HB1698 EngrossedLRB097 07917 AJO 48032 b

1    AN ACT concerning civil law.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Adoption Act is amended by changing Section
510 as follows:
 
6    (750 ILCS 50/10)  (from Ch. 40, par. 1512)
7    Sec. 10. Forms of consent and surrender; execution and
8acknowledgment thereof.
9    A. The form of consent required for the adoption of a born
10child shall be substantially as follows:
11
FINAL AND IRREVOCABLE CONSENT TO ADOPTION
12    I, ...., (relationship, e.g., mother, father, relative,
13guardian) of ...., a ..male child, state:
14    That such child was born on .... at ....
15    That I reside at ...., County of .... and State of ....
16    That I am of the age of .... years.
17    That I hereby enter my appearance in this proceeding and
18waive service of summons on me.
19    That I hereby acknowledge that I have been provided with a
20copy of the Birth Parent Rights and Responsibilities-Private
21Form before signing this Consent and that I have had time to
22read, or have had read to me, this Form. I understand that if I
23do not receive any of the rights as described in this Form, it

 

 

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1shall not constitute a basis to revoke this Final and
2Irrevocable Consent.
3    That I do hereby consent and agree to the adoption of such
4child.
5    That I wish to and understand that by signing this consent
6I do irrevocably and permanently give up all custody and other
7parental rights I have to such child.
8    That I understand such child will be placed for adoption
9and that I cannot under any circumstances, after signing this
10document, change my mind and revoke or cancel this consent or
11obtain or recover custody or any other rights over such child.
12That I have read and understand the above and I am signing it
13as my free and voluntary act.
14    Dated (insert date).
15.........................
 
16    If under Section 8 the consent of more than one person is
17required, then each such person shall execute a separate
18consent.
19    A-1. (1) The form of the Final and Irrevocable Consent to
20Adoption by a Specified Person or Persons: Non-DCFS Case set
21forth in this subsection A-1 is to be used by legal parents
22only. This form is not to be used in cases in which there is a
23pending petition under Section 2-13 of the Juvenile Court Act
24of 1987.
25    (2) The form of the Final and Irrevocable Consent to

 

 

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1Adoption by a Specified Person or Persons in a non-DCFS case
2shall have the caption of the proceeding in which it is to be
3filed and shall be substantially as follows:
4
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
5
A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE
6    I, ...., (relationship, e.g., mother, father) of ...., a
7..male child, state:
8    1. That such child was born on ...., at ....., City of ...
9and State of ....
10    2. That I reside at ...., County of .... and State of ....
11    3. That I am of the age of .... years.
12    4. That I hereby enter my appearance in this proceeding and
13waive service of summons on me.
14    5. That I hereby acknowledge that I have been provided 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 and that I understand
18the Rights and Responsibilities described in this Form. I
19understand that if I do not receive any of my rights as
20described in said Form, it shall not constitute a basis to
21revoke this Final and Irrevocable Consent to Adoption by a
22Specified Person.
23    6. That I do hereby consent and agree to the adoption of
24such child by .... (specified persons) only.
25    7. That I wish to and understand that upon signing this
26consent I do irrevocably and permanently give up all custody

 

 

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1and other parental rights I have to such child if such child is
2adopted by .... (specified person or persons). I hereby
3transfer all of my rights to the custody, care and control of
4such child to ............................. (specified person
5or persons).
6    8. That I understand such child will be adopted by
7....................... (specified person or persons) and that
8I cannot under any circumstances, after signing this document,
9change my mind and revoke or cancel this consent or obtain or
10recover custody or any other rights over such child if
11............................ (specified person or persons)
12adopt(s) such child; PROVIDED that each specified person has
13filed or shall file, within 60 days from the date hereof, a
14petition for the adoption of such child.
15    9. That if the specified person or persons designated
16herein do not file a petition for adoption within the
17time-frame specified above, or, if said petition for adoption
18is filed within the time-frame specified above but the adoption
19petition is dismissed with prejudice or the adoption proceeding
20is otherwise concluded without an order declaring the child to
21be the adopted child of the specified person or persons, then I
22understand that I will receive written notice of such
23circumstances within 10 business days of their occurrence. I
24understand that the notice will be directed to me using the
25contact information I have provided in this consent. I
26understand that I will have 10 business days from the date that

 

 

