Free _______________________________County, Colorado District Court Juvenile Court - Colorado

District Court Denver Juvenile Court _________________________________County, Colorado Court Address:

IN THE MATTER OF THE PETITION OF: _______________________________ (Name of person(s) seeking to adopt) FOR THE ADOPTION OF A CHILD Attorney or Party Without Attorney (Name and Address): COURT USE ONLY Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg. #:

Division

Courtroom

CONSENT TO ADOPTION ­ NON-CUSTODIAL PARENT
1. I _________________________ (name) am the birth parent of ________________________ (name of child). 2. I have received a copy of the Petition for Adoption, Petition to Terminate Child-Legal Relationship and the Notice of Hearing. 3. I hereby voluntarily consent to the adoption of the above-named child by the Petitioner(s) named in this action. 4. I waive notice of any further proceedings based on my consent to the adoption.

Waiver and Acceptance of Service
I declare under oath that I am the Respondent in this case, that I have received and accept service of the Consent to Adoption ­ Non-Custodial Parent and a copy of the Petition for Adoption Petition to Terminate Child-Legal Relationship, Notice of Hearing, and Other (Please identify): ____________________________in this case.

This waiver of service shall not be construed as an admission by me of the truth of the allegations in the Petition and I reserve the right to receive notices of settings and the right to respond and appear in person. Note: If you are in the active military service of the United States of America, you may be entitled to request a temporary suspension of these proceedings under the Servicemembers Civil Relief Act (50 U.S.C. App. §520, et seq.). Please consult with your base legal officer or the attorney of your choice. I have decided to waive the stay provisions of the Servicemembers Civil Relief Act (50 U.S.C. §520, et seq.) as well as my right to court-appointed counsel under the Act and permit the action to proceed. This waiver of service shall not be construed as an admission by me of the truth of the allegations in the Petition.
Date: ______________________________________ ___________________________________________ Respondent

Subscribed and affirmed, or sworn to before me in the County of ________________________, State of ____________________, this _______, day of ________________, 20 ____. My Commission Expires: ________________ ______________________________________ Clerk/ Notary Public

JDF 510

R9/08

CONSENT TO ADOPTION ­ NON-CUSTODIAL PARENT