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Kansas Department of Health and Environment

Office of Vital Statistics

1000 SW Jackson Street, Suite 120, Topeka, KS 66612-2221

(785) 296-1434

Paternity Consent Form for Birth Registration

This completed consent form and a court order are required to amend a child’s birth registration under KSA 38-1138 when no

father’s name appears on the child’s birth certificate and the mother was not married at the time of conception, birth, or

anytime in between. Otherwise, an action under the Kansas Parentage Act is required to add the father’s name on the child’s

birth certificate. This completed form should be submitted by the court to the State Registrar along with the order required by

KSA 38-1138.

Disclosures to BOTH Parents:

Basic Rights and Responsibilities of Acknowledging Paternity



An acknowledgment of paternity creates a permanent father and child relationship which can only be ended by court

order. A person who wants to revoke the acknowledgment of paternity must file the request with the court before

the child is one year old, unless the person was under age 18 when the acknowledgment of paternity was signed. A

person under age 18 when the acknowledgment was signed has until one year after his or her 18th birthday to file a

request, but if the child is more than one year old then, the judge will first consider the child’s best interests. The

person will have to show that the acknowledgment was based on fraud, duress (threat) or an important mistake of

fact, unless the request is filed within 60 days of signing the acknowledgment or before any court hearing about the

child, whichever is earlier.



Both the father and the mother are responsible for the care and support of the child. If necessary, this duty may be

enforced through legal action such as a child support order, an order to pay birth or other medical expenses of the

child, or an order to repay government assistance payments for the child’s care. A parent’s willful failure to support

his or her child is a crime.



Both the father and the mother have rights of custody and visitation with the child unless a court order changes their

rights. If necessary, custody and visitation rights may be spelled out in a court order and enforced.



Both the father and the mother have the right to consent to medical treatment for the child unless a court order

changes those rights.



The child may inherit from the father and the father’s family or from the mother and the mother’s family. The child

may receive public benefits, including, but not limited to, social security or private benefits, including, but not

limited to, insurance or workers compensation because of the father-child or mother-child relationship.



The father or the mother may be entitled to claim the child as a dependent for tax or other purposes. The father or

the mother may inherit from the child or the child’s descendants.



Each parent has the right to sign or not sign an acknowledgment of paternity. Each parent has the right to talk with

an attorney before signing an acknowledgment of paternity. Each parent has the right to be represented by an

attorney in any future legal action involving paternity or their rights or duties as a parent. Usually each person is

responsible for hiring his or her own attorney.

I have read this page.

_______________

Father’s initials

Mother’s initials

Date

VS211, revised 12/2007.

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Paternity Consent Form For Birth Registration Form - Kansas Department Of Health And Environment

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