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1the written notice is sent to me to respond, within which time
2I may request the Court to declare this consent voidable and
3return the child to me. I further understand that the Court
4will make the final decision of whether or not the child will
5be returned to me. If I do not make such request within 10
6business days of the date of the notice, then I expressly waive
7any other notice or service of process in any legal proceeding
8for the adoption of the child.
9    10. That I expressly acknowledge that nothing in this
10Consent impairs the validity and absolute finality of this
11Consent under any circumstance other than those described in
12paragraph 9 of this Consent.
13    11. That I understand that I have a remaining duty and
14obligation to keep .............. (insert name and address of
15the attorney for the specified person or persons) informed of
16my current address or other preferred contact information until
17this adoption has been finalized. My failure to do so may
18result in the termination of my parental rights and the child
19being placed for adoption in another home.
20    12. That I do expressly waive any other notice or service
21of process in any of the legal proceedings for the adoption of
22the child as long as the adoption proceeding by the specified
23person or persons is pending.
24    13. That I have read and understand the above and I am
25signing it as my free and voluntary act.
26    14. That I acknowledge that this consent is valid even if

 

 

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1the specified person or persons separate or divorce or one of
2the specified persons dies prior to the entry of the final
3judgment for adoption.
4    Dated (insert date).
5    .............................................
6    Signature of parent.
7    .............................................
8    Address of parent.
9    .............................................
10    Phone number(s) of parent.
11    .............................................
12    Personal email(s) of parent.
13    .............................................
14    (3) The form of the certificate of acknowledgement for a
15Final and Irrevocable Consent for Adoption by a Specified
16Person or Persons: Non-DCFS Case shall be substantially as
17follows:
 
18STATE OF ..............)
19                       ) SS.
20COUNTY OF .............)
21    I, .................... (Name of Judge or other person),
22..................... (official title, name, and address),
23certify that ............., personally known to me to be the
24same person whose name is subscribed to the foregoing Final and
25Irrevocable Consent for Adoption by a Specified Person or

 

 

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1Persons; non-DCFS case, appeared before me this day in person
2and acknowledged that (she)(he) signed and delivered the
3consent as (her)(his) free and voluntary act, for the specified
4purpose. I am further satisfied that, before signing this
5Consent, ........ has read, or has had read to him or her, the
6Birth Parent Rights and Responsibilities-Private Form.
7    A-2. Birth Parent Rights and Responsibilities-Private
8Form. The Birth Parent Rights and Responsibilities-Private
9Form must be read by, or have been read to, any person
10executing a Final and Irrevocable Consent to Adoption under
11subsection A, a Final and Irrevocable Consent to Adoption by a
12Specified Person or Persons: Non-DCFS Case under subsection
13A-1, or a Consent to Adoption of Unborn Child under subsection
14B prior to the execution of said Consent. The form of the Birth
15Parent Rights and Responsibilities-Private Form shall be
16substantially as follows:
17
Birth Parent Rights and Responsibilities-Private Form
18    As a birth parent in the State of Illinois, you have the
19right:
20    1. To have your own attorney represent you. The prospective
21adoptive parents may agree to pay for the cost of your attorney
22in a manner consistent with Illinois law, but they are not
23required to do so.
24    2. To be treated with dignity and respect at all times and
25to make decisions free from coercion and pressure.
26    3. To receive counseling before and after signing a Final

 

 

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1and Irrevocable Consent to Adoption ("Consent"), a Final and
2Irrevocable Consent to Adoption by a Specified Person or
3Persons: Non-DCFS Case ("Specified Consent"), or a Consent to
4Adoption of Unborn Child ("Unborn Consent"). The prospective
5adoptive parents may agree to pay for the cost of counseling in
6a manner consistent with Illinois law, but they are not
7required to do so.
8    4. To ask to be involved in choosing your child's
9prospective adoptive parents and to ask to meet them.
10    5. To ask your child's prospective adoptive parents any
11questions that pertain to your decision to place your child
12with them.
13    6. To see your child before signing a Consent or Specified
14Consent.
15    7. To request contact with your child and/or the child's
16prospective adoptive parents, with the understanding that any
17promises regarding contact with your child or receipt of
18information about the child after signing a Consent, Specified
19Consent, or Unborn Consent cannot be enforced under Illinois
20law.
21    8. To receive copies of all documents that you sign and
22have those documents provided to you in your preferred
23language.
24    9. To request that your identifying information remain
25confidential, unless required otherwise by Illinois law or
26court order, and to register with the Illinois Adoption

 

 

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1Registry and Medical Information Exchange.
2    10. To work with an adoption agency or attorney of your
3choice, or change said agency or attorney, provided you
4promptly inform all of the parties currently involved.
5    11. To receive, upon request, a written list of any
6promised support, financial or otherwise, from your attorney or
7the attorney for your child's prospective adoptive parents.
8    12. To delay signing a Consent, Specified Consent, or
9Unborn Consent if you are not ready to do so.
10    13. To decline to sign a Consent, Specified Consent, or
11Unborn Consent even if you have received financial support from
12the prospective adoptive parents.
13    If you do not receive any of the rights described in this
14Form, it shall not be a basis to revoke a Consent, Specified
15Consent, or Unborn Consent.
16    As a Birth Parent in the State of Illinois, you have the
17responsibility:
18    1. To carefully consider your reasons for choosing
19adoption.
20    2. 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 provide all known medical, background, and
25family history information about yourself and your family to
26your child's prospective adoptive parents or their attorney.

