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Arizona Consent to Place a Child for Adoption and Waiver of Notice and Appearance

In the State of Arizona, parents who wish to give a child to be adopted need to use the following form to show consent and waiver their rights for court hearing notices regarding the adoption case.

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SUPERIOR COURT OF THE STATE OF ARIZONA	 	
Pima County Juvenile Court	 	
Adoptions & 	Guardianship Program	 	
2225 EAST AJO WAY	 	
TUCSON, ARIZONA 85713	-6295	 	
520	-724	-2920; 520	-724	-9239	 	
FAX 520	-724	-4740	 	_________________________________________________________________________________________________________	 	
CORE VALUES	 	 	Justice for All 	- Community Safety 	- Accountability 	- Competency Development	 	
Staff Development and Participation 	– Pursuit of 	Excellence 	– Collaboration with Stakeholders	 	
Rev. 3	/2014	 	
Veronica Hookland	 	
Support Staff	 	
   Priscilla Ordonez	 	
  Case	 Worker	 	
The Pima County Juvenile Court Adoptions Program is a low	-cost option	 for adoptions.  We provide paperwork to 	
families that will enable them to make their child legally free for adoption.  Once the child is legally free, our program 
assists with the adoption	 process	.  	
 
STEP 1 	– MAKE THE CHILD LEGALLY FREE FROM THE BIRTHPARE	NT(S)	 	
The following documents prove that a child is legally free from the birthparent and eligible for adoption (only one 
document from this list is required for each birthparent):	 	
 	
 	Birthparent(s) signed and notarized CONSENT TO PLACE A CHILD FOR ADOPTION 	 	
OR	 	
 	Severance Hearing 	Minute Entry	 (this shows the termination of the birthparent(s) rights.	 	
OR	 	
 	Putative Father Registry Certificate of NO FILE FOUND	 	
OR	 	
 	Death Certificate for birthparent(s)	 	
 
Consent: 	 If you are able to locate the birthparent(s) and they 	are willing to sign a notarized consent, go to STEP 2	 	
 
Severance: 	If you are unable to obtain a Consent For Adoption (and you 	do not	 qualify for the Putative Father Registry) 	
then you must complete a severance. Severance is a legal term which means ending 	or terminating the birthparent(s) 	
rights. Y	ou can pick up a Severance Packet at the 	Pima County Juvenile Court Center Clerk of the Court’s Office	 at 2225 E. 	
Ajo Way.  	 	
 	There is no cha	rge for the packet but there may	 be publication costs.	 	
 	It takes 	approximately three months to complete a severance.	 	
 	The PCJCC Adoptions Program cannot assist you with the severance. Most families are able to complete the 
severance on their own; however, if you prefer you can seek legal help with your severance and ther	e are many 	
family law attorneys in the community that can offer assistance. The charges for legal representation vary. 	  	
 
Putative Father Registry: 	If the child was born in Arizona, 	AND	 if the birthfather is not listed on the birth certificate, 	AND	 	
if pate	rnity has not been established (i.e., child support or application for public assistance) 	then a check of the Putative 	
Father Registry is sufficient	 to continue with adoption proceedings	 (as long as the result is ‘No File Found’)	. This is 	
completed by our 	office for a five dollar fee. 	 	
 
STEP 2 	– START THE ADOPTION PROCESS	 	
When you have obtained the	 above	-listed documents that prove the child is legally 	free for adoption, please contact our 	
office at 	520	-724	-2920	 to request the Adoption Application Packet. 	Once your packet has been submitted and verified 	
that it has been filled out completely, it takes approximately three months to complete the adoption. 	Thank you for 	
choosing	 the PCJCC Adoptions Program 	- We look forward to working with your fa	mily during th	is important time!

