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1. Declaration of Identity: Full legal names and details of the birth parent(s) giving consent
2. Child Information: Full details of the child including full name, date and place of birth, and registration number if applicable
3. Nature of Consent: Clear statement of what is being consented to (adoption placement, surrender of parental rights)
4. Legal Acknowledgments: Statements confirming understanding of the permanent nature of adoption and surrender of parental rights
5. Counseling Confirmation: Declaration that independent legal advice and/or adoption counseling has been received
6. Revocation Rights: Clear explanation of any rights to revoke consent and applicable time periods
7. Declaration of Voluntariness: Statement that consent is given freely and voluntarily, without coercion or inducement
8. Witness Requirements: Space for witness signatures and details as required by provincial law
1. Indigenous Child Declaration: Required if the child has Indigenous heritage, including details of band membership and Indigenous community notification
2. Medical History Release: Optional authorization to release medical history to adoptive family
3. Contact Preferences: Optional section for stating preferences regarding future contact with the child
4. Translator's Certificate: Required if the birth parent(s) require translation services
5. Minor Parent Declaration: Required if any birth parent is under the age of majority, including additional consents if required
6. Known Adoption Declaration: Required if the adoption is to known adopters, including acknowledgment of any pre-existing relationship
1. Schedule A - Counseling Certificate: Certificate from adoption counselor confirming that appropriate counseling has been provided
2. Schedule B - Legal Advice Certificate: Certificate from legal advisor confirming independent legal advice has been provided
3. Schedule C - Medical History Form: Optional form containing relevant medical history of birth parent(s) and family
4. Schedule D - Witness Affidavit: Affidavit from witnesses confirming the proper execution of the consent
5. Appendix 1 - Rights and Responsibilities: Detailed explanation of legal rights and responsibilities being surrendered through adoption
6. Appendix 2 - Provincial Requirements: Checklist of specific provincial requirements for adoption consent
Birth Parent
Child
Consent
Court
Guardian
Independent Legal Advice
Indigenous Child
Legal Rights
Licensed Adoption Agency
Parent
Parental Rights
Province
Revocation Period
Social Worker
Spouse
Surrender
Termination of Parental Rights
Witness
Child Welfare Authority
Band Representative
Commissioner for Oaths
Counseling Services
Adoption Order
Placement
Stepparent
Relative
Agency
Legal Guardian
Permanent Ward
Declaration
Consent
Voluntariness
Legal Rights
Revocation Rights
Counseling Acknowledgment
Legal Advice
Indigenous Heritage
Medical Disclosure
Confidentiality
Witness Requirements
Certification
Contact Preferences
Translation
Execution
Authority
Affirmation
Notification
Jurisdiction
Privacy
Information Release
Future Contact
Cultural Heritage
Understanding and Acknowledgment
Legal Services
Social Services
Healthcare
Public Administration
Child Welfare
Indigenous Services
Family Services
Non-Profit Organizations
Government Services
Legal
Social Services
Family Services
Child Welfare
Indigenous Services
Court Administration
Adoption Services
Document Processing
Client Services
Compliance
Family Law Attorney
Adoption Lawyer
Social Worker
Adoption Counselor
Court Clerk
Legal Assistant
Family Services Coordinator
Child Welfare Officer
Indigenous Services Coordinator
Legal Aid Officer
Commissioner of Oaths
Notary Public
Family Court Judge
Adoption Agency Director
Child Protection Worker
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