An agreement was entered into on __________ (Date), between _______________, herein referred to as adopting parent, and ________________ (His Wife/Her Husband), herein referred to as natural parent.  (If natural parent is wife and previously married, add) Natural parent's former married name was _______________________.


The above-named adopting parent desires to formally adopt, pursuant to the legal statutes governing adoption in _____________________________________________ (State/Commonwealth), ________________________, minor child of the above-named natural parent, and to regard and treat the child in all respects as __________ (His/Her) natural child.


In consideration of this adoption agreement and other good and valuable consideration, it is hereby agreed as follows:


1.  The adopting parent shall, and hereby does, formally adopt ___________________ (Child), and promises to treat and regard said child in all respects as _______ (His/Her) own natural child, bestowing on the child the guarantee of all rights, benefits, and privileges incident to the parent-child relationship, and hereby undertakes to fulfill _________ (His/Her) responsibilities and duties of a parent in respect to the child.


2.  The natural parent hereby consents to the formal adoption of _________________

(Child) by __________________________ (Name), __________ (His/Her) spouse. The natural parent shall refrain from embarking on any course of action that will interfere with the rights, duties, and privileges of said child or of the adopting parents rights, duties, and privileges pertaining to the child.


3.  The child henceforth shall be raised in the _____________________________ faith.


4.  ___________________________________________________________________  (If appropriate, add: The name of the child shall be changed to.)


The following facts are hereby affirmed by the parties to the adoption:


1.  The child, ______________________________, was born on ________ (Date).


2.  The adopting parent and natural parent were married on ___________ (Date), from which date the natural parent and child have resided on a continuous basis with the adopting parent.


In witness whereof, the parties hereto have signed this agreement at _______________

(Place of Execution) on ___________________ (Date).



__________________________________                                             __________________

Signature of Adopting Parent                                                        Date


__________________________________                                             __________________

Signature of Natural Parent                                                                            Date


This document was hereby signed in the presence of the following:


__________________________________                                             __________________

Signature                                                                                                           Date

__________________________________                                             __________________

Signature                                                                                                           Date