental rights I have to the child, effective upon (my death)
6(the child's other parent's death) or upon (my) (the other
7parent's) request for the entry of a final judgment for
8adoption if ..... (specified person or persons) adopt my child.
9    That I understand that until (I die) (the child's other
10parent dies), I retain all legal rights and obligations
11concerning the child, but at that time, I irrevocably give all
12custody and other parental rights to .... (specified person or
13persons).
14    I understand my child will be adopted by ....... (specified
15person or persons) only and that I cannot, under any
16circumstances, after signing this document, change my mind and
17revoke or cancel this consent or obtain or recover custody or
18any other rights over my child if ..... (specified person or
19persons) adopt my child.
20    I understand that this consent to standby adoption is valid
21only if the petition for standby adoption is filed and that if
22....... (specified person or persons), for any reason, cannot
23or will not file a petition for standby adoption or if his,
24her, or their petition for standby adoption is denied, then
25this consent is void. I have the right to notice of any other
26proceeding that could affect my parental rights.

 

 

HB4641 Enrolled- 30 -LRB099 18531 SMS 42910 b

1    That I have read and understand the above and I am signing
2it as my free and voluntary act.
3    Dated (insert date).
4....................
 
5    If under Section 8 the consent of more than one person is
6required, then each such person shall execute a separate
7consent. A separate consent shall be executed for each child.
8    (2) If the parent consents to a standby adoption by 2
9specified persons, then the form shall contain 2 additional
10paragraphs in substantially the following form:
11    If .... (specified persons) obtain a judgment of
12dissolution of marriage before the judgment for adoption is
13entered, then ..... (specified person) shall adopt my child. I
14understand that I cannot change my mind and revoke this consent
15or obtain or recover custody of my child if ..... (specified
16persons) obtain a judgment of dissolution of marriage and .....
17(specified person) adopts my child. I understand that I cannot
18change my mind and revoke this consent if ...... (specified
19persons) obtain a judgment of dissolution of marriage before
20the adoption is final. I understand that this consent to
21adoption has no effect on who will get custody of my child if
22..... (specified persons) obtain a judgment of dissolution of
23marriage after the adoption is final. I understand that if
24either ..... (specified persons) dies before the petition to
25adopt my child is granted, then the surviving person may adopt

 

 

HB4641 Enrolled- 31 -LRB099 18531 SMS 42910 b

1my child. I understand that I cannot change my mind and revoke
2this consent or obtain or recover custody of my child if the
3surviving person adopts my child.
4    A consent to standby adoption by specified persons on this
5form shall have no effect on a court's determination of custody
6or visitation under the Illinois Marriage and Dissolution of
7Marriage Act if the marriage of the specified persons is
8dissolved before the adoption is final.
9    (3) The form of the certificate of acknowledgement for a
10Final and Irrevocable Consent for Standby Adoption shall be
11substantially as follows:
 
12STATE OF .....)
13              ) SS.
14COUNTY OF ....)
 
15    I, ....... (name of Judge or other person) ..... (official
16title, name, and address), certify that ......., personally
17known to me to be the same person whose name is subscribed to
18the foregoing Final and Irrevocable Consent to Standby
19Adoption, appeared before me this day in person and
20acknowledged that (she) (he) signed and delivered the consent
21as (her) (his) free and voluntary act, for the specified
22purpose.
23    I have fully explained that this consent to adoption is
24valid only if the petition to adopt is filed, and that if the

 

 

HB4641 Enrolled- 32 -LRB099 18531 SMS 42910 b

1specified person or persons, for any reason, cannot or will not
2adopt the child or if the adoption petition is denied, then
3this consent will be void. I have fully explained that if the
4specified person or persons adopt the child, by signing this
5consent (she) (he) is irrevocably and permanently
6relinquishing all parental rights to the child, and (she) (he)
7has stated that such is (her) (his) intention and desire.
8    Dated (insert date).
9    Signature ..............................
10    (4) If a consent to standby adoption is executed in this
11form, the consent shall be valid only if the specified person
12or persons adopt the child. The consent shall be void if:
13    (a) the specified person or persons do not file a petition
14for standby adoption of the child; or
15    (b) a court denies the standby adoption petition.
16    The parent shall not need to take further action to revoke
17the consent if the standby adoption by the specified person or
18persons does not occur, notwithstanding the provisions of
19Section 11 of this Act.
20    C. The form of surrender to any agency given by a parent of
21a born child who is to be subsequently placed for adoption
22shall be substantially as follows and shall contain such other
23facts and statements as the particular agency shall require.
24
FINAL AND IRREVOCABLE SURRENDER
25
FOR PURPOSES OF ADOPTION
26    I, .... (relationship, e.g., mother, father, relative,

