Full Text of HB6080 96th General Assembly
HB6080ham002 96TH GENERAL ASSEMBLY
|
Rep. Sara Feigenholtz
Filed: 3/17/2010
|
|
09600HB6080ham002 |
|
LRB096 18717 AJO 38854 a |
|
| 1 |
| AMENDMENT TO HOUSE BILL 6080
| 2 |
| AMENDMENT NO. ______. Amend House Bill 6080 by replacing | 3 |
| everything after the enacting clause with the following:
| 4 |
| "Section 5. The Adoption Act is amended by changing Section | 5 |
| 10 as follows:
| 6 |
| (750 ILCS 50/10) (from Ch. 40, par. 1512)
| 7 |
| Sec. 10. Forms of consent and surrender; execution and
| 8 |
| acknowledgment thereof. A. The form of consent required for | 9 |
| the
adoption of a born child shall be substantially as follows:
| 10 |
| FINAL AND IRREVOCABLE CONSENT TO ADOPTION
| 11 |
| I, ...., (relationship, e.g., mother, father, relative, | 12 |
| guardian)
of ...., a ..male child, state:
| 13 |
| That such child was born on .... at ....
| 14 |
| That I reside at ...., County of .... and State of ....
| 15 |
| That I am of the age of .... years.
| 16 |
| That I hereby enter my appearance in this proceeding and |
|
|
|
09600HB6080ham002 |
- 2 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| waive
service of summons on me.
| 2 |
| That I hereby acknowledge that I have been provided with a | 3 |
| copy of the Birth Parent Rights and Responsibilities-Private | 4 |
| Form before signing this Consent and that I have had time to | 5 |
| read, or have had read to me, this Form. I understand that if I | 6 |
| do not receive any of the rights as described in this Form, it | 7 |
| shall not constitute a basis to revoke this Final and | 8 |
| Irrevocable Consent. | 9 |
| That I do hereby consent and agree to the adoption of such | 10 |
| child.
| 11 |
| That I wish to and understand that by signing this consent | 12 |
| I do
irrevocably and permanently give up all custody and other | 13 |
| parental
rights I have to such child.
| 14 |
| That I understand such child will be placed for adoption | 15 |
| and that I
cannot under any circumstances, after signing this | 16 |
| document, change my
mind and revoke or cancel this consent or | 17 |
| obtain or recover custody or
any other rights over such child. | 18 |
| That I have read and understand the
above and I am signing it | 19 |
| as my free and voluntary act.
| 20 |
| Dated (insert date).
| 21 |
| .........................
| 22 |
| If under Section 8 the consent of more than one person is | 23 |
| required,
then each such person shall execute a separate | 24 |
| consent.
| 25 |
| A-1. (1) The form of the Final and Irrevocable Consent to |
|
|
|
09600HB6080ham002 |
- 3 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| Adoption by a Specified Person or Persons: Non-DCFS Case set | 2 |
| forth in this subsection A-1 is to be used by legal parents | 3 |
| only. This form is not to be used in cases in which there is a | 4 |
| pending petition under Section 2-13 of the Juvenile Court Act | 5 |
| of 1987. | 6 |
| (2) The form of the Final and Irrevocable Consent to | 7 |
| Adoption by a Specified Person or Persons in a non-DCFS case | 8 |
| shall have the caption of the proceeding in which it is to be | 9 |
| filed and shall be substantially as follows: | 10 |
| FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY | 11 |
| A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE | 12 |
| I, ...., (relationship, e.g., mother, father) of ...., a | 13 |
| ..male child, state: | 14 |
| 1. That such child was born on .... at ......City ... and | 15 |
| State of.... | 16 |
| 2. That I reside at ...., County of .... and State of .... | 17 |
| 3. That I am of the age of .... years. | 18 |
| 4. That I hereby enter my appearance in this proceeding and | 19 |
| waive service of summons on me. | 20 |
| 5. That I hereby acknowledge that I have been provided a | 21 |
| copy of the Birth Parent Rights and Responsibilities-Private | 22 |
| Form before signing this Consent and that I have had time to | 23 |
| read, or have had read to me, this Form and that I understand | 24 |
| the Rights and Responsibilities described in this Form. I | 25 |
| understand that if I do not receive any of my rights as | 26 |
| described in said Form, it shall not constitute a basis to |
|
|
|
09600HB6080ham002 |
- 4 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| revoke this Final and Irrevocable Consent to Adoption by a | 2 |
| Specified Person. | 3 |
| 6. That I do hereby consent and agree to the adoption of | 4 |
| such child by .... (specified persons) only. | 5 |
| 7. That I wish to and understand that upon signing this | 6 |
| consent I do irrevocably and permanently give up all custody | 7 |
| and other parental rights I have to such child if such child is | 8 |
| adopted by .... (specified person or persons). I hereby | 9 |
| transfer all of my rights to the custody, care and control of | 10 |
| such child to ............................. (specified person | 11 |
| or persons). | 12 |
| 8. That I understand such child will be adopted by | 13 |
| ....................... (specified person or persons) and that | 14 |
| I cannot under any circumstances, after signing this document, | 15 |
| change my mind and revoke or cancel this consent or obtain or | 16 |
| recover custody or any other rights over such child if | 17 |
| ............................ (specified person or persons) | 18 |
| adopt(s) such child; PROVIDED that each specified person has | 19 |
| filed or shall file, within 60 days from the date hereof, a | 20 |
| petition for the adoption of such child. | 21 |
| 9. That if the specified person or persons designated | 22 |
| herein do not file a petition for adoption within the | 23 |
| time-frame specified above, or, if said petition for adoption | 24 |
| is filed within the time-frame specified above but the adoption | 25 |
| petition is dismissed with prejudice or the adoption proceeding | 26 |
| is otherwise concluded without an order declaring the child to |
|
|
|
09600HB6080ham002 |
