ADOPT-200 Adoption Request

All persons with parental rights agree to the adoption and have signed the Independent Adoptive Placement
Agreement or consent on the appropriate California Department of Social Services form.
(If no, list the name and relationship to child of each person who has not signed the agreement form):
If this is a stepparent adoption:
The birth parent (name):
The adopting parents were married on or The domestic partnership was registered on
(For court use only. This does not affect social worker’s recommendation.
There is no waiting period.)
Contact After Adoption Agreement (form ADOPT-310)
(date):
Contact after adoption
I/We will file promptly with the department or delegated county adoption agency the information required by the
department in the investigation of the proposed adoption.
The birth parent (name):
12
13
14
Case Number:
Your name:
No
Yes
b.
No
Yes
c.
b.
c.
a.
has signed a consent
has signed a consent
will sign a consent
will sign a consent
There is no presumed or biological father because the child was conceived by artificial insemination using semen
provided to a medical doctor or a sperm bank. (Fam. Code, § 7613.)
will not be usedis attached
will be filed at least 30 days before the adoption hearing
This is a tribal customary adoption. Postadoption contact is governed by the attached tribal customary adoption
order.
is undecided at this time.
ADOPT-200, Page 3 of 5
Adoption Request
Revised January 1, 2014
If this is an independent adoption:
A copy of the Independent Adoptive Placement Agreement from the California Department of Social Services is
attached. (This is required in most independent adoptions; see Fam. Code, § 8802.)
11
Yes
No
a.
This is an adoption conducted under the requirements of the Hague Adoption Convention and the child will be
moving or has already moved with the adopting parent(s) to another Hague Convention member country at the
conclusion of this adoption. If yes, child will be moving or has moved to (name of country):
and adopting parent(s):
c.
d.
No
Yes
seek(s) a California adoption
will be petitioning for a Hague Adoption Certificate
This is a tribal customary adoption under Welfare and Institutions Code section 366.24. Parental rights have
been modified under and in accordance with the attached tribal customary adoption order, and the child has been
ordered placed for adoption.
is not necessary because
(check the applicable reasons under Fam. Code, § 8606):
(2)
(3)
(4)
(5)
Consent for adoption is not necessary because (complete all sections that apply to your adoption):
a.
(1)
15
The consent of the birth parent presumed father
The parent has been judicially deprived of the custody and control of the child.
The parent has voluntarily surrendered the right to custody and control of the child in a judicial
proceeding in another jurisdiction, under a law of that jurisdiction providing for the surrender.
The parent has deserted the child without providing information to identify the child.
The parent has relinquished the child under Family Code section 8700.
The parent has relinquished the child for adoption to a licensed or authorized child-placing agency in
another jurisdiction.
will be seeking a Hague Custody Declaration.
Yes
No
Page 3/5
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ADOPT-200 Adoption Request PDF

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