 

 

HB4641 Enrolled- 33 -LRB099 18531 SMS 42910 b

1guardian) of ...., a ..male child, state:
2    That such child was born on ...., at .....
3    That I reside at ...., County of ...., and State of .....
4    That I am of the age of .... years.
5    That I do hereby surrender and entrust the entire custody
6and control of such child to the .... (the "Agency"), a
7(public) (licensed) child welfare agency with its principal
8office in the City of ...., County of .... and State of ....,
9for the purpose of enabling it to care for and supervise the
10care of such child, to place such child for adoption and to
11consent to the legal adoption of such child.
12    That I hereby grant to the Agency full power and authority
13to place such child with any person or persons it may in its
14sole discretion select to become the adopting parent or parents
15and to consent to the legal adoption of such child by such
16person or persons; and to take any and all measures which, in
17the judgment of the Agency, may be for the best interests of
18such child, including authorizing medical, surgical and dental
19care and treatment including inoculation and anaesthesia for
20such child.
21    That I wish to and understand that by signing this
22surrender I do irrevocably and permanently give up all custody
23and other parental rights I have to such child.
24    That I understand I cannot under any circumstances, after
25signing this surrender, change my mind and revoke or cancel
26this surrender or obtain or recover custody or any other rights

 

 

HB4641 Enrolled- 34 -LRB099 18531 SMS 42910 b

1over such child.
2    That I have read and understand the above and I am signing
3it as my free and voluntary act.
4    Dated (insert date).
5........................
6    C-5. The form of a Final and Irrevocable Designated
7Surrender for Purposes of Adoption to any agency given by a
8parent of a born child who is to be subsequently placed for
9adoption is to be used by legal parents only. The form shall be
10substantially as follows and shall contain such other facts and
11statements as the particular agency shall require:
12
FINAL AND IRREVOCABLE DESIGNATED SURRENDER
13
FOR PURPOSES OF ADOPTION
14    I, .... (relationship, e.g., mother, father, relative,
15guardian) of ...., a ..male child, state:
16    1. That such child was born on ...., at .....
17    2. That I reside at ...., County of ...., and State of
18.....
19    3. That I am of the age of .... years.
20    4. That I do hereby surrender and entrust the entire
21custody and control of such child to the .... (the "Agency"), a
22(public) (licensed) child welfare agency with its principal
23office in the City of ...., County of .... and State of ....,
24for the purpose of enabling it to care for and supervise the
25care of such child, to place such child for adoption with
26............................. (specified person or persons)

 

 

HB4641 Enrolled- 35 -LRB099 18531 SMS 42910 b

1and to consent to the legal adoption of such child and to take
2any and all measures which, in the judgment of the Agency, may
3be for the best interests of such child, including authorizing
4medical, surgical and dental care and treatment including
5inoculation and anesthesia for such child.
6    5. That I wish to and understand that by signing this
7surrender I do irrevocably and permanently give up all custody
8and other parental rights I have to such child.
9    6. That if the petition for adoption is not filed by the
10specified person or persons designated herein or, if the
11petition for adoption is filed but the adoption petition is
12dismissed with prejudice or the adoption proceeding is
13otherwise concluded without an order declaring the child to be
14the adopted child of each specified person, then I understand
15that the Agency will provide notice to me within 10 business
16days and that such notice will be directed to me using the
17contact information I have provided to the Agency. I understand
18that I will have 10 business days from the date that the Agency
19sends me its notice to respond, within which time I may choose
20to designate other adoptive parent(s). However, I acknowledge
21that the Agency has full power and authority to place the child
22for adoption with any person or persons it may in its sole
23discretion select to become the adopting parent or parents and
24to consent to the legal adoption of the child by such person or
25persons.
26    7. That I acknowledge that this surrender is valid even if

 

 

HB4641 Enrolled- 36 -LRB099 18531 SMS 42910 b

1the specified persons separate or divorce or one of the
2specified persons dies prior to the entry of the final judgment
3for adoption.
4    8. That I expressly acknowledge that the above paragraphs 6
5and 7 do not impair the validity and absolute finality of this
6surrender under any circumstance.
7    9. That I understand that I have a remaining obligation to
8keep the Agency informed of my current contact information
9until the adoption of the child has been finalized if I wish to
10be notified in the event the adoption by the specified
11person(s) cannot proceed.
12    10. That I understand I cannot under any circumstances,
13after signing this surrender, change my mind and revoke or
14cancel this surrender or obtain or recover custody or any other
15rights over such child.
16    11. That I have read and understand the above and I am
17signing it as my free and voluntary act.
18    Dated (insert date).
19..............................
20    D. The form of surrender to an agency given by a parent of
21an unborn child who is to be subsequently placed for adoption
22shall be substantially as follows and shall contain such other
23facts and statements as the particular agency shall require.
24
SURRENDER OF UNBORN CHILD FOR
25
PURPOSES OF ADOPTION
26    I, .... (father), state:

