ADOPT-216 Verification of Compliance with Hague Adoption Convention Attachment

Judge (or Judicial Officer)
Date:
The court grants
Your name:
Case Number:
Final adoption order.
Final custody decree.
Verification of Compliance with
Hague Adoption Convention Attachment
ADOPT-216, Page 2 of 2
New July 1, 2013
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The court verifies that the agency has met the substantive regulatory requirements of 22 C.F.R. § 97.3(a)–(k) in the
following categories:
Preparation of child background study (Convention, art. 16(1)(a); 22 C.F.R. § 97.3(a));
Transmission of child data to foreign authorized entity (Convention, art. 16(2); 22 § C.F.R. 97.3(b));
Reasonable efforts to find domestic placement (Convention, art. 4(b); 22 C.F.R. § 97.3(c));
Preparation and transmission of home study (Convention, art. 15; 22 C.F.R. § 97.3(d));
Authorization for the child to enter the receiving country (Convention, art. 5; 22 C.F.R. § 97.3(e));
Consent to the adoption/custody by foreign authorized entity (name of entity):
(Convention, art. 17; 22 C.F.R. § 97.3(f));
Guardian/parent counseling and consent (specify):
(Convention, art. 4(d); 22 C.F.R. § 97.3(g));
Child counseling and consent (if applicable)(specify):
(22 C.F.R. § 97.3(h));
The agency and the Central Authority of the receiving country, as defined in Family Code section 8900.5(c),
(name of receiving country):
(name of central authority):
have both signed Placement Adoption Papers (22 C.F.R. § 97.3(i));
The agency has taken all steps to ensure the secure transfer of the child, including obtaining permission for
the child to leave the United States (Convention, arts. 18 & 19; 22 C.F.R. § 97.3(i));
The agency has taken all steps to keep the Central Authority of the receiving country informed about the
adoption process, as well as the progress of the placement if a probationary period is required (Convention, art.
20; 22 C.F.R. § 97.3(i));
Proper observance of the “no-contact” rule, if applicable (22 C.F.R. § 97.3(j));
That no improper financial or other gain was derived (22 C.F.R. § 97.3(k)).
By clear and convincing evidence, an intercountry adoption is in the best interest of the child. (Convention, art.
4(b).)
The adoption services provider meets the requirements of 22 C.F.R. (Code of Federal Regulations) part 96.
Court Verifications (to be completed by the judge)
3
Court Orders
4
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ADOPT-216 Verification of Compliance with Hague Adoption Convention Attachment PDF

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