CONSENT 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:
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.