 

 

HB4641 Enrolled- 37 -LRB099 18531 SMS 42910 b

1    That I am the father of a child expected to be born on or
2about .... to .... (name of mother).
3    That I reside at ...., County of ...., and State of .....
4    That I am of the age of .... years.
5    That I do hereby surrender and entrust the entire custody
6and control of such child to the .... (the "Agency"), a
7(public) (licensed) child welfare agency with its principal
8office in the City of ...., County of .... and State of ....,
9for the purpose of enabling it to care for and supervise the
10care of such child, to place such child for adoption and to
11consent to the legal adoption of such child, and that I have
12not previously executed a consent or surrender with respect to
13such child.
14    That I hereby grant to the Agency full power and authority
15to place such child with any person or persons it may in its
16sole discretion select to become the adopting parent or parents
17and to consent to the legal adoption of such child by such
18person or persons; and to take any and all measures which, in
19the judgment of the Agency, may be for the best interests of
20such child, including authorizing medical, surgical and dental
21care and treatment, including inoculation and anaesthesia for
22such child.
23    That I wish to and understand that by signing this
24surrender I do irrevocably and permanently give up all custody
25and other parental rights I have to such child.
26    That I understand I cannot under any circumstances, after

 

 

HB4641 Enrolled- 38 -LRB099 18531 SMS 42910 b

1signing this surrender, change my mind and revoke or cancel
2this surrender or obtain or recover custody or any other rights
3over such child, except that I have the right to revoke this
4surrender by giving written notice of my revocation not later
5than 72 hours after the birth of such child.
6    That I have read and understand the above and I am signing
7it as my free and voluntary act.
8    Dated (insert date).
9........................
10    E. The form of consent required from the parents for the
11adoption of an adult, when such adult elects to obtain such
12consent, shall be substantially as follows:
13
CONSENT
14    I, ...., (father) (mother) of ...., an adult, state:
15    That I reside at ...., County of .... and State of .....
16    That I do hereby consent and agree to the adoption of such
17adult by .... and .....
18    Dated (insert date).
19.........................
20    F. The form of consent required for the adoption of a child
21of the age of 14 years or over, or of an adult, to be given by
22such person, shall be substantially as follows:
23
CONSENT
24    I, ...., state:
25    That I reside at ...., County of .... and State of .....
26That I am of the age of .... years. That I hereby enter my

 

 

HB4641 Enrolled- 39 -LRB099 18531 SMS 42910 b

1appearance in this proceeding and waive service of summons on
2me. That I consent and agree to my adoption by .... and .....
3    Dated (insert date).
4........................
5    G. The form of consent given by an agency to the adoption
6by specified persons of a child previously surrendered to it
7shall set forth that the agency has the authority to execute
8such consent. The form of consent given by a guardian of the
9person of a child sought to be adopted, appointed by a court of
10competent jurisdiction, shall set forth the facts of such
11appointment and the authority of the guardian to execute such
12consent.
13    H. A consent (other than that given by an agency, or
14guardian of the person of the child sought to be adopted who
15was appointed by a court of competent jurisdiction) shall be
16acknowledged by a parent before a judge of a court of competent
17jurisdiction or, except as otherwise provided in this Act,
18before a representative of an agency, or before a person, other
19than the attorney for the prospective adoptive parent or
20parents, designated by a court of competent jurisdiction.
21    I. A surrender, or any other document equivalent to a
22surrender, by which a child is surrendered to an agency shall
23be acknowledged by the person signing such surrender, or other
24document, before a judge of a court of competent jurisdiction,
25or, except as otherwise provided in this Act, before a
26representative of an agency, or before a person designated by a

 

 

HB4641 Enrolled- 40 -LRB099 18531 SMS 42910 b

1court of competent jurisdiction.
2    J. The form of the certificate of acknowledgment for a
3consent, a surrender, or any other document equivalent to a
4surrender, shall be substantially as follows:
5STATE OF ....)
6             ) SS.
7COUNTY OF ...)
8    I, .... (Name of judge or other person), .... (official
9title, name and location of court or status or position of
10other person), certify that ...., personally known to me to be
11the same person whose name is subscribed to the foregoing
12(consent) (surrender), appeared before me this day in person
13and acknowledged that (she) (he) signed and delivered such
14(consent) (surrender) as (her) (his) free and voluntary act,
15for the specified purpose.
16    I have fully explained that by signing such (consent)
17(surrender) (she) (he) is irrevocably relinquishing all
18parental rights to such child or adult and (she) (he) has
19stated that such is (her) (his) intention and desire. (Add if
20Consent only) I am further satisfied that, before signing this
21Consent, ........ has read, or has had read to him or her, the
22Birth Parent Rights and Responsibilities-Private Form.
23    Dated (insert date).
24    Signature ...............
25    K. When the execution of a consent or a surrender is
26acknowledged before someone other than a judge, such other