 

 

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1    3. (Birth mothers only) To accurately complete an Affidavit
2of Identification, which identifies the father of the child
3when known, with the understanding that a birth mother has a
4right to decline to identify the birth father.
5    4. To not accept financial support or reimbursement of
6pregnancy related expenses simultaneously from more than one
7source.
8    B. The form of consent required for the adoption of an
9unborn child shall be substantially as follows:
10
CONSENT TO ADOPTION OF UNBORN CHILD
11    I, ...., state:
12    That I am the father of a child expected to be born on or
13about .... to .... (name of mother).
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 such adoption
17proceeding and waive service of summons on me.
18    That I hereby acknowledge that I have been provided with a
19copy of the Birth Parent Rights and Responsibilities-Private
20Form before signing this Consent, and that I have had time to
21read, or have had read to me, this Form. I understand that if I
22do not receive any of the rights as described in this Form, it
23shall not constitute a basis to revoke this Consent to Adoption
24of Unborn Child.
25    That I do hereby consent and agree to the adoption of such
26child, and that I have not previously executed a consent or

 

 

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1surrender with respect to such child.
2    That I wish to and do understand that by signing this
3consent I do irrevocably and permanently give up all custody
4and other parental rights I have to such child, except that I
5have the right to revoke this consent by giving written notice
6of my revocation not later than 72 hours after the birth of the
7child.
8    That I understand such child will be placed for adoption
9and that, except as hereinabove provided, I cannot under any
10circumstances, after signing this document, change my mind and
11revoke or cancel this consent or obtain or recover custody or
12any other rights over such child.
13    That I have read and understand the above and I am signing
14it as my free and voluntary act.
15    Dated (insert date).
16........................
17    B-5. (1) The parent of a child may execute a consent to
18standby adoption by a specified person or persons. A consent
19under this subsection B-5 shall be acknowledged by a parent
20pursuant to subsection H and subsection K of this Section. The
21form of consent required for the standby adoption of a born
22child effective at a future date when the consenting parent of
23the child dies or requests that a final judgment of adoption be
24entered shall be substantially as follows:
25
FINAL AND IRREVOCABLE CONSENT
26
TO STANDBY ADOPTION

 

 

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1    I, ..., (relationship, e.g. mother or father) of ...., a
2..male child, state:
3    That the child was born on .... at .....
4    That I reside at ...., County of ...., and State of .....
5    That I am of the age of .... years.
6    That I hereby enter my appearance in this proceeding and
7waive service of summons on me in this action only.
8    That I do hereby consent and agree to the standby adoption
9of the child, and that I have not previously executed a consent
10or surrender with respect to the child.
11    That I wish to and understand that by signing this consent
12I do irrevocably and permanently give up all custody and other
13parental rights I have to the child, effective upon (my death)
14(the child's other parent's death) or upon (my) (the other
15parent's) request for the entry of a final judgment for
16adoption if ..... (specified person or persons) adopt my child.
17    That I understand that until (I die) (the child's other
18parent dies), I retain all legal rights and obligations
19concerning the child, but at that time, I irrevocably give all
20custody and other parental rights to .... (specified person or
21persons).
22    I understand my child will be adopted by ....... (specified
23person or persons) only and that I cannot, under any
24circumstances, after signing this document, change my mind and
25revoke or cancel this consent or obtain or recover custody or
26any other rights over my child if ..... (specified person or

 

 

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1persons) adopt my child.
2    I understand that this consent to standby adoption is valid
3only if the petition for standby adoption is filed and that if
4....... (specified person or persons), for any reason, cannot
5or will not file a petition for standby adoption or if his,
6her, or their petition for standby adoption is denied, then
7this consent is void. I have the right to notice of any other
8proceeding that could affect my parental rights.
9    That I have read and understand the above and I am signing
10it as my free and voluntary act.
11    Dated (insert date).
12....................
 
