Consent to adoption. The Adoption and Children Act 2002
| Published date | 21 March 2018 |
| Subject Matter | Adoption forms |
A104 Consent to Adoption (04.13)
Consent to Adoption
The Adoption and Children Act 2002
Name of child.......……..........................…………......
Before signing this form you are advised to seek legal advice about consenting to adoption and the effect
on your parental rights. Publicly funded legal advice may be available from the Civil Legal Aid. You can get
information about this or find a solicitor through CLA Direct on www.gov.uk/legal-aid
I, the undersigned __________________________________________consent to the making of a final adoption
order in respect of ________________________________(my child), who is the child to whom the attached birth
certificate relates(1), in favour of (2)
_________________________________________________________________
(the applicant(s))
the applicant(s) applying under serial number ________________________
I understand that, once the application for the adoption order has been started in the court, my child may only be
returned to me if the court so orders. When the adoption order is made, I understand that I will no longer legally be
treated as the parent and that my child will from then on become part of the applic ant(s)’ family. I will have no right
to have my child returned to me. I also understand that I will have no right to contact with my child unless it is by
arrangement with the applicant(s), or under a court order, when the court will decide on the contact arrangements it
considers are most appropriate. Until the adoption order is made, I am entitled to apply to the court for an order for
contact with my child at any time. Once the adoption order is made, I will only be entitled to apply for a contact
order if the court gives permission.
I understand that when the application for an adoption order is heard, this document may be used as evidence of
my consent to the making of the order, unless I inform the court otherwise.
As far as I know, the only person(s) or body(ies) who has/have taken part in the arrangements for my child’s
adoption is/are(3)__________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
I have not received any payment or reward from any person making arrangements for the adoption of my child.
*[I have taken legal advice] /*[I have not taken legal advice, but I have been advised to do so],
about giving my consent to adoption and the effect on my parental rights.
*(delete as appropriate)
I consent, unconditionally and with full understanding of what is involved, to the making of a final adoption order for
_______________________________________ (my child).
Signed....................................................................................................................
On the.............................................day of ..............................................................20
Witness statement
This form was signed by .............................................................................................
on the.............................................day of .............................................................20
before me (print full name)..................................................................................................
Signed.............................................................................................................................
Office of witness*....... ….………………………………………………………………… ….
Address of witness.…........…………………………………………………………………..
…………………………………........……………………………………………………… ……
………………………………………........………………………………………………… ……
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