- 5 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| be the adopted child of the specified person or persons, then I | 2 |
| understand that I may request the Court to declare this consent | 3 |
| voidable and return the child to me. I further understand that | 4 |
| the Court will make the final decision of whether or not the | 5 |
| child will be returned to me. | 6 |
| 10. That I understand that I must request the return of the | 7 |
| child to me within 10 business days from the date that written | 8 |
| notice is sent to me. If I do not make such request within 10 | 9 |
| business days of the date of the notice, then I expressly waive | 10 |
| any other notice or service of process in any legal proceeding | 11 |
| for the adoption of the child. | 12 |
| 11. That I expressly acknowledge that nothing in this | 13 |
| Consent
impairs the validity and absolute finality of this
| 14 |
| Consent under any circumstance other than those described in
| 15 |
| paragraph 9 of this Consent. | 16 |
| 12. That I understand that I have a remaining duty and
| 17 |
| obligation to keep .............. (insert name and address of | 18 |
| the attorney
for the specified person or persons) informed of | 19 |
| my current
address or other preferred contact information until | 20 |
| this adoption has been finalized. My failure to
do so may | 21 |
| result in the termination of my parental rights and
the child | 22 |
| being placed for adoption in another home. | 23 |
| 13. That I do expressly waive any other notice or service | 24 |
| of process in any of the legal proceedings for the adoption of | 25 |
| the child as long as the adoption proceeding by the specified | 26 |
| person or persons is pending. |
|
|
|
09600HB6080ham002 |
- 6 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| 14. That I have read and understand the above and I am | 2 |
| signing it as my free and voluntary act. | 3 |
| 15. That I acknowledge that this consent is valid even if | 4 |
| the specified person or persons separate or divorce or one of | 5 |
| the specified persons dies prior to the entry of the final | 6 |
| judgment for adoption. | 7 |
| Dated (insert date). | 8 |
| ............................................. | 9 |
| Signature of parent | 10 |
| ............................................. | 11 |
| Address of parent | 12 |
| ............................................. | 13 |
| Phone number(s) of parent | 14 |
| ............................................. | 15 |
| Personal email(s) of parent | 16 |
| (3) The form of the certificate of acknowledgement for a | 17 |
| Final and Irrevocable Consent for Adoption by a Specified | 18 |
| Person or Persons: Non-DCFS Case shall be substantially as | 19 |
| follows: | 20 |
| STATE OF..............)
| 21 |
| ) SS.
| 22 |
| COUNTY OF.............) | 23 |
| I, .................... (Name of Judge or other person), | 24 |
| ..................... (official title, name, and address), | 25 |
| certify that ............., personally known to me to be the |
|
|
|
09600HB6080ham002 |
- 7 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| same person whose name is subscribed to the foregoing Final and | 2 |
| Irrevocable Consent for Adoption by a Specified Person or | 3 |
| Persons; non-DCFS case, appeared before me this day in person | 4 |
| and acknowledged that (she)(he) signed and delivered the | 5 |
| consent as (her)(his) free and voluntary act, for the specified | 6 |
| purpose. I am further satisfied that, before signing this | 7 |
| Consent, ........ has read, or has had read to him or her, the | 8 |
| Birth Parent Rights and Responsibilities-Private Form. | 9 |
| A-2. Birth Parent Rights and Responsibilities-Private | 10 |
| Form. The Birth Parent Rights and Responsibilities-Private | 11 |
| Form must be read by, or have been read to, any person | 12 |
| executing a Final and Irrevocable Consent to Adoption under | 13 |
| subsection A, a Final and Irrevocable Consent to Adoption by a | 14 |
| Specified Person or Persons: Non-DCFS Case under subsection | 15 |
| A-1, or a Consent to Adoption of Unborn Child under subsection | 16 |
| B prior to the execution of said Consent. The form of the Birth | 17 |
| Parent Rights and Responsibilities-Private Form shall be | 18 |
| substantially as follows: | 19 |
| Birth Parent Rights and Responsibilities-Private Form | 20 |
| As a birth parent in the State of Illinois, you have the | 21 |
| right: | 22 |
| 1. To have your own attorney represent you. The prospective | 23 |
| adoptive parents may agree to pay for the cost of your attorney | 24 |
| in a manner consistent with Illinois law, but they are not | 25 |
| required to do so. | 26 |
| 2. To be treated with dignity and respect at all times and |
|
|
|
09600HB6080ham002 |
- 8 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| to make decisions free from coercion and pressure. | 2 |
| 3. To receive counseling before and after signing a Final | 3 |
| and Irrevocable Consent to Adoption ("Consent"), a Final and | 4 |
| Irrevocable Consent to Adoption by a Specified Person or | 5 |
| Persons: Non-DCFS Case ("Specified Consent"), or a Consent to | 6 |
| Adoption of Unborn Child ("Unborn Consent"). The prospective | 7 |
| adoptive parents may agree to pay for the cost of counseling in | 8 |
| a manner consistent with Illinois law, but they are not | 9 |
| required to do so. | 10 |
| 4. To ask to be involved in choosing your child's | 11 |
| prospective adoptive parents and to ask to meet them. | 12 |
| 5. To ask your child's prospective adoptive parents any | 13 |
| questions that pertain to your decision to place your child | 14 |
| with them. | 15 |
| 6. To see your child before signing a Consent or Specified | 16 |
| Consent. | 17 |
| 7. To request contact with your child and/or the child's | 18 |
| prospective adoptive parents, with the understanding that any | 19 |
| promises regarding contact with your child or receipt of | 20 |
| information about the child after signing a Consent, Specified | 21 |