13    If under Section 8 the consent of more than one person is
14required, then each such person shall execute a separate
15consent. A separate consent shall be executed for each child.
16    (2) If the parent consents to a standby adoption by 2
17specified persons, then the form shall contain 2 additional
18paragraphs in substantially the following form:
19    If .... (specified persons) obtain a judgment of
20dissolution of marriage before the judgment for adoption is
21entered, then ..... (specified person) shall adopt my child. I
22understand that I cannot change my mind and revoke this consent
23or obtain or recover custody of my child if ..... (specified
24persons) obtain a judgment of dissolution of marriage and .....
25(specified person) adopts my child. I understand that I cannot

 

 

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1change my mind and revoke this consent if ...... (specified
2persons) obtain a judgment of dissolution of marriage before
3the adoption is final. I understand that this consent to
4adoption has no effect on who will get custody of my child if
5..... (specified persons) obtain a judgment of dissolution of
6marriage after the adoption is final. I understand that if
7either ..... (specified persons) dies before the petition to
8adopt my child is granted, then the surviving person may adopt
9my child. I understand that I cannot change my mind and revoke
10this consent or obtain or recover custody of my child if the
11surviving person adopts my child.
12    A consent to standby adoption by specified persons on this
13form shall have no effect on a court's determination of custody
14or visitation under the Illinois Marriage and Dissolution of
15Marriage Act if the marriage of the specified persons is
16dissolved before the adoption is final.
17    (3) The form of the certificate of acknowledgement for a
18Final and Irrevocable Consent for Standby Adoption shall be
19substantially as follows:
 
20STATE OF .....)
21              ) SS.
22COUNTY OF ....)
 
23    I, ....... (name of Judge or other person) ..... (official
24title, name, and address), certify that ......., personally

 

 

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1known to me to be the same person whose name is subscribed to
2the foregoing Final and Irrevocable Consent to Standby
3Adoption, appeared before me this day in person and
4acknowledged that (she) (he) signed and delivered the consent
5as (her) (his) free and voluntary act, for the specified
6purpose.
7    I have fully explained that this consent to adoption is
8valid only if the petition to adopt is filed, and that if the
9specified person or persons, for any reason, cannot or will not
10adopt the child or if the adoption petition is denied, then
11this consent will be void. I have fully explained that if the
12specified person or persons adopt the child, by signing this
13consent (she) (he) is irrevocably and permanently
14relinquishing all parental rights to the child, and (she) (he)
15has stated that such is (her) (his) intention and desire.
16    Dated (insert date).
17    Signature ..............................
18    (4) If a consent to standby adoption is executed in this
19form, the consent shall be valid only if the specified person
20or persons adopt the child. The consent shall be void if:
21    (a) the specified person or persons do not file a petition
22for standby adoption of the child; or
23    (b) a court denies the standby adoption petition.
24    The parent shall not need to take further action to revoke
25the consent if the standby adoption by the specified person or
26persons does not occur, notwithstanding the provisions of

 

 

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1Section 11 of this Act.
2    C. The form of surrender to any agency given by a parent of
3a born child who is to be subsequently placed for adoption
4shall be substantially as follows and shall contain such other
5facts and statements as the particular agency shall require.
6
FINAL AND IRREVOCABLE SURRENDER
7
FOR PURPOSES OF ADOPTION
8    I, .... (relationship, e.g., mother, father, relative,
9guardian) of ...., a ..male child, state:
10    That such child was born on ...., at .....
11    That I reside at ...., County of ...., and State of .....
12    That I am of the age of .... years.
13    That I do hereby surrender and entrust the entire custody
14and control of such child to the .... (the "Agency"), a
15(public) (licensed) child welfare agency with its principal
16office in the City of ...., County of .... and State of ....,
17for the purpose of enabling it to care for and supervise the
18care of such child, to place such child for adoption and to
19consent to the legal adoption of such child.
20    That I hereby grant to the Agency full power and authority
21to place such child with any person or persons it may in its
22sole discretion select to become the adopting parent or parents
23and to consent to the legal adoption of such child by such
24person or persons; and to take any and all measures which, in
25the judgment of the Agency, may be for the best interests of
26such child, including authorizing medical, surgical and dental

 

 

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1care and treatment including inoculation and anaesthesia for
2such child.
3    That I wish to and understand that by signing this
4surrender I do irrevocably and permanently give up all custody
5and other parental rights I have to such child.
6    That I understand I cannot under any circumstances, after
7signing this surrender, change my mind and revoke or cancel
8this surrender or obtain or recover custody or any other rights
9over such child.
10    That I have read and understand the above and I am signing
11it as my free and voluntary act.
12    Dated (insert date).
13........................
14    C-5. The form of a Final and Irrevocable Designated
15Surrender for Purposes of Adoption to any agency given by a
16parent of a born child who is to be subsequently placed for
17adoption shall be substantially as follows and shall contain
18such other facts and statements as the particular agency shall
19require:
20
FINAL AND IRREVOCABLE DESIGNATED SURRENDER
21
FOR PURPOSES OF ADOPTION
22    I, .... (relationship, e.g., mother, father, relative,
23guardian) of ...., a ..male child, state:
24    1. That such child was born on ...., at .....
25    2. That I reside at ...., County of ...., and State of
26.....

