Form 9-102.10. Attorney affidavit as to consent of a child to adoption
Affidavit by Attorney as to Consent of (Child) to Adoption
1. I am the attorney representing , the individual who is the
subject of this adoption proceeding ("the child").
2. The child, at the time of the signing of the consent form, was
years old. The child's date of birth is . To the best of my knowledge,
the child is not an Indian child subject to the provisions of the Indian Child
3. (Check one of the following)
[ ] The child is not disabled or is disabled but the disability would not
affect the child's ability to understand the meaning of the consent to
[ ] The child has a disability that could affect the child's ability to
understand the meaning of consenting to adoption. The disability is .
Despite the child's disability, I believe that the child understands the
meaning of the consenting adoption. The following additional steps were taken
to ensure that the child understood the meaning of the consent form prior to
4. The child understands English, or the consent form that the child
signed has been translated into , a language that the child
5. I have explained to the child that have asked the court to
be permitted to adopt the child, that the child has the right to decide
whether or not the child wants to be adopted, and the possible options if the
adoption is not approved.
6. I reviewed the consent form thoroughly with the child, and I believe
that the child agrees to the adoption and has signed the consent form
knowingly and voluntarily and not due to duress or coercion.
I solemnly affirm under the penalties of perjury that the contents of this
affidavit are true to the best of my knowledge, information, and belief.
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