| Consent, or Unborn Consent cannot be enforced under Illinois | 22 |
| law. | 23 |
| 8. To receive copies of all documents that you sign and | 24 |
| have those documents provided to you in your preferred | 25 |
| language. | 26 |
| 9. To request that your identifying information remain |
|
|
|
09600HB6080ham002 |
- 9 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| confidential, unless required otherwise by Illinois law or | 2 |
| court order, and to register with the Illinois Adoption | 3 |
| Registry and Medical Information Exchange. | 4 |
| 10. To work with an adoption agency or attorney of your | 5 |
| choice, or change said agency or attorney, provided you | 6 |
| promptly inform all of the parties currently involved. | 7 |
| 11. To receive, upon request, a written list of any | 8 |
| promised support, financial or otherwise, from your attorney or | 9 |
| the attorney for your child's prospective adoptive parents. | 10 |
| 12. To delay signing a Consent, Specified Consent, or | 11 |
| Unborn Consent if you are not ready to do so. | 12 |
| 13. To decline to sign a Consent, Specified Consent, or | 13 |
| Unborn Consent even if you have received financial support from | 14 |
| the prospective adoptive parents. | 15 |
| If you do not receive any of the rights described in this | 16 |
| Form, it shall not be a basis to revoke a Consent, Specified | 17 |
| Consent, or Unborn Consent. | 18 |
| As a Birth Parent in the State of Illinois, you have the | 19 |
| responsibility: | 20 |
| 1. To carefully consider your reasons for choosing | 21 |
| adoption. | 22 |
| 2. To provide all known medical background and family | 23 |
| information about yourself and your immediate family to your | 24 |
| child's prospective adoptive parents or their attorney. | 25 |
| 3. (Birth mothers only) To accurately complete an Affidavit | 26 |
| of Identification, which identifies the father of the child |
|
|
|
09600HB6080ham002 |
- 10 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| when known, with the understanding that a birth mother has a | 2 |
| right to decline to identify the birth father. | 3 |
| 4. To not accept financial support or reimbursement of | 4 |
| pregnancy related expenses simultaneously from more than one | 5 |
| source. | 6 |
| B. The form of consent required for the adoption of an | 7 |
| unborn child
shall be substantially as follows:
| 8 |
| CONSENT TO ADOPTION OF UNBORN CHILD
| 9 |
| I, ...., state:
| 10 |
| That I am the father of a child expected to be born on or | 11 |
| about ....
to .... (name of mother).
| 12 |
| That I reside at .... County of ...., and State of .....
| 13 |
| That I am of the age of .... years.
| 14 |
| That I hereby enter my appearance in such adoption | 15 |
| proceeding and
waive service of summons on me.
| 16 |
| That I hereby acknowledge that I have been provided with a | 17 |
| copy of the Birth Parent Rights and Responsibilities-Private | 18 |
| Form before signing this Consent, and that I have had time to | 19 |
| read, or have had read to me, this Form. I understand that if I | 20 |
| do not receive any of the rights as described in this Form, it | 21 |
| shall not constitute a basis to revoke this Consent to Adoption | 22 |
| of Unborn Child. | 23 |
| That I do hereby consent and agree to the adoption of such | 24 |
| child, and
that I have not previously executed a consent or | 25 |
| surrender with respect
to such child.
| 26 |
| That I wish to and do understand that by signing this |
|
|
|
09600HB6080ham002 |
- 11 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| consent I do
irrevocably and permanently give up all custody | 2 |
| and other parental
rights I have to such child, except that I | 3 |
| have the right to revoke this
consent by giving written notice | 4 |
| of my revocation not later than 72
hours after the birth of the | 5 |
| child.
| 6 |
| That I understand such child will be placed for adoption | 7 |
| and that,
except as hereinabove provided, I cannot under any | 8 |
| circumstances, after
signing this document, change my mind and | 9 |
| revoke or cancel this consent
or obtain or recover custody or | 10 |
| any other rights over such child.
| 11 |
| That I have read and understand the above and I am signing | 12 |
| it as my
free and voluntary act.
| 13 |
| Dated (insert date).
| 14 |
| ........................
| 15 |
| B-5. (1) The parent of a child may execute a consent to | 16 |
| standby
adoption by a specified person or persons. A consent | 17 |
| under this subsection B-5
shall be acknowledged by a parent | 18 |
| pursuant to subsection H and subsection K of
this Section.
The | 19 |
| form of consent required for the standby adoption of a born | 20 |
| child
effective at a future date when the consenting
parent of | 21 |
| the child dies or
requests that a final judgment of adoption be | 22 |
| entered shall be substantially as
follows:
| 23 |
| FINAL AND IRREVOCABLE CONSENT
| 24 |
| TO STANDBY ADOPTION
| 25 |
| I, ..., (relationship, e.g. mother or father)
of ...., a | 26 |
| ..male child, state:
|
|
|
|
09600HB6080ham002 |
- 12 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| That the child was born on .... at .....
| 2 |
| That I reside at ...., County of ...., and State of .....
| 3 |
| That I am of the age of .... years.
| 4 |
| That I hereby enter my appearance in this proceeding and | 5 |
| waive service of
summons on me in this action only.
| 6 |
| That I do hereby consent and
agree to the standby adoption | 7 |
| of the child, and that I have not previously
executed a consent | 8 |
| or surrender with respect to the child.
| 9 |
| That I wish to and understand that by signing this consent | 10 |
| I do irrevocably
and permanently give up all custody and other | 11 |
| parental rights I have to the
child, effective upon
(my death) | 12 |
| (the child's other parent's death) or upon (my) (the other
| 13 |
| parent's) request for the entry of a final judgment for | 14 |
| adoption if .....
