If you are adopting more than one child, fill out an adoption
request for each child.
Your name(s) (adopting parent(s)):
Relationship to child:
Type of adoption (check one):
Judicial Council of California, www.courts.ca.gov
Revised January 1, 2014, Mandatory Form
Family Code, §§ 170–180, 7822, 7892.5, 8601.5,
8604, 8606, 8700, 8714, 8714.5, 8802, 8900–8905,
8908–8912, 8919, 8924, 8925, 9000, 9208;
Welfare and Institutions Code, §§ 366.24, 16119;
Cal. Rules of Court, rules 5.480–5.487, 5.730
Lawyer (if any): (Name, address, telephone numbers, and State Bar
same time as this Adoption Request.
I/We filed this Adoption Request in this court because it is in the county
(check all that apply):
Where the adopting parent(s) reside;
Where the child was born or resides at the time of filing;
Where an office of the agency that placed the child for adoption is located;
Where an office of the department or public adoption agency that is investigating the petition is located;
Where a placing birth parent or parents resided when the adoptive placement agreement, consent, or
relinquishment was signed;
Where a placing birth parent or parents resided when the petition was filed;
Where the child was freed for adoption.
Tribal customary adoption
(attach tribal customary adoption order)
Intercountry (name of agency):
This adoption may be subject to the Hague Adoption Convention (form ADOPT-216 must be filed with
Joinder is being filed at Joinder will be filed.
ADOPT-200, Page 1 of 5
(If the child is a dependent of the court, the Adoption Request must be filed in the county where the child was freed
for adoption or the county where the adopting parent(s) reside(s). See Fam. Code, § 8714.)
Clerk stamps date here when form is filed.
Fill in court name and street address:
Superior Court of California, County of
Court fills in case number when form is filed.
(To be completed by the clerk of the superior court
if a hearing date is available.)
Hearing is set for:
Name and address of court if different from above:
To the person served with this request: If you do
not come to this hearing, the judge can order the
adoption without your input.