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Specific Consent to Adoption

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FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I	
  
 	
SPECIFIC CONSENT TO ADOPTION 
  OF [ ]MOTHER  [ ]FATHER 
  [ ]OTHER                            	
 
CASE NUMBER 
FC-A NO.	
 	
 
INFORMATION REGARDING THE PROPOSED ADOPTIVE PARENTS: 
 
  
 PETITIONER  
 PETITIONER 
 
Name	
 (Full Legal Name)  
  
 	
 
Relationship to Child(ren)  
  
 
 
INFORMATION REGARDING THE CHILD(REN)'S PARENTS 
 
  
 FATHER  
 MOTHER 
 
Name	
 (Full Legal Name)	  
  
 	
 
Street Address  
  
 
 
City, State, Zip Code  
  
 
 
Telephone Number  
  
 
 
Social Security Number  
  
 
 
Date of Birth  
  
 
 
Racial Extraction  
  
 
 
INFORMATION REGARDING THE CHILD(REN)'S PARENTS 
 
  
  LEGAL ONLY FATHER  
  OTHER LEGAL PARENT 
 
Name 	
(Full Legal Name)	  
  
 	
 
Street Address  
  
 
 
City, State, Zip Code  
  
 
 
Telephone Number  
  
 
 
Social Security Number  
  
 
 
Date of Birth  
  
 
 
Racial Extraction  
  
 
 
 
 
 
 
 
  
08/07/01          PAGE 1 OF 4 PAGES SPECIFIC CONSENT TO ADOPTION

FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I	
  
 	
SPECIFIC CONSENT TO ADOPTION  
  OF [ ]MOTHER  [ ]FATHER 
  [ ]OTHER                            	
 
CASE NUMBER 
FC-A NO	
. 	
 
INFORMATION REGARDING THE CHILD  
 
 
Full Legal Name  
 
 
Sex  
[ ]MALE   [ ]FEMALE 
 
Date of Birth  
 
 
Place of Birth  
 
 
 
 
 
INFORMATION REGARDING THE CHILD 
 
Full Legal Name  
 
 
Sex  
[ ]MALE   [ ]FEMALE 
 
Date of Birth  
 
 
Place of Birth  
 
 
 
 
 
INFORMATION REGARDING THE CHILD  
 
Full Legal Name  
 
 
Sex  
[ ]MALE   [ ]FEMALE 
 
Date of Birth  
 
 
Place of Birth  
 
 
 
 
 
INFORMATION REGARDING THE CHILD  
 
Full Legal Name  
 
 
Sex  
[ ]MALE   [ ]FEMALE 
 
Date of Birth  
 
 
Place of Birth  
 
08/07/01          PAGE 2 OF 4 PAGES SPECIFIC CONSENT TO ADOPTION

FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I	
  
 	
SPECIFIC CONSENT TO ADOPTION 
  OF [ ]MOTHER  [ ]FATHER 
  [ ]OTHER                            	
 
CASE NUMBER 
FC-A NO.	
 	
 
The undersigned being first duly sworn on oath, deposes and says that: 
1.  I am the parent of the above-identified child(ren), 
2.  I hereby consent to the legal adoption of said above-identified child(ren) by the above-named proposed 
adoptive parent(s), with the understanding and intent that when such adoption is completed by the entry of 
a decree, the legal name of the child(ren) may be changed:  (Check only one (1) of the following) 
 
[ ]  I understand that after I sign this Consent to Adoption and the Court approves the adoption all of the 
my parental rights as well as responsibilities for said child(ren) will continue.  
 
[ ]  I understand that after I sign this Consent to Adoption and the Court approves the adoption all of the 
my parental rights as well as responsibilities for said child(ren) will be terminated. 
 
I further understand that by signing this Consent to Adoption I will give up any legal right that I may 
have to provide care, guidance and control for said child(ren). 
 
I further understand that by signing this Consent to Adoption I will give up any legal right that I may 
have to visit with said child(ren). 
 
I declare that no representations have been made to me, by anyone, which would serve in any way 
to limit the complete surrender of all the my parental rights intended by this consent or to limit the 
parental rights to be acquired by the proposed adoptive parent(s). 
 
3.  I further understand that after this consent has been signed by me, the consent will be valid and binding, 
even though I may be under the age of 18 years. 
 