(specified person or persons) adopt my child.
| 15 |
| That I understand that until (I die) (the child's other | 16 |
| parent dies), I
retain all legal rights and obligations | 17 |
| concerning the child, but at that time,
I irrevocably give all | 18 |
| custody and other parental rights to .... (specified
person or | 19 |
| persons).
| 20 |
| I understand my child will be adopted by ....... (specified | 21 |
| person or
persons) only and that I cannot, under any | 22 |
| circumstances, after signing this
document, change my mind and | 23 |
| revoke or cancel this consent or obtain or recover
custody or | 24 |
| any other rights over my child if ..... (specified person or
| 25 |
| persons) adopt my child.
| 26 |
| I understand that this consent to standby adoption is valid |
|
|
|
09600HB6080ham002 |
- 13 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| only if the
petition for standby adoption is filed and that if | 2 |
| ....... (specified person or
persons), for any reason, cannot | 3 |
| or will not file a petition for standby
adoption or if his, | 4 |
| her, or their petition for standby adoption is denied, then
| 5 |
| this consent is void. I have the right to notice of any other | 6 |
| proceeding that
could affect my parental rights.
| 7 |
| That I have read and understand the above and I am signing | 8 |
| it as my free and
voluntary act.
| 9 |
| Dated (insert date).
| 10 |
| ....................
| 11 |
| If under Section 8 the consent of more than one person is | 12 |
| required, then each
such
person shall execute a separate | 13 |
| consent. A separate consent shall be executed
for each
child.
| 14 |
| (2) If the parent consents to a standby adoption by 2 | 15 |
| specified persons,
then the form shall contain 2 additional | 16 |
| paragraphs in substantially the
following form:
| 17 |
| If .... (specified persons) obtain a judgment of
| 18 |
| dissolution of
marriage before the judgment for adoption is | 19 |
| entered, then .....
(specified person) shall adopt my child. I | 20 |
| understand that I cannot change my
mind and revoke this consent | 21 |
| or obtain or recover custody of my child if .....
(specified | 22 |
| persons) obtain a judgment of dissolution of marriage and .....
| 23 |
| (specified person) adopts my child. I understand that I cannot | 24 |
| change my
mind and revoke this consent if ...... (specified | 25 |
| persons) obtain a
judgment of dissolution of marriage before |
|
|
|
09600HB6080ham002 |
- 14 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| the adoption is final. I
understand that this consent to | 2 |
| adoption has no effect on who will get custody
of my child if | 3 |
| ..... (specified persons) obtain a judgment of dissolution
of | 4 |
| marriage after the adoption is final. I understand that if | 5 |
| either .....
(specified persons) dies before the petition to | 6 |
| adopt my child is granted, then
the surviving person may adopt | 7 |
| my child. I understand that I cannot change my
mind and revoke | 8 |
| this consent or obtain or recover custody of my child if the
| 9 |
| surviving person adopts my child.
| 10 |
| A consent to standby adoption by specified persons on this | 11 |
| form shall have no
effect on a court's determination of custody | 12 |
| or visitation under the Illinois
Marriage and Dissolution
of | 13 |
| Marriage Act if the marriage of the specified persons is | 14 |
| dissolved before
the adoption is final.
| 15 |
| (3) The form of the certificate of acknowledgement for a | 16 |
| Final and
Irrevocable Consent for Standby Adoption shall be | 17 |
| substantially as follows:
| 18 |
| STATE OF .....)
| 19 |
| ) SS.
| 20 |
| COUNTY OF ....)
| 21 |
| I, ....... (name of Judge or other person) ..... (official | 22 |
| title,
name, and address), certify that ......., personally | 23 |
| known to me to be
the same person whose name is subscribed to | 24 |
| the foregoing Final and Irrevocable
Consent to Standby |
|
|
|
09600HB6080ham002 |
- 15 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| Adoption, appeared before me this day in person and
| 2 |
| acknowledged that (she) (he) signed and
delivered the consent | 3 |
| as (her) (his) free and voluntary act, for the specified
| 4 |
| purpose.
| 5 |
| I have fully explained that this consent to adoption is | 6 |
| valid only if the
petition to adopt is filed, and that if the | 7 |
| specified person or persons, for
any reason, cannot or will not | 8 |
| adopt the child or if the adoption petition is
denied, then | 9 |
| this consent will be void. I have fully explained that if the
| 10 |
| specified person or persons adopt the child, by signing this | 11 |
| consent (she) (he)
is irrevocably and permanently | 12 |
| relinquishing all parental rights to the child,
and (she) (he) | 13 |
| has stated that such is (her) (his) intention and desire.
| 14 |
| Dated (insert date).
| 15 |
| Signature..............................
| 16 |
| (4) If a consent to standby adoption is executed in this | 17 |
| form,
the consent shall be valid only if the specified
person | 18 |
| or persons adopt the child. The consent shall be void if:
| 19 |
| (a) the specified person or persons do not file a petition | 20 |
| for standby
adoption of the child; or
| 21 |
| (b) a court denies the standby adoption petition.
| 22 |
| The parent shall not need to take further action to revoke | 23 |
| the consent if the
standby adoption by the specified person or | 24 |
| persons does not occur,
notwithstanding the provisions of | 25 |
| Section 11 of this Act.
| 26 |
| C. The form of surrender to any agency given by a parent of |
|
|
|
09600HB6080ham002 |
- 16 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| a born
child who is to be subsequently placed for adoption | 2 |
| shall be
substantially as follows and shall contain such other | 3 |
| facts and
statements as the particular agency shall require.
| 4 |
| FINAL AND IRREVOCABLE SURRENDER
| 5 |
| FOR PURPOSES OF ADOPTION
| 6 |
| I, .... (relationship, e.g., mother, father, relative, | 7 |
| guardian) of
...., a ..male child, state:
| 8 |
| That such child was born on ...., at .....
| 9 |
| That I reside at ...., County of ...., and State of .....
| 10 |
| That I am of the age of .... years.
| 11 |
| That I do hereby surrender and entrust the entire custody | 12 |
| and control
of such child to the .... (the "Agency"), a | 13 |
| (public) (licensed) child
welfare agency with its principal | 14 |
| office in the City of ...., County of
.... and State of ...., | 15 |
| for the purpose of enabling it to care for and
supervise the | 16 |
| care of such child, to place such child for adoption and
to | 17 |
| consent to the legal adoption of such child.
| 18 |
| That I hereby grant to the Agency full power and authority | 19 |
| to place
such child with any person or persons it may in its | 20 |
| sole discretion
select to become the adopting parent or parents | 21 |
| and to consent to the
legal adoption of such child by such | 22 |
| person or persons; and to take any
and all measures which, in | 23 |
| the judgment of the Agency, may be for the
best interests of | 24 |
| such child, including authorizing medical, surgical
and dental | 25 |
| care and treatment including inoculation and anaesthesia for
| 26 |
| such child.
