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Waiver of Rights from Adoptees Guardian, Custodian or Spouse

In the case of the adoptee’s guardian, spouse or custodian wanting to waiver their legal rights, they are required to use the following form. This has been approved by the Board of District Court Judges December 17, 2010, and revised April 1, 2012.

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Waiver of Rights  Approved Board of District Court Judges December 17, 2010 
Revised April 8, 2015 Page 1 of 2 
   
This is a private record.
My Name 
 
Address 
 
City, State, Zip 
 
Phone 
 
Email 
 
In the District Court of Utah 
__________ Judicial District ________________ County 
Court Address ______________________________________________________ 
In the Matter of the Adoption of 
_____________________________________
(adoptee’s name) 	
Waiver of Rights 
Case Number ___________________ 
Judge  _________________________ 
Commissioner ___________________ 	
Do not sign this document without reading it. Do not sign it unless everything 
stated is true and correct. If you have any questions, talk with an attorney. 
  You have the right to be notified of hearings and to be served with papers in this 
matter. You have the right to intervene and oppose the adoption. By signing this 
document you are giving up these rights. 
  If you want to waive your rights, complete this form, sign it, and return it to the 
Petitioner. 
  If you want to intervene and oppose the adoption, file a motion to intervene with 
this court within 30 days after the Notice of Petition to Adopt was served on you. 
(1)  I make this statement free from duress. 
(2)  I am the adoptee’s

Waiver of Rights  Approved Board of District Court Judges December 17, 2010 
Revised April 8, 2015 Page 2 of 2 
 [  ] Guardian without the right to consent to the adoption 
[  ] Custodian 
[  ] Spouse 
(3)  I understand that: 
  I have the right to be notified of hearings and to be served with papers in this 
matter. 
  I have the right to intervene and oppose the adoption. 
  By signing this document I am giving up these rights. 
(4)  Understanding all of this, I voluntarily waive my right to be notified of hearings 
and served with papers in this matter, and I voluntarily waive my right to 
intervene in this matter. 
Do not sign this document without reading it. Do not sign it unless everything 
stated is true and correct. If you have any questions, talk with an attorney. 
I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true 
and correct. 
Sign here ►
Date 
Typed or Printed Name
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