 

 

HB4641 Enrolled- 41 -LRB099 18531 SMS 42910 b

1person shall have his or her signature on the certificate
2acknowledged before a notary public, in form substantially as
3follows:
4STATE OF ....)
5             ) SS.
6COUNTY OF ...)
7    I, a Notary Public, in and for the County of ......, in the
8State of ......, certify that ...., personally known to me to
9be the same person whose name is subscribed to the foregoing
10certificate of acknowledgment, appeared before me in person and
11acknowledged that (she) (he) signed such certificate as (her)
12(his) free and voluntary act and that the statements made in
13the certificate are true.
14    Dated (insert date).
15    
Signature ...................... Notary Public
16
(official seal)

 
17    There shall be attached a certificate of magistracy, or
18other comparable proof of office of the notary public
19satisfactory to the court, to a consent signed and acknowledged
20in another state.
21    L. A surrender or consent executed and acknowledged outside
22of this State, either in accordance with the law of this State
23or in accordance with the law of the place where executed, is
24valid.
25    M. Where a consent or a surrender is signed in a foreign

 

 

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1country, the execution of such consent shall be acknowledged or
2affirmed in a manner conformable to the law and procedure of
3such country.
4    N. If the person signing a consent or surrender is in the
5military service of the United States, the execution of such
6consent or surrender may be acknowledged before a commissioned
7officer and the signature of such officer on such certificate
8shall be verified or acknowledged before a notary public or by
9such other procedure as is then in effect for such division or
10branch of the armed forces.
11    O. (1) The parent or parents of a child in whose interests
12a petition under Section 2-13 of the Juvenile Court Act of 1987
13is pending may, with the approval of the designated
14representative of the Department of Children and Family
15Services ("Department" or "DCFS"), execute a consent to
16adoption by a specified person or persons:
17        (a) in whose physical custody the child has resided for
18    at least 6 months; or
19        (b) in whose physical custody at least one sibling of
20    the child who is the subject of this consent has resided
21    for at least 6 months, and the child who is the subject of
22    this consent is currently residing in this foster home; or
23        (c) in whose physical custody a child under one year of
24    age has resided for at least 3 months.
25    The court may waive the time frames in subdivisions (a),
26(b), and (c) for good cause shown if the court finds it to be in

 

 

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1the child's best interests.
2    A consent under this subsection O shall be acknowledged by
3a parent pursuant to subsection H and subsection K of this
4Section.
5    (2) The final and irrevocable consent to adoption by a
6specified person or persons in a Department of Children and
7Family Services (DCFS) case shall be substantially as follows:
8
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
9
A SPECIFIED PERSON OR PERSONS: DCFS CASE
10    I, ......................................, the
11.................. (mother or father) of a ....male child,
12state:
13        1. My child ............................ (name of
14    child) was born on (insert date) at ....................
15    Hospital in the municipality of ........., in
16    ................ County, State of ...............
17        2. I reside at ......................, County of
18    ............. and State of ..............
19        Mail may also be sent to me at this address
20    ............................, in care of .................
21        My home telephone number is......................
22        My cell telephone number is......................
23        My e-mail address is.................................
24        3. I, ..........................., am .... years old.
25        4. I enter my appearance in this action for my child to
26    be adopted by the person or persons specified herein by me

 

 

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1    and waive service of summons on me in this action only.
2        5. I hereby acknowledge that I have been provided a
3    copy of the Birth Parent Rights and Responsibilities for
4    DCFS Cases before signing this Consent and that I have had
5    time to read this form or have it read to me and that I
6    understand the rights and responsibilities described in
7    this form. I understand that if I do not receive any of my
8    rights as described in the form, it shall not constitute a
9    basis to revoke this Final and Irrevocable Consent to
10    Adoption by a Specified Person or Persons.
11        6. I do hereby consent and agree to the adoption of
12    such child by .......... (specified person or persons)
13    only.
14        7. I wish to sign this consent and I understand that by
15    signing this consent I irrevocably and permanently give up
16    all my parental rights I have to my child.
17        8. I understand that this consent allows my child to be
18    adopted by .......... only and that I cannot under any
19    circumstances after signing this document change my mind
20    and revoke or cancel this consent.
21        9. I understand that this consent will be void if:
22            (a) the Department places my child with someone
23        other than the specified person or persons; or
24            (b) a court denies the adoption petition for the
25        specified person or persons to adopt my child; or
26            (c) the DCFS Guardianship Administrator refuses to

