Adoption Placement Agreement Form printable pdf download

ADOPTION PLACEMENT AGREEMENT

This agreement between _________, an agency duly authorized to place children for

adoption, called agency, and _________ and _________, his wife, residing at _________, called

foster parents:

1. In consideration of this agreement made by the foster parents, agency places in the home of

the foster parents, for the purpose of adoption a [fe(male)] child known to them as

_________, born _________, division of child welfare case number _________, the child

being called child:

2. Foster parents will:

(a). Receive the child in their home and care for the child according to standards established

by the Commissioner of Public Welfare with due regard for the emotional, intellectual,

physical and spiritual needs of the child.

(b). Accept the supervision of the child by the agency for the period of time prior to legal

adoption.

(c). Accept termination of the placement if, in the judgment of agency, the best interests of the

child will require this action.

(d). Agree that until the decree of adoption has actually been granted, they will obtain proper

authorization from the agency for surgery, or major medical treatment of the child. Further,

they will notify the agency immediately, or on the next work day, of any illness which

requires the attention of a physician.

(e). Notify the agency of any change of address before the change takes place.

(f). Obtain permission from the agency before taking the child out of the state.

3. Agency will:

(a). Terminate the placement at any time at the request of the foster parents.

(b). Give casework service. A caseworker will call in the home of the foster parents during the

supervisory period and may be called on for consultation at any time.

(c). Give its consent to the adoption and assist in its completion at the end of the supervisory

period if it is agreed by both parties that legal adoption is in the best interests of the child.

_________

4. Legal adoption cancels this agreement.

Adoption Placement Agreement Form