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1. Personal Details of Consenting Party: Full details of the biological parent or guardian giving consent, including ID number, contact information, and relationship to the child
2. Child's Information: Full details of the child including name, date of birth, birth registration number, and current place of residence
3. Nature of Consent: Clear statement specifying consent for adoption and understanding that this terminates all parental rights and responsibilities
4. Counselling Confirmation: Confirmation that the consenting party has received counselling about the effects of adoption and understands the implications
5. Legal Rights Statement: Statement outlining the legal rights of the consenting party, including the right to withdraw consent within 60 days
6. Declaration of Voluntary Consent: Statement confirming that consent is given freely and voluntarily, without inducement or compensation
7. Witness Details: Information and signatures of required witnesses to the consent
8. Commissioner of Oaths Certification: Section for official certification by a Commissioner of Oaths
1. Second Parent Consent: Required when both parents are known and available, and both must provide consent
2. Unborn Child Declaration: Special section required when consent is being given for an unborn child, including expected date of birth
3. Inter-country Adoption Acknowledgment: Required when the child may be adopted by parents from another country, acknowledging understanding of international implications
4. Guardian Consent: Required when consent is being given by a legal guardian rather than biological parent
5. Interpreter Declaration: Required when an interpreter has been used to explain the consent form to the consenting party
1. Annexure A - Proof of Identity: Certified copies of identity documents of the consenting party
2. Annexure B - Child's Birth Certificate: Certified copy of the child's birth certificate or proof of registration of birth
3. Annexure C - Counselling Certificate: Certificate from adoption social worker confirming that counselling has been provided
4. Annexure D - Supporting Affidavit: Additional affidavit providing background information or explaining special circumstances if required
5. Annexure E - Medical Information: Relevant medical information about the child and family medical history
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Family Services Coordinator
Adoption Agency Director
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