 

 

HB4641 Enrolled- 45 -LRB099 18531 SMS 42910 b

1        consent to my child's adoption by the specified person
2        or persons on the basis that the adoption is not in my
3        child's best interests.
4        I understand that if this consent is void I have
5    parental rights to my child, subject to any applicable
6    court orders including those entered under Article II of
7    the Juvenile Court Act of 1987, unless and until I sign a
8    new consent or surrender or my parental rights are
9    involuntarily terminated. I understand that if this
10    consent is void, my child may be adopted by someone other
11    than the specified person or persons only if I sign a new
12    consent or surrender, or my parental rights are
13    involuntarily terminated. I understand that if this
14    consent is void, the Department will notify me within 30
15    days using the addresses and telephone numbers I provided
16    in paragraph 2 of this form. I understand that if I receive
17    such a notice, it is very important that I contact the
18    Department immediately, and preferably within 30 days, to
19    have input into the plan for my child's future.
20        10. I understand that if a petition for adoption of my
21    child is filed by someone other than the specified person
22    or persons, the Department will notify me within 14 days
23    after the Department becomes aware of the petition. The
24    fact that someone other than the specified person or
25    persons files a petition to adopt my child does not make
26    this consent void.

 

 

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1        11. If a person other than the specified person or
2    persons files a petition to adopt my child or if the
3    consent is void under paragraph 9, the Department will send
4    written notice to me using the mailing address and email
5    address provided by me in paragraph 2 of this form. The
6    Department will also contact me using the telephone numbers
7    I provided in paragraph 2 of this form. It is very
8    important that I let the Department know if any of my
9    contact information changes. If I do not let the Department
10    know if any of my contact information changes, I understand
11    that I may not receive notification from the Department if
12    this consent is void or if someone other than the specified
13    person or persons files a petition to adopt my child. If
14    any of my contact information changes, I should immediately
15    notify:
16        Caseworker's name and telephone number:
17    ............................................................;
18        Agency name, address, zip code, and telephone number:
19    ............................................................;
20        Supervisor's name and telephone number:
21    ............................................................;
22    DCFS Advocacy Office for Children and Families:
23    800-232-3798.
24        12. I expressly acknowledge that paragraph 9 (and
25    paragraphs 8a and 8b, if applicable) do not impair the
26    validity and finality of this consent under any

 

 

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1    circumstances.
2         13. I have read and understand the above and I am
3    signing it as my free and voluntary act.
4        Dated (insert date).
5        .............................................
6        Signature of parent
7    (3) If the parent consents to an adoption by 2 specified
8persons, then the form shall contain 2 additional paragraphs in
9substantially the following form:
10        8a. If ............... (specified persons) get a
11    divorce or are granted a dissolution of a civil union
12    before the petition to adopt my child is granted, this
13    consent is valid for ........... (specified person) to
14    adopt my child. I understand that I cannot change my mind
15    or revoke this consent or recover custody of my child on
16    the basis that the specified persons divorce or are granted
17    a dissolution of a civil union.
18        8b. I understand that if either ...............
19    (specified persons) dies before the petition to adopt my
20    child is granted, this consent remains valid for the
21    surviving person to adopt my child. I understand that I
22    cannot change my mind or revoke this consent or recover
23    custody of my child on the basis that one of the specified
24    persons dies.
25    (4) The form of the certificate of acknowledgement for a
26Final and Irrevocable Consent for Adoption by a Specified

 

 

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1Person or Persons: DCFS Case shall be substantially as follows:
 
2STATE OF ..............)
3                       ) SS.
4COUNTY OF .............)
 
5    I, .................... (Name of Judge or other person),
6..................... (official title, name, and address),
7certify that ............., personally known to me to be the
8same person whose name is subscribed to the foregoing Final and
9Irrevocable Consent for Adoption by a Specified Person or
10Persons: DCFS Case, appeared before me this day in person and
11acknowledged that (she)(he) signed and delivered the consent as
12(her)(his) free and voluntary act, for the specified purpose.
13    I have fully explained that by signing this consent this
14parent is irrevocably and permanently relinquishing all
15parental rights to the child so that the child may be adopted
16by a specified person or persons, and this parent has stated
17that such is (her)(his) intention and desire. I have fully
18explained that this consent is void only if:
19        (a) the placement is disrupted and the child is moved
20    to a different placement; or
21        (b) a court denies the petition for adoption; or
22        (c) the Department of Children and Family Services
23    Guardianship Administrator refuses to consent to the
24    child's adoption by a specified person or persons on the

 

