Parental Consent to Adoption



We, ________________________________ and ______________________________, the parents of _____________________________, a _______ (Male/Female) child born to us on ___________ (Date) consent to _______ (His/Her) adoption by _____________________________ and ___________________________, husband and wife, who currently reside at ________________________________________________________ (Address).

In witness whereof, we have signed this instrument at ___________________________ (Place of Execution) on ____________ (Date).

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Signature of Parent

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Signature of Parent

This document was signed in the presence of the following:

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Signature Date

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Signature Date