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Kentucky Entry of Appearance and Waiver Form

After a petition has been filed in the State of Kentucky, the following form has to be completed and submitted by the defendant in the case.

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Case No._______________________
Court__________________________
County_________________________ AOC-292	
     Doc. Code:  AWCA	
Rev. 5-06
Page 1 of 2
Commonwealth of Kentucky
Court of Justice   	
  www.kycourts.net	
KRS 625.041(3); 199.011(14); and
199.500	APPEARANCE WAIVER AND
CONSENT TO ADOPTION
IN THE INTEREST OF:
_____________________________________________, a child	
Respondent	
        	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:	
Address

AOC-292	        Doc. Code: AWCA	
Rev. 5-06
Page 2 of 2	
CONSENT TO ADOPTION
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  __________________________________________	
(child's date of birth)	
in ________________________________________________________________________________________.	
(city, state, country of child's birth)	
 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consent and that this consent may be withdrawn 	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.
SUBSCRIBED AND SWORN TO before me this _______ day of ______________________, 2______.
     My commission expires:  _________________________________________________________
Notary Public Consenting Parent's Signature	
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.	
SUBSCRIBED AND SWORN TO before me this _______ day of ______________________, 2______.
     My commission expires:  _________________________________________________________
Notary Public
I received a completed and signed copy of this consent on the same day I signed it.	
Consenting Parent's Signature	
Preparer's Name & Address  Reviewer's Name & Address
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