CONSENT TO PLACE A CHILD FOR ADOPTION and WAIVER OF NOTICE AND APPEARANCE	 	
 
I, _________________________________________, born on ______________________, am the _____________________of  	 	
        	(Parent’s Full Name)                            	 	   	                             	(Date of Birth)                               	       	 (Relationship)        	  	
__________________________________________, born on______________________, in____________	____________.	 	
        	(Child’s Full Name)                                                	 	 	             	(Date of Birth)                         	     	 (City, State, Country)	 	
I am signing this consent to give my permission 	for___________________________________________________ to adopt the above 	
named child.	 	                                                                          	(Full Name of	 Prospective Adoptive Parent/s)	 	
I understand that my parental rights will be termi	nated based upon the grounds of this consent to adoption.  (A.R.S. § 8	-533(B)(7).  	 	
I  further  understand  that  I  no  longer  will  have  any  legal  rights,  privileges,  duties  and  obligations,  including  the  right  to 	custody  and 	
the  right  to  visit  the  child.    The 	only  exceptions  are  that  my  obligations  to  pay  support  and  the  child’s  right  to  inheritance  will 	
continue until the child’s adoption is final.	 	
At the time the child’s adoption is final, the adoptive family will have the same legal rights, privileges, dutie	s and obligations as if the 	
child  had  been  born  to  them,  and  all  my  rights  and  obligations,  including  my  obligations  to  pay  support  and  the  child’s  right	 to 	
inheritance, will be completely ended.  (A.R.S. § 8	-117)	 	
I  am  signing  this  consent  freely  and  volun	tarily  and  not  as  a  result  of  any  fraud,  duress  or  undue  influence  (	force  or  trickery)	.    I 	
understand that once this consent is signed, I cannot revoke (cancel or withdraw) it unless it was obtained by fraud, duress 	or undue 	
influence.  (A.R.S. § 8	-106)	 	
I have been advised of the provisions of A.R.S. § 8	-106 (E) and    	□ give my permission	   □ withhold my permission	 for  this child  to 	
obtain  identifying  information  about  me  and  his/herself  upon  reaching  age  18.    I  understand  that  my  decision  to  grant  or  with	hold 	
this permission may be changed at any time by filing a notarized statement with the court and this agency.	 	
I  voluntarily  give  up  my  rights  to  all  notices  and  appearances  to  any  and  all  hearings  or  proceedings  in  connection  with  the 
dependency, severan	ce, and adoption of the above	-named child.	 	
I  understand  that  this  means  I  will  NOT  be  notified  on  any  such  hearings  or  proceedings,  and  that  my  attendance  will  NOT  be 
required OR expected.  I understand that these hearings and proceedings will take place w	ithout my presence, and that the result of 	
the  hearings  and  proceedings  most  likely  will  be  that  ALL  my  rights  to  the  child,  including  the  right  to  custody,  care,  contr	ol  and 	
visitation will be completely ended.	 	
Dated this __________ day of _______________	________, 20____, at _____________ ___.m. 	 	
 	          	(DAY)	 	 	        	(MONTH)	 	 	 	 	              	(TIME)	 	
Parent’s Signature: ___________	_______________________________	  	 	    	 	 	
Parent’s Address: 	_________________________________________________________________________	 	
 	 	 	Street Address	 	 	 	City	 	 	 	State	 	 	Zip    	 	
Signed before me on _______________________, 20___ at __________    	 	
 	 	 	(DATE)	 	 	 	 	           	(TIME)	 	 	 	 	
My commission expires:	  	             	                   	 	
____________________	 	Notary Public: ______________________________________________________	 	
 	 	 	 	Street Address: ______________________________________________________	 	
 	 	 	 	City, State, ZIP: ___________________________________________	__________

REQUEST BY BIRTH OR LEGAL PARENT TO BE NOTIFIED WHEN THE ADOPTION IS FINAL	 	
 	If you have been ordered to pay child support	 for the 	child	(ren) being adopted, 	it is your responsibility	 to 	
contact your	 Child Support Division or the c	ourt to have the Support Order ended when the adoption is final. 	 	
 	Even if you are not currently paying child support but were ordered to pay	, you must contact your	 Child 	
Support Division or the c	ourt to have the Support Order ended when the adoption is fin	alized. 	 	
 	If you do not contact	 your Child Support Division or the	 court, the payroll deduction, garnishment or tax refund 	
intercept	 for child s	upport will continue to be assessed against you. 	 	
Arrears payments remain your responsibility even if the Suppor	t Order is ended. 	 	
If you would like	 to be notified when the adoption is finalized so that you can contact you	r Child Support Division, please 	
complete the following information: 	 	
 
CHILD(REN) TO BE ADOPTED: 	______________________________	_____________________________	 	
ADOPTIVE PARENT(S) NAME(S): _________________________________________________________	 	
YOUR NAME (please print):	 __________________________________________	 	
 
YOUR MAILING ADDRESS: ____________________________________________	 	
 	 	 	     	____________________________________________	 	
 
YOU MUST INCLUDE A SELF	-ADDRESSED, STAMPED ENVELOPE IN ORDER TO BE NOTIFIED THAT 	THE ADOPTION HAS 	
BEEN FINALIZED
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