 

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1    basis that the adoption is not in the child's best
2    interests.
3    Dated (insert date).
4    ...............................
5    Signature
6    (5) If a consent to adoption by a specified person or
7persons is executed in this form, the following provisions
8shall apply. The consent shall be valid only for the specified
9person or persons to adopt the child. The consent shall be void
10if:
11        (a) the placement disrupts and the child is moved to
12    another placement; or
13        (b) a court denies the petition for adoption; or
14        (c) the Department of Children and Family Services
15    Guardianship Administrator refuses to consent to the
16    child's adoption by the specified person or persons on the
17    basis that the adoption is not in the child's best
18    interests.
19    If the consent is void under this Section, the parent shall
20not need to take further action to revoke the consent. No
21proceeding for termination of parental rights shall be brought
22unless the parent who executed the consent to adoption by a
23specified person or persons has been notified of the
24proceedings pursuant to Section 7 of this Act or subsection (4)
25of Section 2-13 of the Juvenile Court Act of 1987.
26    (6) The Department of Children and Family Services is

 

 

HB4641 Enrolled- 50 -LRB099 18531 SMS 42910 b

1authorized to promulgate rules necessary to implement this
2subsection O.
3    (7) (Blank).
4    (8) The Department of Children and Family Services shall
5promulgate a rule and procedures regarding Consents to Adoption
6by a Specified Person or Persons in DCFS cases. The rule and
7procedures shall provide for the development of the Birth
8Parent Rights and Responsibilities Form for DCFS Cases.
9    (9) A consent to adoption by specified persons on this
10consent form shall have no effect on a court's determination of
11custody or visitation under the Illinois Marriage and
12Dissolution of Marriage Act or the Illinois Religious Freedom
13Protection and Civil Union Act if the marriage or civil union
14of the specified persons is dissolved after the adoption is
15final.
16    P. If the person signing a consent is incarcerated or
17detained in a correctional facility, prison, jail, detention
18center, or other comparable institution, either in this State
19or any other jurisdiction, the execution of such consent may be
20acknowledged before social service personnel of such
21institution, or before a person designated by a court of
22competent jurisdiction.
23    Q. A consent may be acknowledged telephonically, via
24audiovisual connection, or other electronic means, provided
25that a court of competent jurisdiction has entered an order
26approving the execution of the consent in such manner and has

 

 

HB4641 Enrolled- 51 -LRB099 18531 SMS 42910 b

1designated an individual to be physically present with the
2parent executing such consent in order to verify the identity
3of the parent.
4    R. An agency whose representative is acknowledging a
5consent pursuant to this Section shall be a public child
6welfare agency, or a child welfare agency, or a child placing
7agency that is authorized or licensed in the State or
8jurisdiction in which the consent is signed.
9    S. The form of waiver by a putative or legal father of a
10born or unborn child shall be substantially as follows:
 
11
FINAL AND IRREVOCABLE
12
WAIVER OF PARENTAL RIGHTS OF PUTATIVE OR LEGAL FATHER

 
13    I, .................... , state under oath or affirm as
14follows:
15        1. That the biological mother ............... has
16    named me as a possible biological or legal father of her
17    minor child who was born, or is expected to be born on
18    ..........., ......, in the City/Town of........., State
19    of ...........
20        2. That I understand that the biological mother
21    ............. intends to or has placed the child for
22    adoption.
23        3. That I reside at ................, in the City/Town
24    of..........., State of ................

 

 

HB4641 Enrolled- 52 -LRB099 18531 SMS 42910 b

1        4. That I am ................ years of age and my date
2    of birth is ..............., .............
3        5. That I (select one):
4            ..... am married to the biological mother.
5            ..... am not married to the biological mother and
6        have not been married to the biological mother within
7        300 days before the child's birth or expected date of
8        child's birth.
9            ..... am not currently married to the biological
10        mother, but was married to the biological mother,
11        within 300 days before the child's birth or expected
12        date of child's birth.
13        6. That I (select one):
14            ..... neither admit nor deny that I am the
15        biological father of the child.
16            ..... deny that I am the biological father of the
17        child.
18        7. That I hereby agree to the termination of my
19    parental rights, if any, without further notice to me of
20    any proceeding for the adoption of the minor child, even if
21    I have taken any action to establish parental rights or
22    take any such action in the future including registering
23    with any putative father registry.
24        8. That I understand that by signing this Waiver I do
25    irrevocably and permanently give up all custody and other
26    parental rights I may have to such child.

