AOC-292 Doc. Code: AWCA Rev. 5-06 08/22/2007 02:03 pm Page 1 of 2 Ver. 1.02 Commonwealth of Kentucky Court of Justice www.kycourts.net KRS 625.041(3); 199.011(14); and 199.500
Case No._______________________
Circuit Court Family Court Court__________________________
Reset
APPEARANCE WAIVER AND CONSENT TO ADOPTION
County_________________________
IN THE INTEREST OF:
_____________________________________________, a child
Respondent
Address
WAIVER OF APPEARANCE I, ___________________________________________________________, hereby state that I am the natural parent of the above-named child and I hereby voluntarily, and with full knowledge and agreement, waive my right to appear in the above-styled proceeding to terminate my parental rights.
Parent's Signature
Parent's Name (Printed) Counsel for Parent Guardian ad litem for Minor Parent Cabinet Designee
SUBSCRIBED and SWORN TO before me this _______ day of ______________________, 2______. My commission expires: _____________________
Notary Public
[ ] Please mail a copy of the FINAL JUDGMENT to:
AOC-292 Rev. 5-06 Page 2 of 2
Doc. Code: AWCA
CONSENT TO ADOPTION
Reset
I, ____________________________________________, hereby state that I am the natural [ ] mother [ ] father
(parent's name)
of ______________________________________________________________________, the child to be adopted,
(child's name)
who was born to me [ ] in wedlock [ ] out-of-wedlock on __________________________________________
Reset
(child's date of birth)
in ________________________________________________________________________________________.
(city, state, country of child's birth)
I also state, and acknowledge by my initials, that: [ ] I do not desire to know the identification of the proposed adoptive parent(s) of my child; or [ ] The proposed adoptive parent of my child is:______________________________________________. [ ] I understand that if the adoption is not adjudged, that the disposition of my child will be made pursuant to KRS 199.550. [ ] The total amount of my legal fees related to the execution of this consent are $_______________________ to be paid by______________________________________________________________________________. [ ] That I have reviewed this consent and the legal effect of this consent has been fully explained to me. [ ] That I have not been coerced in any way to execute this consent, nor have I been given or promised anything of value, except those expenses allowable under KRS 199.590(6), to execute this consent. [ ] That it is my intention to consent to the adoption of my child. I understand that this consent to the adoption of my child will become final and irrevocable twenty (20) days after the later of the placement approval (if required by the secretary for families and children) or the execution of this consent and that this consent may be withdrawn only by written notification sent to the proposed adoptive parent or the attorney for the proposed adoptive parent on or before the twentieth day by certified or registered mail and also by first class mail. If placement approval by the secretary is not required, the voluntary and informed consent shall become final and irrevocable twenty (20) days after execution. I hereby acknowledge, by my signature, executed this ______ day of ____________________, 2______ in ________________________________________, _________________________________ County, Kentucky at ______________ a.m./p.m. that I have voluntarily and knowingly given my informed consent to the adoption of my child. Consenting Parent's Signature SUBSCRIBED AND SWORN TO before me this _______ day of ______________________, 2______. My commission expires: __________________ _______________________________________ Notary Public Preparer's Name & Address Reviewer's Name & Address
I received a completed and signed copy of this consent on the same day I signed it. Consenting Parent's Signature SUBSCRIBED AND SWORN TO before me this _______ day of ______________________, 2______. My commission expires: __________________ _______________________________________ Notary Public
Print
Reset Form