|
|
|
|
09600HB6080ham002 |
- 17 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| That I wish to and understand that by signing this | 2 |
| surrender I do
irrevocably and permanently give up all custody | 3 |
| and other parental
rights I have to such child.
| 4 |
| That I understand I cannot under any circumstances, after | 5 |
| signing
this surrender, change my mind and revoke or cancel | 6 |
| this surrender or
obtain or recover custody or any other rights | 7 |
| over such child.
| 8 |
| That I have read and understand the above and I am signing | 9 |
| it as my
free and voluntary act.
| 10 |
| Dated (insert date).
| 11 |
| ........................
| 12 |
| C-5. The form of a Final and Irrevocable Designated | 13 |
| Surrender for Purposes of Adoption to any agency given by a | 14 |
| parent of a born child who is to be subsequently placed for | 15 |
| adoption shall be substantially as follows and shall contain | 16 |
| such other facts and statements as the particular agency shall | 17 |
| require: | 18 |
| FINAL AND IRREVOCABLE DESIGNATED SURRENDER | 19 |
| FOR PURPOSES OF ADOPTION | 20 |
| I, .... (relationship, e.g., mother, father, relative, | 21 |
| guardian) of ...., a ..male child, state: | 22 |
| 1. That such child was born on ...., at ..... | 23 |
| 2. That I reside at ...., County of ...., and State of | 24 |
| ..... | 25 |
| 3. That I am of the age of .... years. | 26 |
| 4. That I do hereby surrender and entrust the entire |
|
|
|
09600HB6080ham002 |
- 18 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| custody and control of such child to the .... (the "Agency"), a | 2 |
| (public) (licensed) child welfare agency with its principal | 3 |
| office in the City of ...., County of .... and State of ...., | 4 |
| for the purpose of enabling it to care for and supervise the | 5 |
| care of such child, to place such child for adoption with | 6 |
| ............................. (specified person or persons) | 7 |
| and to consent to the legal adoption of such child and to take | 8 |
| any and all measures which, in the judgment of the Agency, may | 9 |
| be for the best interests of such child, including authorizing | 10 |
| medical, surgical and dental care and treatment including | 11 |
| inoculation and anesthesia for such child. | 12 |
| 5. That I wish to and understand that by signing this | 13 |
| surrender I do irrevocably and permanently give up all custody | 14 |
| and other parental rights I have to such child. | 15 |
| 6. That if the petition for adoption is not filed by the
| 16 |
| specified person or persons designated herein or, if the
| 17 |
| petition for adoption is filed but the adoption petition is
| 18 |
| dismissed with prejudice or the adoption proceeding is
| 19 |
| otherwise concluded without an order declaring the child to be
| 20 |
| the adopted child of each specified person, then I understand | 21 |
| that the Agency will provide notice to me within 10 business | 22 |
| days and that such notice will be directed to me using the | 23 |
| contact information I have provided to the Agency. I understand | 24 |
| that I will have 10 business days from the date that the Agency | 25 |
| sends me its notice to respond, within which time I may choose | 26 |
| to designate other adoptive parent(s). However, I acknowledge |
|
|
|
09600HB6080ham002 |
- 19 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| that
the Agency has full power and authority to place the child | 2 |
| for adoption with
any person or persons it may in its sole | 3 |
| discretion select to
become the adopting parent or parents and | 4 |
| to consent to the
legal adoption of the child by such person or | 5 |
| persons. | 6 |
| 7. That I acknowledge that this surrender is valid even if | 7 |
| the specified persons separate or divorce or one of the | 8 |
| specified persons dies prior to the entry of the final judgment | 9 |
| for adoption. | 10 |
| 8. That I expressly acknowledge that the above paragraphs 6 | 11 |
| and 7 do not impair the validity and absolute finality of this | 12 |
| surrender under any circumstance. | 13 |
| 9. That I understand that I have a remaining obligation to | 14 |
| keep the Agency informed of my current contact information | 15 |
| until the adoption of the child has been finalized if I wish to | 16 |
| be notified in the event the adoption by the specified | 17 |
| person(s) cannot proceed. | 18 |
| 10. That I understand I cannot under any circumstances, | 19 |
| after signing this surrender, change my mind and revoke or | 20 |
| cancel this surrender or obtain or recover custody or any other | 21 |
| rights over such child. | 22 |
| 11. That I have read and understand the above and I am | 23 |
| signing it as my free and voluntary act. | 24 |
| Dated (insert date). | 25 |
| .............................. | 26 |
| D. The form of surrender to an agency given by a parent of |
|
|
|
09600HB6080ham002 |
- 20 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| an unborn
child who is to be subsequently placed for adoption | 2 |
| shall be
substantially as follows and shall contain such other | 3 |
| facts and
statements as the particular agency shall require.
| 4 |
| SURRENDER OF UNBORN CHILD FOR
| 5 |
| PURPOSES OF ADOPTION
| 6 |
| I, .... (father), state:
| 7 |
| That I am the father of a child expected to be born on or | 8 |
| about ....
to .... (name of mother).
| 9 |
| That I reside at ...., County of ...., and State of .....
| 10 |
| That I am of the age of .... years.
| 11 |
| That I do hereby surrender and entrust the entire custody | 12 |
| and control
of such child to the .... (the "Agency"), a | 13 |
| (public) (licensed) child
welfare agency with its principal | 14 |
| office in the City of ...., County of
.... and State of ...., | 15 |
| for the purpose of enabling it to care for and
supervise the | 16 |
| care of such child, to place such child for adoption and
to | 17 |
| consent to the legal adoption of such child, and that I have | 18 |
| not
previously executed a consent or surrender with respect to | 19 |
| such child.