4.  I further understand that after the child(ren) has started to reside with the adoptive parent(s) reflected on 
Page 1 of this Consent to Adoption or after this consent has been filed with the Court in an adoption 
proceeding by the proposed adoptive parent(s), this consent may not be withdrawn or repudiated without 
the written  order of a judge who has jurisdiction in adoption proceedings, based upon a written finding, 
supported by proof to be submitted by  me, that the withdrawal of my consent would be in the best interest 
of the child(ren). 
 
5.  No one has forced or coerced me to sign this Consent to Adoption. 
 
6.  No one has made any promises whatsoever to me in return for signing this Consent to Adoption. 
 
7.  I have not been offered nor have I accepted any reward or money in exchange for signing this Consent to 
 Adoption. 
 
8.  I waive further notice of any proceeding regarding the adoption of the child(ren), however if the adoption 
fails to be granted, I want to be given notice. 
03/25/02          PAGE 3 OF 4 PAGES SPECIFIC CONSENT TO ADOPTION

FAMILY COURT 
 FIRST CIRCUIT 
  STATE OF HAWAI‘I	
  
 	
SPECIFIC CONSENT TO ADOPTION 
  OF [ ]MOTHER  [ ]FATHER 
  [ ]OTHER                            	
 
CASE NUMBER 
FC-A NO.	
 	
 
CONFIDENTIALITY PURSUANT TO HRS §578-15	
: 
 	
9.  I have been advised of the requirements of Section 578-15 of the Hawai‘i Revised Statutes regarding 
confidentiality of the court's adoption file. 
 
10.  When my child becomes 18 years old, my child or the adoptive parents can request, in writing, to see the 
court's file regarding this adoption.  
 
11.  If I do not want the Family Court to reveal my identity to my child or the adoptive parents, I must file an 
affidavit requesting confidentiality with the Family Court (on this island that the adoption occurred) within 
ninety (90) calendar days before my child's 18th birthday.  This affidavit is good for ten (10) years. 
 
12.  After that, I can file an affidavit every ten (10) years or I can file an affidavit to keep my identity confidential 
for the rest of my life. 
 
13.  All affidavits must be filed within ninety (90) days prior to the expiration of the previous affidavit. 
 
14.  After my child reaches 18 years old, I can request to see the court's adoption file, too, but my child has the 
same rights as I do the keep the file confidential. 
 
15.  My decision to keep my information confidential or not applies to only me and does not apply to the other 
natural parent. 
 
16.  I can agree to open up the adoption file at any time and my child can to after turning 18 years old. 
 
17.  It will be my responsibility to keep the Family Court informed of my current address if I want disclosure to 
be made. 
 
18.  The Family Court has no responsibility to notify the child, adoptive parent(s) or the natural parent(s) of any 
deadlines or expiration dates. 
 
 
 
DATE 
 
  
SIGNATURE OF PARENT 
 
On this day, before me personally appeared                                                          	,   to me known to be person named in and who 
executed the foregoing consent to adoption and acknowledged that said consent was read and is understood by said person 
and was executed as the free act and deed of said person.	
 	
 
State of Hawai‘i, County 
of Honolulu: 
 
                                        
 Date  
Signature: 
 
 
                                                                  
Notary Public, State of Hawai‘i  
Printed Name of Notary Public: 
 
 
                                                     
Commission 
Expires: 
 
                            	
 	
08/07/01          PAGE 4 OF 4 PAGES SPECIFIC CONSENT TO ADOPTION
Relevant article from our knowledge database

Based on your state, both parents may have to provide consent. Most parents intuitively satisfy their challenges. Prospective parents will also receive all the suitable information in regards to the youngster's past that is valuable to the distinctive needs youngster's future. Both avoid holding parents accountable for their kids' behavior. It's every time a kid is left with no adult supervision, food, shelter, water, etc.. There are children who might not be in great health, but they need a house as well.
Read more

You wouldn't have to think about hiring an affordable divorce lawyer as there are many available online. Hence a nice and experienced New York divorce attorney would attempt to resolve the case away from the court so the court proceedings take place outside court. The nyc divorce attorney shall also counsel you in the proper direction in many issues and matters. A dependable family lawyer handling different cases like child adoption, divorce, child custody etc. should have the ability to supply excellent advice to both parties about what ought to be the correct and the best suited step to be taken in this kind of situation.

A great way of thinking about it's that the law can offer guidance and is really the initial step in out how a court produces a choice. Family law is an extremely wide facet of law, and can incorporate a wide selection of issue. An attorney has a huge experience in managing child custody cases. The truth is it's so simple it can be questioned why you would require legal counsel in any respect. A specialist attorney is able to guide you the greatest in guarding your rights.

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