This is a private record.
My Name
Address
City, State, Zip
Phone
Email
In the District Court of Utah
______Judicial District ______County
Court Address ______
In the Matter of the Adoption of
______
(adoptee’s name) / Guardian’s Consent to Adoption and Waiver of Notice
Case Number ______
Judge ______
Commissioner ______

Do not sign this document without reading it. Do not sign it unless everything stated is true and correct. If you have any questions, talk with an attorney.

·  You have the right to be notified of hearings and to be served with papers in this matter. You have the right to intervene and oppose the adoption. By signing this document you are giving up these rights and consenting that the adoptee be adopted.

·  If you agree with the adoption, complete this form, sign it, and return it to the Petitioner.

·  If you want to intervene and oppose the adoption, file a motion to intervene with this court within 30 days after the Notice of Petition to Adopt was served on you.

(1) I make this statement free from duress.

(2) I am the adoptee’s court-appointed guardian, and my order of appointment includes the authority to consent to the adoptee’s adoption.

(3) I understand that if my ward is adopted, I will not have any guardian’s rights and responsibilities for my ward.

(4) I understand that if my ward is adopted, the adopting parent will be known as my ward’s parent and my ward will be known as the adopting parent’s child. My ward may take the adopting parent’s family name.

(5) Understanding all of this, I voluntarily waive my right to be notified of hearings and served with papers in this matter, and I voluntarily waive my right to intervene in this matter.

(6) Understanding all of this, I voluntarily consent that my ward be adopted.

(7) I understand that upon entry of the Decree of Adoption I must file a motion to terminate the guardianship with the court that appointed me.

Do not sign this document without reading it. Do not sign it unless everything stated is true and correct. If you have any questions, talk with an attorney.

I declare under penalty of Utah Code Section 78B-5-705 that everything stated in this document is true and correct.
Sign here ►
Date / Typed or Printed Name
Guardian’ Consent to Adoption and Waiver of Notice / Approved Board of District Court Judges December 17, 2010
Revised April 8, 2015 / Page 2 of 2