 

 

HB4641 Enrolled- 53 -LRB099 18531 SMS 42910 b

1        9. That I understand that this Waiver is FINAL AND
2    IRREVOCABLE and that I am permanently barred from
3    contesting any proceeding for the adoption of the child
4    after I sign this Waiver.
5        10. That I waive any further service of summons or
6    other pleadings in any proceeding to terminate parental
7    rights, if any to this child, or any proceeding for
8    adoption of this child.
9        11. That I understand that if a final judgment or order
10    of adoption for this child is not entered, then any
11    parental rights or responsibilities that I may have remain
12    intact.
13        12. That I have read and understand the above and that
14    I am signing it as my free and voluntary act.
 
15    Dated: ................... , ..............
16    ...........................................
17    Signature
 
18
OATH
19I have been duly sworn and I state under oath that I have read
20and understood this Final and Irrevocable Waiver of Parental
21Rights of Putative or Legal Father. The facts contained in it
22are true and correct to the best of my knowledge. I have signed
23this document as my free and voluntary act in order to
24facilitate the adoption of the child.
 

 

 

HB4641 Enrolled- 54 -LRB099 18531 SMS 42910 b

1..............................
2Signature
 
3Signed and Sworn before me on
4this ............ day
5of ..........., 20....
 
6...................
7Notary Public
8(Source: P.A. 97-493, eff. 8-22-11; 97-988, eff. 1-1-13;
997-1063, eff. 1-1-13; 98-463, eff. 8-16-13.)
 
10    (750 ILCS 50/12.2 new)
11    Sec. 12.2. Adoptive parent rights and responsibilities.
12Prior to finalization of an adoption pursuant to this Act, any
13prospective adoptive parent in a private adoption who is not
14being provided with adoption services by a licensed child
15welfare agency pursuant to the Child Care Act of 1969, who is
16not adopting a related child, and who is not adopting a child
17who is a ward of the Department of Children and Family Services
18shall be provided with the following form:
19
Adoptive Parents Rights and Responsibilities-Private Form
20
THIS FORM DOES NOT CONSTITUTE LEGAL ADVICE. LEGAL ADVICE IS
21
DEPENDENT ON THE SPECIFIC CIRCUMSTANCES OF EACH SITUATION AND
22
JURISDICTION. THE INFORMATION IN THIS FORM CANNOT REPLACE THE

 

 

HB4641 Enrolled- 55 -LRB099 18531 SMS 42910 b

1
ADVICE OF AN ATTORNEY LICENSED IN YOUR STATE.
2    As an adoptive parent in the State of Illinois, you have
3the right:
4    1. To be treated with dignity and respect.
5    2. To make decisions free from pressure or coercion,
6including your decision to accept or reject the placement of a
7particular child.
8    3. To be informed of the rights of birth parents.
9    4. To know that the birth parent shall have the right to
10request to receive counseling before and after signing a Final
11and Irrevocable Consent to Adoption ("Consent"), a Final and
12Irrevocable Consent to Adoption by a Specified Person or
13Persons: Non-DCFS Case ("Specified Consent"), or a Consent to
14Adoption of Unborn Child ("Unborn Consent"). You may agree to
15pay for the cost of counseling in a manner consistent with
16Illinois law, but you are not required to do so.
17    5. To receive a written schedule of fees and refund
18policies from the entity who will handle the investigation of
19your adoption for the Court.
20    6. To explore the possibility of a subsidy for a child with
21special needs who is not a ward of the Illinois Department of
22Children and Family Services. The Department may provide a
23subsidy if the child meets certain criteria. If you adopt a
24child who is eligible for supplemental security income (SSI),
25or who meets other special needs criteria, your child may be
26subsidy eligible. You should discuss eligibility for a subsidy

 

 

HB4641 Enrolled- 56 -LRB099 18531 SMS 42910 b

1with your attorney before the adoption is finalized, as this
2option is only available before the entry of a Judgment Order
3for Adoption.
4    7. To share information and connect in the future with the
5birth parent(s) of your child. The birth parent(s), you, and
6the adopted person have the right to voluntarily share medical,
7background, and identifying information, including information
8on the original birth certificate. This can be done through the
9Illinois Adoption Registry and Medical Information Exchange or
10through the birth parent completing a Birth Parent Preference
11Form. Please visit http://www.dph.illinois.gov and search for
12adoption or www.newillinoisadoptionlaw.com.
13    8. To access the Confidential Intermediary program, which
14provides a way for a court appointed person to connect and/or
15exchange information between adopted persons, adoptive parents
16and birth parents, and other biological family members,
17provided in most cases that mutual consent is given. Please
18visit www.ci-illinois.org or call (800) 526-9022(x29).
19    As an adoptive parent in the State of Illinois, it is your
20responsibility:
21    1. To work cooperatively and honestly with the person or
22entity handling your investigation and appointed by the court,
23including disclosing information requested by that person or
24entity.
25    2. To pay the agreed-upon fees to the investigating person
26or entity promptly.

