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1. Title and Court Information: Identifies the court jurisdiction, case number if applicable, and document type
2. Deponent Information: Full legal name, address, and identification of the parent relinquishing rights
3. Child Information: Full legal name, date and place of birth, and current residence of the child(ren)
4. Jurisdiction Declaration: Statement establishing the court's jurisdiction over the matter
5. Voluntary Declaration: Express statement that the relinquishment is voluntary and made without coercion
6. Mental Capacity Declaration: Statement confirming sound mental state and understanding of consequences
7. Rights Relinquishment: Detailed enumeration of all parental rights being permanently relinquished
8. Future Contact Provisions: Statement regarding any agreed arrangements for future contact or complete severance
9. Understanding of Consequences: Explicit acknowledgment of the permanent nature and consequences of relinquishment
10. Execution: Signature block, notarization section, and witness attestations
1. Indigenous Heritage Declaration: Required when the child has Indigenous heritage, addressing specific legal requirements and cultural considerations
2. Adoption Consent: Included when the relinquishment is connected to a planned adoption
3. Financial Support Release: Statement releasing or maintaining financial obligations, depending on jurisdiction requirements
4. Counseling Certification: Documentation of required counseling or legal advice received, if mandated by jurisdiction
5. Revocation Period Acknowledgment: Required in jurisdictions with statutory revocation periods
6. Medical History Authorization: Permission to share medical history with future caregivers or adoptive parents
1. Schedule A - Proof of Identity: Certified copies of deponent's identification documents
2. Schedule B - Birth Certificate: Certified copy of child's birth certificate
3. Schedule C - Counseling Verification: Documentation from counselor or legal advisor confirming consultation
4. Schedule D - Service of Notice: Proof of service to other parent or interested parties if required
5. Schedule E - Criminal Record Check: If required by jurisdiction or circumstances
6. Appendix 1 - Consent Forms: Additional consent forms required by the jurisdiction
7. Appendix 2 - Medical Records: Relevant medical history if being shared with future caregivers
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Healthcare
Mental Health Services
Legal Affairs
Social Services
Child Protection
Court Administration
Family Services
Document Processing
Indigenous Relations
Adoption Services
Records Management
Client Services
Family Law Attorney
Social Worker
Child Protection Worker
Court Clerk
Legal Assistant
Family Court Judge
Adoption Specialist
Commissioner of Oaths
Notary Public
Child Welfare Officer
Indigenous Services Coordinator
Family Services Coordinator
Legal Aid Officer
Guardian ad Litem
Court Administrator
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