Amador — ADOPT-225

Source: http://www.courts.ca.gov/documents/adopt225.pdf

Clerk stamps date here when form is filed. Parent of Indian Child Agrees ADOPT-225 to End Parental Rights 1 I want my child to be adopted by (name(s)): a. b. Their relationship to Indian child: (Check all that apply) Related to child (specify): Members of child’s tribe Indian parents None of the above Fill in court name and street address: Superior Court of California, County of 2 The parent(s) in 1 meet do not meet the placement preference requirements of the Indian Child Welfare Act. 3 Indian child (name): Date of birth: Age: Child’s tribe(s): Enrollment #: Case Number: Check here if you do not know the enrollment #. 4 Your name: Mother Father (Check only one. Each parent fills out a separate form.) Your address (skip this if you have a lawyer):

City: State: Zip:
Phone #: Your tribe(s): Enrollment #:
Check here if you do not know the enrollment #.
Your lawyer (if you have one): (Name, address, phone #, and State Bar #):

5 I am the parent in 1 and I understand and say: a. I agree to give up my parental rights. b. I agree to the adoption of my child by the parent(s) listed in 1 . c. I understand what will happen when I sign this form. d. No one has threatened me or made promises to me to get me to sign this form. e. I understand that until the judge signs an Adoption Order (ADOPT-215) or an order to end my parental rights, I can change my mind and my child will be returned to me. f. I want the court to let me know if the adoption is canceled so I can ask the court to give custody of my child back to me. The court will give the custody of my child back to me if the judge decides it is in my child’s best interest. g. I do not give up any of my rights under the Indian Child Welfare Act by signing this form. h. My child was at least 10 days old when I signed this form. i. I understand that notice of the adoption request will be sent to any Indian tribe of which my child may be a member or eligible for membership.

Judicial Council of California, www.courts.ca.gov Rev. January 1, 2005, Mandatory Form Parent of Indian Child Agrees ADOPT-225, Page 1 of 2 25 U.S.C. § 1913 to End Parental Rights

Case Number: Your name:

6 Indian child’s biological Indian grandmothers (names; include maiden names if you know them): Date: Type or print your name Signature of Indian parent

Judge’s Certification

I, Judge , Superior Court of California, County of , certify This form was completed in writing and recorded before me. I fully explained the terms and consequences to (name of parent): The parent fully understood the terms and consequences. The parent speaks English or used an interpreter at the hearing.

Certified:

Date: Judge (or Judicial Officer)

Rev. January 1, 2005 Parent of Indian Child Agrees ADOPT-225, Page 2 of 2 to End Parental Rights For your protection and privacy, please press the Clear button after you have printed the form. Print Save Clear