 

 

HB4641 Enrolled- 57 -LRB099 18531 SMS 42910 b

1    3. To keep the person or entity handling your investigation
2informed of any new pertinent information about your family.
3    4. To cooperate with post-placement monitoring and
4support.
5    5. To consult with your attorney prior to offering any
6financial assistance to the birth parent or parents.
7    6. To obtain training in parenting an adopted child, which
8may include on-line and in-person training on adoption related
9topics.
 
10    (750 ILCS 50/12.3 new)
11    Sec. 12.3. Additional requirements in private adoptions.
12In cases of adoptions in which an Illinois licensed child
13welfare agency is not providing adoption services and the child
14who is the subject of the adoption is not a related child of
15the prospective adoptive parent and not under the custody or
16guardianship of the Department of Children and Family Services
17under the Juvenile Court Act of 1987, the following
18requirements shall apply in addition to any other applicable
19requirements set forth in Section 6 or other provisions of this
20Act:
21        (1) Within 10 days of filing a petition for adoption
22    pursuant to Section 5 of this Act, the prospective adoptive
23    parents and anyone 18 years of age or older who resides in
24    the adoptive home must initiate requests for background
25    checks from the following: the State police and child abuse

 

 

HB4641 Enrolled- 58 -LRB099 18531 SMS 42910 b

1    registry from every state of residence for the 5 years
2    preceding the filing date of the petition, the FBI, the
3    National Sex Offender Registry, and, if Illinois
4    residents, from the Illinois State Police and Child Abuse
5    and Neglect Tracking System. The background checks must be
6    fingerprint-based, if available. The Child Abuse and
7    Neglect Tracking System background check must also be
8    requested for each person 13 to 17 years of age living in
9    the adoptive home.
10        (2) Within 30 days of filing a petition for adoption,
11    the results of the background checks set forth in paragraph
12    (1) of this Section shall be provided to the guardian ad
13    litem of the child appointed by the court or, should there
14    not be a guardian ad litem, to the investigator appointed
15    by the court pursuant to subsection A of Section 6 of this
16    Act.
17        (3) An initial assessment, including a home visit, must
18    be made by the guardian ad litem or the investigator
19    appointed by the court pursuant to subsection A of Section
20    6 of this Act no later than 30 days of said appointment;
21        (4) As part of the investigation, the guardian ad litem
22    or the investigator appointed by the court pursuant to
23    subsection A of Section 6 of this Act must provide the
24    prospective adoptive parents with the Adoptive Parent
25    Rights and Responsibilities-Private Form set forth in
26    Section 12.2 of this Act. The prospective adoptive parent

 

 

HB4641 Enrolled- 59 -LRB099 18531 SMS 42910 b

1    or parents must sign the form acknowledging receipt of the
2    form, and the original form must be filed with the court at
3    the time of the issuance of the interim order, and a copy
4    must be provided to the prospective parent or parents;
5        (5) The attorney for the prospective adoptive parent or
6    parents or the birth parent or parents shall provide the
7    prospective adoptive parent or parents with the Birth
8    Parent Medical form or forms if completed by the birth
9    parent or parents as set forth in subsection A-2 of Section
10    10 of this Act, as soon as practicable but no later than
11    the time of entry of the interim order;
12        (6) The guardian ad litem, or the court-appointed
13    investigator appointed pursuant to subsection A of Section
14    6 of this Act, shall provide a report of investigation to
15    the Court within 6 months after appointment, or earlier if
16    so ordered by the court.
17        (7) The birth parent shall have the right to request to
18    receive counseling before and after signing a Final and
19    Irrevocable Consent to Adoption form, a Final and
20    Irrevocable Consent to Adoption by a Specified Person or
21    Persons: Non-DCFS Case form, or a Consent to Adoption of
22    Unborn Child form. The prospective adoptive parent or
23    parents may agree to pay for the cost of counseling in a
24    manner consistent with Illinois law, but the prospective
25    adoptive parent or parents are not required to do so.

 

 

HB4641 Enrolled- 60 -LRB099 18531 SMS 42910 b

1 INDEX
2 Statutes amended in order of appearance
3    225 ILCS 10/2.08from Ch. 23, par. 2212.08
4    225 ILCS 10/2.17from Ch. 23, par. 2212.17
5    225 ILCS 10/2.23
6    225 ILCS 10/2.25
7    225 ILCS 10/3.2 new
8    225 ILCS 10/3.3 new
9    225 ILCS 10/7.4
10    225 ILCS 10/7.6
11    750 ILCS 50/10from Ch. 40, par. 1512
12    750 ILCS 50/12.2 new
13    750 ILCS 50/12.3 new