Santa Barbara — SC-4036*

Source: https://www.santabarbara.courts.ca.gov/system/files/sc4036.pdf

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ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY

ATTORNEY FOR (NAME):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA

Santa Barbara–Anacapa Santa Maria-Cook Lompoc Division
1100 Anacapa Street 312-C East Cook Street 115 Civic Center Plaza

Santa Barbara, CA 93101 Santa Maria, CA 93454 Lompoc, CA 93436

PETITIONER ADOPTING PARENT:

PETITIONER ADOPTING PARENT:

PETITIONER ADOPTEE:

CASE NUMBER:

ADOPTION AGREEMENT (ADULT) (Family Code §9300, et seq.)

Petitioners, the adopting parent(s) (name(s)) ______________________________________________ (“Adopting

Parent”) and adoptee (name) ______________________________________________________ (“Adoptee”) have

entered into the following agreement:

1. Adopting parent was born on _______________ (date), is currently ________ years old, and resides
at __________________________________ (city, county, and state or country). Adopting parent
wishes to adopt (name) _________________________________________.

2. Adopting parent was born on ______________ (date), is currently ________ years old, and resides
at ___________________________________ (city, county, and state or country). Adopting parent
wishes to adopt (name) _________________________________________.

3. Adoptee was born on __________________ (date), is currently __________ years old, and resides
at ___________________________________ (city, county, and state or country). Adoptee wishes to
be adopted by (name(s)) ________________________________________.

4. The parties agree to assume toward each other the legal relationship of parent and child, and to have
all of the rights and be subject to all of the duties and responsibilities of that relationship.

5. The parties agree to jointly file a petition in the Superior Court of California, County of Santa Barbara,
seeking the court's approval of their adoption agreement and requesting the court to issue an order of
adoption.

6. The adoptee’s name will be changed to: _______________________________________________.

Dated: (Print Name of Adopting Parent) (Signature of Adopting Parent)

Dated: (Print Name of Adopting Parent) (Signature of Adopting Parent)

Dated (Print Name of Adoptee) (Signature of Adoptee)

Form Adopted for Mandatory Use ADOPTION AGREEMENT (ADULT) Santa Barbara Superior Court SC-4036 [New January 2019] Print Form Clear Form