 

 

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1    3. That I am of the age of .... years.
2    4. That I do hereby surrender and entrust the entire
3custody and control of such child to the .... (the "Agency"), a
4(public) (licensed) child welfare agency with its principal
5office in the City of ...., County of .... and State of ....,
6for the purpose of enabling it to care for and supervise the
7care of such child, to place such child for adoption with
8............................. (specified person or persons)
9and to consent to the legal adoption of such child and to take
10any and all measures which, in the judgment of the Agency, may
11be for the best interests of such child, including authorizing
12medical, surgical and dental care and treatment including
13inoculation and anesthesia for such child.
14    5. That I wish to and understand that by signing this
15surrender I do irrevocably and permanently give up all custody
16and other parental rights I have to such child.
17    6. That if the petition for adoption is not filed by the
18specified person or persons designated herein or, if the
19petition for adoption is filed but the adoption petition is
20dismissed with prejudice or the adoption proceeding is
21otherwise concluded without an order declaring the child to be
22the adopted child of each specified person, then I understand
23that the Agency will provide notice to me within 10 business
24days and that such notice will be directed to me using the
25contact information I have provided to the Agency. I understand
26that I will have 10 business days from the date that the Agency

 

 

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1sends me its notice to respond, within which time I may choose
2to designate other adoptive parent(s). However, I acknowledge
3that the Agency has full power and authority to place the child
4for adoption with any person or persons it may in its sole
5discretion select to become the adopting parent or parents and
6to consent to the legal adoption of the child by such person or
7persons.
8    7. That I acknowledge that this surrender is valid even if
9the specified persons separate or divorce or one of the
10specified persons dies prior to the entry of the final judgment
11for adoption.
12    8. That I expressly acknowledge that the above paragraphs 6
13and 7 do not impair the validity and absolute finality of this
14surrender under any circumstance.
15    9. That I understand that I have a remaining obligation to
16keep the Agency informed of my current contact information
17until the adoption of the child has been finalized if I wish to
18be notified in the event the adoption by the specified
19person(s) cannot proceed.
20    10. That I understand I cannot under any circumstances,
21after signing this surrender, change my mind and revoke or
22cancel this surrender or obtain or recover custody or any other
23rights over such child.
24    11. That I have read and understand the above and I am
25signing it as my free and voluntary act.
26    Dated (insert date).

 

 

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1..............................
2    D. The form of surrender to an agency given by a parent of
3an unborn child who is to be subsequently placed for adoption
4shall be substantially as follows and shall contain such other
5facts and statements as the particular agency shall require.
6
SURRENDER OF UNBORN CHILD FOR
7
PURPOSES OF ADOPTION
8    I, .... (father), state:
9    That I am the father of a child expected to be born on or
10about .... to .... (name of mother).
11    That I reside at ...., County of ...., and State of .....
12    That I am of the age of .... years.
13    That I do hereby surrender and entrust the entire custody
14and control of such child to the .... (the "Agency"), a
15(public) (licensed) child welfare agency with its principal
16office in the City of ...., County of .... and State of ....,
17for the purpose of enabling it to care for and supervise the
18care of such child, to place such child for adoption and to
19consent to the legal adoption of such child, and that I have
20not previously executed a consent or surrender with respect to
21such child.
22    That I hereby grant to the Agency full power and authority
23to place such child with any person or persons it may in its
24sole discretion select to become the adopting parent or parents
25and to consent to the legal adoption of such child by such
26person or persons; and to take any and all measures which, in

 

 

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1the judgment of the Agency, may be for the best interests of
2such child, including authorizing medical, surgical and dental
3care and treatment, including inoculation and anaesthesia for
4such child.
5    That I wish to and understand that by signing this
6surrender I do irrevocably and permanently give up all custody
7and other parental rights I have to such child.
8    That I understand I cannot under any circumstances, after
9signing this surrender, change my mind and revoke or cancel
10this surrender or obtain or recover custody or any other rights
11over such child, except that I have the right to revoke this
12surrender by giving written notice of my revocation not later
13than 72 hours after the birth of such child.
14    That I have read and understand the above and I am signing
15it as my free and voluntary act.
16    Dated (insert date).
17........................
18    E. The form of consent required from the parents for the
19adoption of an adult, when such adult elects to obtain such
20consent, shall be substantially as follows:
21
CONSENT
22    I, ...., (father) (mother) of ...., an adult, state:
23    That I reside at ...., County of .... and State of .....
24    That I do hereby consent and agree to the adoption of such
25adult by .... and .....
26    Dated (insert date).