| 20 |
| That I hereby grant to the Agency full power and authority | 21 |
| to place
such child with any person or persons it may in its | 22 |
| sole discretion
select to become the adopting parent or parents | 23 |
| and to consent to the
legal adoption of such child by such | 24 |
| person or persons; and to take any
and all measures which, in | 25 |
| the judgment of the Agency, may be for the
best interests of | 26 |
| such child, including authorizing medical, surgical
and dental |
|
|
|
09600HB6080ham002 |
- 21 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| care and treatment, including inoculation and anaesthesia for
| 2 |
| such child.
| 3 |
| That I wish to and understand that by signing this | 4 |
| surrender I do
irrevocably and permanently give up all custody | 5 |
| and other parental
rights I have to such child.
| 6 |
| That I understand I cannot under any circumstances, after | 7 |
| signing
this surrender, change my mind and revoke or cancel | 8 |
| this surrender or
obtain or recover custody or any other rights | 9 |
| over such child, except
that I have the right to revoke this | 10 |
| surrender by giving written notice
of my revocation not later | 11 |
| than 72 hours after the birth of such child.
| 12 |
| That I have read and understand the above and I am signing | 13 |
| it as my
free and voluntary act.
| 14 |
| Dated (insert date).
| 15 |
| ........................
| 16 |
| E. The form of consent required from the parents for the | 17 |
| adoption of
an adult, when such adult elects to obtain such | 18 |
| consent, shall be
substantially as follows:
| 19 |
| CONSENT
| 20 |
| I, ...., (father) (mother) of ...., an adult, state:
| 21 |
| That I reside at ...., County of .... and State of .....
| 22 |
| That I do hereby consent and agree to the adoption of such | 23 |
| adult by
.... and .....
| 24 |
| Dated (insert date).
| 25 |
| .........................
| 26 |
| F. The form of consent required for the adoption of a child |
|
|
|
09600HB6080ham002 |
- 22 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| of the
age of 14 years or upwards, or of an adult, to be given | 2 |
| by such person,
shall be substantially as follows:
| 3 |
| CONSENT
| 4 |
| I, ...., state:
| 5 |
| That I reside at ...., County of .... and State of ..... | 6 |
| That I am
of the age of .... years. That I consent and agree to | 7 |
| my adoption by
.... and .....
| 8 |
| Dated (insert date).
| 9 |
| ........................
| 10 |
| G. The form of consent given by an agency to the adoption | 11 |
| by
specified persons of a child previously surrendered to it | 12 |
| shall set
forth that the agency has the authority to execute | 13 |
| such consent. The
form of consent given by a guardian of the | 14 |
| person of a child sought to
be adopted, appointed by a court of | 15 |
| competent jurisdiction, shall set
forth the facts of such | 16 |
| appointment and the authority of the guardian to
execute such | 17 |
| consent.
| 18 |
| H. A consent (other than that given by an agency, or | 19 |
| guardian of the
person of the child sought to be adopted who | 20 |
| was appointed by a court of
competent jurisdiction) shall be | 21 |
| acknowledged by a parent before a judge of a court of competent | 22 |
| jurisdiction or, except as otherwise provided in
this Act, | 23 |
| before a representative of an agency, or before a person, other | 24 |
| than the attorney for the prospective adoptive parent or | 25 |
| parents, designated by a court of competent
jurisdiction.
| 26 |
| I. A surrender, or any other document equivalent to a |
|
|
|
09600HB6080ham002 |
- 23 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| surrender, by
which a child is surrendered to an agency shall | 2 |
| be acknowledged by the
person signing such surrender, or other | 3 |
| document, before a judge of a court of competent jurisdiction, | 4 |
| or, except as otherwise provided in this Act, before a | 5 |
| representative of an agency, or before a person designated by a | 6 |
| court
of competent jurisdiction.
| 7 |
| J. The form of the certificate of acknowledgment for a | 8 |
| consent, a
surrender, or any other document equivalent to a | 9 |
| surrender, shall be
substantially as follows:
| 10 |
| STATE OF ....)
| 11 |
| ) SS.
| 12 |
| COUNTY OF ...)
| 13 |
| I, .... (Name of judge or other person), .... (official | 14 |
| title, name and
location of court or status or position of | 15 |
| other person),
certify that ...., personally known to me to be | 16 |
| the same person whose
name is subscribed to the foregoing | 17 |
| (consent) (surrender), appeared
before me this day in person | 18 |
| and acknowledged that (she) (he) signed and
delivered such | 19 |
| (consent) (surrender) as (her) (his) free and voluntary
act, | 20 |
| for the specified purpose.
| 21 |
| I have fully explained that by signing such (consent) | 22 |
| (surrender)
(she) (he) is irrevocably relinquishing all | 23 |
| parental rights to such
child or adult and (she) (he) has | 24 |
| stated that such is (her) (his)
intention and desire. (Add if | 25 |
| Consent only) I am further satisfied that, before signing this | 26 |
| Consent, ........ has read, or has had read to him or her, the |
|
|
|
09600HB6080ham002 |
- 24 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| Birth Parent Rights and Responsibilities-Private Form.
| 2 |
| Dated (insert date).
| 3 |
| Signature ...............
| 4 |
| K. When the execution of a consent or a surrender is | 5 |
| acknowledged
before someone other than a judge,
such other | 6 |
| person shall have his or her signature on the certificate
| 7 |
| acknowledged before a notary public, in form substantially as | 8 |
| follows:
| 9 |
| STATE OF ....)
| 10 |
| ) SS.
| 11 |
| COUNTY OF ...)
| 12 |
| I, a Notary Public, in and for the County of ......, in the | 13 |
| State of
......, certify that ...., personally known to me to | 14 |
| be the
same person whose name is subscribed to the foregoing | 15 |
| certificate of
acknowledgment, appeared before me in person and | 16 |
| acknowledged that (she)
(he) signed such certificate as (her) | 17 |
| (his) free and voluntary act and
that the statements made in | 18 |
| the certificate are true.
| 19 |
| Dated (insert date).
