Consent to Adoption by Institution



The ______________________________________________ ( Institution), as represented by __________________________________, its duly authorized representative, by virtue of the authority vested in it by _________________________________ (State), in regard to ___________________________________(Name), a ___________ (Male/Female) child who was born ____________(Date), and who was lawfully relinquished to the above-referenced institution on ___________(Date), for the purpose of placing the above-named child with a suitable family for adoption, does hereby consent to _______ (His/Her) adoption by _________________________ and ______________________________, husband and wife.

In witness whereof, I have signed this instrument in my capacity as the duly authorized representative of ____________________________________ (Institution) on ____________, _____.


Signature and Title

This document was signed in the presence of the following:

___________________________ _____________

Signature Date

___________________________ _____________

Signature Date




These forms are provided AS IS. They may not be any good. Even if they are good in one jurisdiction, they may not work in another. And the facts of your situation may make these forms inappropriate for you. They are for informational purposes only, and you should consult an attorney before using them.

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