 

 

HB1698 Engrossed- 22 -LRB097 07917 AJO 48032 b

1.........................
2    F. The form of consent required for the adoption of a child
3of the age of 14 years or upwards, or of an adult, to be given
4by such person, shall be substantially as follows:
5
CONSENT
6    I, ...., state:
7    That I reside at ...., County of .... and State of .....
8That I am of the age of .... years. That I consent and agree to
9my adoption by .... and .....
10    Dated (insert date).
11........................
12    G. The form of consent given by an agency to the adoption
13by specified persons of a child previously surrendered to it
14shall set forth that the agency has the authority to execute
15such consent. The form of consent given by a guardian of the
16person of a child sought to be adopted, appointed by a court of
17competent jurisdiction, shall set forth the facts of such
18appointment and the authority of the guardian to execute such
19consent.
20    H. A consent (other than that given by an agency, or
21guardian of the person of the child sought to be adopted who
22was appointed by a court of competent jurisdiction) shall be
23acknowledged by a parent before a judge of a court of competent
24jurisdiction or, except as otherwise provided in this Act,
25before a representative of an agency, or before a person, other
26than the attorney for the prospective adoptive parent or

 

 

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1parents, designated by a court of competent jurisdiction.
2    I. A surrender, or any other document equivalent to a
3surrender, by which a child is surrendered to an agency shall
4be acknowledged by the person signing such surrender, or other
5document, before a judge of a court of competent jurisdiction,
6or, except as otherwise provided in this Act, before a
7representative of an agency, or before a person designated by a
8court of competent jurisdiction.
9    J. The form of the certificate of acknowledgment for a
10consent, a surrender, or any other document equivalent to a
11surrender, shall be substantially as follows:
12STATE OF ....)
13             ) SS.
14COUNTY OF ...)
15    I, .... (Name of judge or other person), .... (official
16title, name and location of court or status or position of
17other person), certify that ...., personally known to me to be
18the same person whose name is subscribed to the foregoing
19(consent) (surrender), appeared before me this day in person
20and acknowledged that (she) (he) signed and delivered such
21(consent) (surrender) as (her) (his) free and voluntary act,
22for the specified purpose.
23    I have fully explained that by signing such (consent)
24(surrender) (she) (he) is irrevocably relinquishing all
25parental rights to such child or adult and (she) (he) has
26stated that such is (her) (his) intention and desire. (Add if

 

 

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1Consent only) I am further satisfied that, before signing this
2Consent, ........ has read, or has had read to him or her, the
3Birth Parent Rights and Responsibilities-Private Form.
4    Dated (insert date).
5    Signature ...............
6    K. When the execution of a consent or a surrender is
7acknowledged before someone other than a judge, such other
8person shall have his or her signature on the certificate
9acknowledged before a notary public, in form substantially as
10follows:
11STATE OF ....)
12             ) SS.
13COUNTY OF ...)
14    I, a Notary Public, in and for the County of ......, in the
15State of ......, certify that ...., personally known to me to
16be the same person whose name is subscribed to the foregoing
17certificate of acknowledgment, appeared before me in person and
18acknowledged that (she) (he) signed such certificate as (her)
19(his) free and voluntary act and that the statements made in
20the certificate are true.
21    Dated (insert date).
22    
Signature ...................... Notary Public
23
(official seal)

 
24    There shall be attached a certificate of magistracy, or
25other comparable proof of office of the notary public

 

 

HB1698 Engrossed- 25 -LRB097 07917 AJO 48032 b

1satisfactory to the court, to a consent signed and acknowledged
2in another state.
3    L. A surrender or consent executed and acknowledged outside
4of this State, either in accordance with the law of this State
5or in accordance with the law of the place where executed, is
6valid.
7    M. Where a consent or a surrender is signed in a foreign
8country, the execution of such consent shall be acknowledged or
9affirmed in a manner conformable to the law and procedure of
10such country.
11    N. If the person signing a consent or surrender is in the
12military service of the United States, the execution of such
13consent or surrender may be acknowledged before a commissioned
14officer and the signature of such officer on such certificate
15shall be verified or acknowledged before a notary public or by
16such other procedure as is then in effect for such division or
17branch of the armed forces.
18    O. (1) The parent or parents of a child in whose interests
19a petition under Section 2-13 of the Juvenile Court Act of 1987
20is pending may, with the approval of the designated
21representative of the Department of Children and Family
22Services, execute a consent to adoption by a specified person
23or persons:
24        (a) in whose physical custody the child has resided for
25    at least 6 months; or
26        (b) in whose physical custody at least one sibling of

 

 

HB1698 Engrossed- 26 -LRB097 07917 AJO 48032 b

1    the child who is the subject of this consent has resided
2    for at least 6 months, and the child who is the subject of
3    this consent is currently residing in this foster home; or
4        (c) in whose physical custody a child under one year of
5    age has resided for at least 3 months.
6A consent under this subsection O shall be acknowledged by a
7parent pursuant to subsection H and subsection K of this
8Section.
9    (2) The consent to adoption by a specified person or
10persons shall have the caption of the proceeding in which it is
11to be filed and shall be substantially as follows:
12
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
13
A SPECIFIED PERSON OR PERSONS: DCFS CASE
14    I, ......................................, the
15.................. (mother or father) of a ....male child,
16state:
17         My child ............................ (name of child)
18    was born on (insert date) at .................... Hospital
19    in ................ County, State of ...............
20         I reside at ......................, County of
21    ............. and State of ..............
22         I, ..........................., am .... years old.
23         I enter my appearance in this action to adopt my child
24    by the person or persons specified herein by me and waive
25    service of summons on me in this action only.
26         I consent to the adoption of my child by