| 20 |
| Signature ...................... Notary Public
| 21 |
| (official seal)
| 22 |
| There shall be attached a certificate of magistracy, or | 23 |
| other
comparable proof of office of the notary public | 24 |
| satisfactory to the
court, to a consent signed and acknowledged | 25 |
| in another state.
|
|
|
|
09600HB6080ham002 |
- 25 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| L. A surrender or consent executed and acknowledged outside | 2 |
| of this
State, either in accordance with the law of this State | 3 |
| or in accordance
with the law of the place where executed, is | 4 |
| valid.
| 5 |
| M. Where a consent or a surrender is signed in a foreign | 6 |
| country,
the execution of such consent shall be acknowledged or | 7 |
| affirmed in a
manner conformable to the law and procedure of | 8 |
| such country.
| 9 |
| N. If the person signing a consent or surrender is in the | 10 |
| military
service of the United States, the execution of such | 11 |
| consent or surrender
may be acknowledged before a commissioned | 12 |
| officer and the signature of
such officer on such certificate | 13 |
| shall be verified or acknowledged
before a notary public or by | 14 |
| such other procedure as is then in effect
for such division or | 15 |
| branch of the armed forces.
| 16 |
| O. (1) The parent or parents of a child in whose interests | 17 |
| a petition
under Section 2-13 of the Juvenile Court Act of 1987 | 18 |
| is pending may, with the
approval of the designated | 19 |
| representative of the Department of Children and
Family | 20 |
| Services, execute a consent to adoption by a specified person | 21 |
| or
persons:
| 22 |
| (a) in whose physical custody the child has resided for | 23 |
| at least 6
months;
or
| 24 |
| (b) in whose physical custody at least one sibling of | 25 |
| the child who is the
subject of this consent has resided | 26 |
| for at least 6 months, and
the child who is
the subject of |
|
|
|
09600HB6080ham002 |
- 26 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| this consent is currently residing in this foster home; or
| 2 |
| (c) in whose physical custody a child under one year of | 3 |
| age has resided
for at least 3 months.
| 4 |
| A consent under this subsection O shall be acknowledged by a | 5 |
| parent pursuant to
subsection H and subsection K of this | 6 |
| Section.
| 7 |
| (2) The consent to adoption by a specified person or | 8 |
| persons shall have the
caption of the proceeding in which it is | 9 |
| to be filed and shall be substantially
as follows:
| 10 |
| FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
| 11 |
| A SPECIFIED PERSON OR PERSONS : DCFS CASE
| 12 |
| I, ......................................, the | 13 |
| .................. (mother or
father) of a ....male child, | 14 |
| state:
| 15 |
| 1. My child ............................ (name of | 16 |
| child) was born on
(insert date) at .................... | 17 |
| Hospital in
................ County, State of | 18 |
| ...............
| 19 |
| 2. I reside at ......................, County of | 20 |
| ............. and
State of ..............
| 21 |
| 3. I, ..........................., am .... years old.
| 22 |
| 4. I enter my appearance in this action to adopt my | 23 |
| child by the
person or persons specified herein by me and | 24 |
| waive service of
summons on me in this action only.
| 25 |
| 5. I consent to the adoption of my child by
| 26 |
| .............................
(specified person or |
|
|
|
09600HB6080ham002 |
- 27 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| persons) only.
| 2 |
| 6. I wish to sign this consent and I understand that by | 3 |
| signing this
consent I irrevocably and permanently give up | 4 |
| all parental rights I have to my
child if my child is | 5 |
| adopted by ............................. (specified person
| 6 |
| or persons).
| 7 |
| 7. I understand my child will be adopted by | 8 |
| .............................
(specified person or | 9 |
| persons) only and that I cannot under any circumstances,
| 10 |
| after signing this document, change my mind and revoke or | 11 |
| cancel this consent
or obtain or recover custody or any | 12 |
| other rights over my child if
............................ | 13 |
| (specified person or persons) adopt my child.
| 14 |
| 8. I understand that this consent to adoption is valid | 15 |
| only if the
petition to adopt is filed within one year from | 16 |
| the date that I sign it and
that if ....................... | 17 |
| (specified person or persons), for any reason,
cannot or | 18 |
| will not file a petition to adopt my child within that one | 19 |
| year
period or if their adoption petition is denied, then | 20 |
| this consent will be
voidable after one year upon the | 21 |
| timely filing of my motion. If I file this
motion before | 22 |
| the filing of the petition for adoption, I understand that | 23 |
| the
court shall revoke this specific consent.
I have the | 24 |
| right to notice of any other proceeding that could affect | 25 |
| my
parental rights, except for the proceeding for | 26 |
| ............. (specified person
or persons) to adopt my |
|
|
|
09600HB6080ham002 |
- 28 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| child.
| 2 |
| 9. 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 | 8 |
| persons, then the
form shall contain 2 additional paragraphs in | 9 |
| substantially the following form:
| 10 |
| 10. If ............... (specified persons) get a | 11 |
| divorce
before the petition to adopt my child is granted, | 12 |
| then ..........
(specified person) shall adopt my child. I | 13 |
| understand that I
cannot change my mind and revoke this | 14 |
| consent or obtain or
recover custody over my child if | 15 |
| ............. (specified persons)
divorce and | 16 |
| ............. (specified person) adopts my
child. I | 17 |
| understand that I cannot change my mind and revoke
this | 18 |
| consent or obtain or recover custody over my child if
| 19 |
| ................. (specified persons) divorce after the
| 20 |
| adoption is final. I understand that this consent to | 21 |
| adoption
has no effect on who will get custody of my child | 22 |
| if they
divorce after the adoption is final.
| 23 |
| 11. I understand that if either ...............
| 24 |
| (specified persons) dies before the petition to adopt
my | 25 |
| child is granted, then the surviving person can adopt my | 26 |
| child. I
understand that I cannot change my mind and revoke |
|
|
|
09600HB6080ham002 |
- 29 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| this consent
or obtain or recover custody over my child if | 2 |
| the surviving
person adopts my child.