 

 

HB1698 Engrossed- 27 -LRB097 07917 AJO 48032 b

1    ............................. (specified person or
2    persons) only.
3         I wish to sign this consent and I understand that by
4    signing this consent I irrevocably and permanently give up
5    all parental rights I have to my child if my child is
6    adopted by ............................. (specified person
7    or persons).
8         I understand my child will be adopted by
9    ............................. (specified person or
10    persons) only and that I cannot under any circumstances,
11    after signing this document, change my mind and revoke or
12    cancel this consent or obtain or recover custody or any
13    other rights over my child if ............................
14    (specified person or persons) adopt my child.
15         I understand that this consent to adoption is valid
16    only if the petition to adopt is filed within one year from
17    the date that I sign it and that if .......................
18    (specified person or persons), for any reason, cannot or
19    will not file a petition to adopt my child within that one
20    year period or if their adoption petition is denied, then
21    this consent will be voidable after one year upon the
22    timely filing of my motion. If I file this motion before
23    the filing of the petition for adoption, I understand that
24    the court shall revoke this specific consent. I have the
25    right to notice of any other proceeding that could affect
26    my parental rights, except for the proceeding for

 

 

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1    ............. (specified person or persons) to adopt my
2    child.
3         I have read and understand the above and I am signing
4    it as my free and voluntary act.
5        Dated (insert date).
6        .............................................
7        Signature of parent
8    (3) If the parent consents to an adoption by 2 specified
9persons, then the form shall contain 2 additional paragraphs in
10substantially the following form:
11         If ............... (specified persons) get a divorce
12    before the petition to adopt my child is granted, then
13    .......... (specified person) shall adopt my child. I
14    understand that I cannot change my mind and revoke this
15    consent or obtain or recover custody over my child if
16    ............. (specified persons) divorce and
17    ............. (specified person) adopts my child. I
18    understand that I cannot change my mind and revoke this
19    consent or obtain or recover custody over my child if
20    ................. (specified persons) divorce after the
21    adoption is final. I understand that this consent to
22    adoption has no effect on who will get custody of my child
23    if they divorce after the adoption is final.
24         I understand that if either ...............
25    (specified persons) dies before the petition to adopt my
26    child is granted, then the surviving person can adopt my

 

 

HB1698 Engrossed- 29 -LRB097 07917 AJO 48032 b

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

 

 

HB1698 Engrossed- 30 -LRB097 07917 AJO 48032 b

1from the date that it is signed, and that if the specified
2person or persons, for any reason, cannot or will not adopt the
3child or if the adoption petition is denied, then this consent
4will be voidable after one year upon the timely filing of a
5motion by the parent to revoke the consent. I explained that if
6this motion is filed before the filing of the petition for
7adoption, the court shall revoke this specific consent. I have
8fully explained that if the specified person or persons adopt
9the child, by signing this consent this parent is irrevocably
10and permanently relinquishing all parental rights to the child,
11and this parent has stated that such is (her)(his) intention
12and desire.
13    Dated (insert date).
14    ...............................
15    Signature
16    (5) If a consent to adoption by a specified person or
17persons is executed in this form, the following provisions
18shall apply. The consent shall be valid only if that specified
19person or persons adopt the child. The consent shall be
20voidable after one year if:
21        (a) the specified person or persons do not file a
22    petition to adopt the child within one year after the
23    consent is signed and the parent files a timely motion to
24    revoke this consent. If this motion is filed before the
25    filing of the petition for adoption the court shall revoke
26    this consent; or

 

 

HB1698 Engrossed- 31 -LRB097 07917 AJO 48032 b

1        (b) a court denies the adoption petition; or
2        (c) the Department of Children and Family Services
3    Guardianship Administrator determines that the specified
4    person or persons will not or cannot complete the adoption,
5    or in the best interests of the child should not adopt the
6    child.
7    Within 30 days of the consent becoming void, the Department
8of Children and Family Services Guardianship Administrator
9shall make good faith attempts to notify the parent in writing
10and shall give written notice to the court and all additional
11parties in writing that the adoption has not occurred or will
12not occur and that the consent is void. If the adoption by a
13specified person or persons does not occur, no proceeding for
14termination of parental rights shall be brought unless the
15biological parent who executed the consent to adoption by a
16specified person or persons has been notified of the proceeding
17pursuant to Section 7 of this Act or subsection (4) of Section
182-13 of the Juvenile Court Act of 1987. The parent shall not
19need to take further action to revoke the consent if the
20specified adoption does not occur, notwithstanding the
21provisions of Section 11 of this Act.
22    (6) The Department of Children and Family Services is
23authorized to promulgate rules necessary to implement this
24subsection O.
25    (7) The Department shall collect and maintain data
26concerning the efficacy of specific consents. This data shall

 

 

HB1698 Engrossed- 32 -LRB097 07917 AJO 48032 b

1include the number of specific consents executed and their
2outcomes, including but not limited to the number of children
3adopted pursuant to the consents, the number of children for
4whom adoptions are not completed, and the reason or reasons why
5the adoptions are not completed.
6    P. If the person signing a consent is incarcerated or
7detained in a correctional facility, prison, jail, detention
8center, or other comparable institution, either in this State
9or any other jurisdiction, the execution of such consent may be
10acknowledged before social service personnel of such
11institution, or before a person designated by a court of
12competent jurisdiction.
13    Q. A consent may be acknowledged telephonically, via
14audiovisual connection, or other electronic means, provided
15that a court of competent jurisdiction has entered an order
16approving the execution of the consent in such manner and has
17designated an individual to be physically present with the
18parent executing such consent in order to verify the identity
19of the parent.
20    R. An agency whose representative is acknowledging a
21consent pursuant to this Section shall be a public child
22welfare agency, or a child welfare agency, or a child placing
23agency that is authorized or licensed in the State or
24jurisdiction in which the consent is signed.
25    S. The form of waiver by a putative or legal father of a
26born or unborn child shall be substantially as follows:
 

 

 

HB1698 Engrossed- 33 -LRB097 07917 AJO 48032 b

1
FINAL AND IRREVOCABLE
2
WAIVER OF PARENTAL RIGHTS OF PUTATIVE OR LEGAL FATHER

 
3    I, .................... , state under oath or affirm as
4follows:
5        1. That the biological mother ............... has
6    named me as a possible biological or legal father of her
7    minor child who was born, or is expected to be born on
8    ..........., ......, in the City/Town of........., State
9    of ...........
10        2. That I understand that the biological mother
11    ............. intends to or has placed the child for
12    adoption.
13        3. That I reside at ................, in the City/Town
14    of..........., State of ................
15        4. That I am ................ years of age and my date
16    of birth is ..............., .............
17        5. That I (select one):
18            ..... am married to the biological mother.
19            ..... am not married to the biological mother and
20        have not been married to the biological mother within
21        300 days before the child's birth or expected date of
22        child's birth.
23            ..... am not currently married to the biological
24        mother, but was married to the biological mother,

 

 

HB1698 Engrossed- 34 -LRB097 07917 AJO 48032 b

1        within 300 days before the child's birth or expected
2        date of child's birth.
3        6. That I (select one):
4            ..... neither admit nor deny that I am the
5        biological father of the child.
6            ..... deny that I am the biological father of the
7        child.
8        7. That I hereby agree to the termination of my
9    parental rights, if any, without further notice to me of
10    any proceeding for the adoption of the minor child, even if
11    I have taken any action to establish parental rights or
12    take any such action in the future including registering
13    with any putative father registry.
14        8. That I understand that by signing this Waiver I do
15    irrevocably and permanently give up all custody and other
16    parental rights I may have to such child.
17        9. That I understand that this Waiver is FINAL AND
18    IRREVOCABLE and that I am permanently barred from
19    contesting any proceeding for the adoption of the child
20    after I sign this Waiver.
21        10. That I waive any further service of summons or
22    other pleadings in any proceeding to terminate parental
23    rights, if any to this child, or any proceeding for
24    adoption of this child.
25        11. That I understand that if a final judgment or order
26    of adoption for this child is not entered, then any

 

 

HB1698 Engrossed- 35 -LRB097 07917 AJO 48032 b

1    parental rights or responsibilities that I may have remain
2    intact.
3        12. That I have read and understand the above and that
4    I am signing it as my free and voluntary act.
 
5    Dated: ................... , ..............
6    ...........................................
7    Signature
 
8
OATH
9I have been duly sworn and I state under oath that I have read
10and understood this Final and Irrevocable Waiver of Parental
11Rights of Putative or Legal Father. The facts contained in it
12are true and correct to the best of my knowledge. I have signed
13this document as my free and voluntary act in order to
14facilitate the adoption of the child.
 
15..............................
16Signature
 
17Signed and Sworn before me on
18this ............ day
19of ..........., 20....
 
20...................
21Notary Public

 

 

HB1698 Engrossed- 36 -LRB097 07917 AJO 48032 b

1(Source: P.A. 96-601, eff. 8-21-09; 96-1461, eff. 1-1-11.)