| 3 |
| A consent to adoption by specified persons on this form | 4 |
| shall
have no effect on a court's determination of custody or | 5 |
| visitation
under the Illinois Marriage and Dissolution of | 6 |
| Marriage Act if the
marriage of the
specified persons is | 7 |
| dissolved after the adoption is final.
| 8 |
| (4) The form of the certificate of acknowledgement for a | 9 |
| Final and
Irrevocable Consent for Adoption by a Specified | 10 |
| Person or Persons : DCFS Case shall be
substantially as follows:
| 11 |
| STATE OF..............)
| 12 |
| ) SS.
| 13 |
| COUNTY OF.............)
| 14 |
| I, .................... (Name of Judge or other person),
| 15 |
| ..................... (official title, name, and address),
| 16 |
| certify that ............., personally known to me to be the | 17 |
| same person whose
name is subscribed to the foregoing Final and | 18 |
| Irrevocable Consent for Adoption
by a Specified Person or | 19 |
| Persons, appeared before me this day
in person and acknowledged | 20 |
| that (she)(he) signed and delivered the consent as
(her)(his) | 21 |
| free and voluntary act, for the specified purpose.
| 22 |
| I have fully explained that this consent to adoption is | 23 |
| valid only if the
petition to adopt is filed within one year | 24 |
| from the date that it is signed, and
that if the specified |
|
|
|
09600HB6080ham002 |
- 30 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| person or persons, for any reason, cannot or will not
adopt the | 2 |
| child or if the adoption petition is denied, then this consent | 3 |
| will
be voidable after one year upon the timely filing of a | 4 |
| motion by the parent
to revoke the consent. I explained that if | 5 |
| this motion is filed before the
filing of the petition for | 6 |
| adoption, the court shall revoke this specific
consent. I have | 7 |
| fully explained that if the specified person or
persons adopt
| 8 |
| the child, by signing this consent this parent is irrevocably
| 9 |
| and permanently
relinquishing all parental rights to the child, | 10 |
| and this parent has stated that
such is (her)(his) intention | 11 |
| and desire.
| 12 |
| Dated (insert date).
| 13 |
| ...............................
| 14 |
| Signature
| 15 |
| (5) If a consent to adoption by a specified person or | 16 |
| persons is executed in
this form, the following provisions | 17 |
| shall apply. The consent shall be valid
only if that specified | 18 |
| person or persons adopt the child. The consent shall be
| 19 |
| voidable after one year if:
| 20 |
| (a) the specified person or persons do not file a | 21 |
| petition to adopt the
child within one year after the | 22 |
| consent is signed and the parent files a
timely motion to | 23 |
| revoke this consent. If this motion is filed before the
| 24 |
| filing of the petition for adoption the court shall revoke | 25 |
| this consent; or
| 26 |
| (b) a court denies the adoption petition; or
|
|
|
|
09600HB6080ham002 |
- 31 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| (c) the Department of Children and Family Services | 2 |
| Guardianship
Administrator determines that the specified | 3 |
| person or persons will not or
cannot complete the adoption, | 4 |
| or in the best interests of the child should not
adopt the | 5 |
| child.
| 6 |
| Within 30 days of the consent becoming void, the Department | 7 |
| of Children and
Family Services Guardianship Administrator | 8 |
| shall make good faith attempts to
notify the parent in writing | 9 |
| and shall give written notice to the court and all
additional | 10 |
| parties in writing that the adoption has not occurred or will | 11 |
| not
occur and that the consent is void. If the adoption by a | 12 |
| specified person or
persons does not occur, no proceeding for | 13 |
| termination of parental rights shall
be brought unless the | 14 |
| biological parent who executed the consent to adoption by
a | 15 |
| specified person or persons has been notified of the proceeding | 16 |
| pursuant to
Section 7 of this Act or subsection (4) of Section | 17 |
| 2-13 of the Juvenile Court
Act of 1987. The parent shall not | 18 |
| need to take further action to revoke the
consent if the | 19 |
| specified adoption does not occur, notwithstanding the
| 20 |
| provisions of Section 11 of this Act.
| 21 |
| (6) The Department of Children and Family Services is | 22 |
| authorized
to promulgate rules necessary to implement this | 23 |
| subsection O.
| 24 |
| (7) The Department shall collect and maintain data | 25 |
| concerning the efficacy
of specific consents. This data shall | 26 |
| include the number of specific consents
executed and their |
|
|
|
09600HB6080ham002 |
- 32 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| outcomes, including but not limited to the number of
children | 2 |
| adopted pursuant to the consents, the number of children for | 3 |
| whom
adoptions are not completed, and the reason or reasons why | 4 |
| the adoptions are
not completed.
| 5 |
| P. If the person signing a consent is incarcerated or | 6 |
| detained in a correctional facility, prison, jail, detention | 7 |
| center, or other comparable institution, either in this State | 8 |
| or any other jurisdiction, the execution of such consent may be | 9 |
| acknowledged before social service personnel of such | 10 |
| institution, or before a person designated by a court of | 11 |
| competent jurisdiction. | 12 |
| Q. A consent may be acknowledged telephonically, via | 13 |
| audiovisual connection, or other electronic means, provided | 14 |
| that a court of competent jurisdiction has entered an order | 15 |
| approving the execution of the consent in such manner and has | 16 |
| designated an individual to be physically present with the | 17 |
| parent executing such consent in order to verify the identity | 18 |
| of the parent. | 19 |
| R. An agency whose representative is acknowledging a | 20 |
| consent pursuant to this Section shall be a public child | 21 |
| welfare agency, or a child welfare agency, or a child placing | 22 |
| agency that is authorized or licensed in the State or | 23 |
| jurisdiction in which the consent is signed. | 24 |
| (Source: P.A. 96-601, eff. 8-21-09.)
| 25 |
| Section 99. Effective date. This Act takes effect January |
|
|
|
09600HB6080ham002 |
- 33 - |
LRB096 18717 AJO 38854 a |
|
| 1 |
| 1, 2011.".
|
|