Form Ad 927 - Statement Of Understanding - Parent Who Places The Indian Child With The Prospective Adoptive Parent(S) Page 4
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8CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
____ b. If I should change my mind about the adoption after signing the adoption placement
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agreement, I may withdraw the agreement before the adoption is granted by the court and my
child will be returned to me.
_____ c. I will be told immediately if my child’s other parent asks to take back his/her consent to
adoption and of any court proceedings because he/she is asking to take back the consent to
adoption. I understand I must keep the adoption agency informed of my current address if I
want to receive this notice.
_____ d. The child’s Indian tribe has a right to be noticed and participate in the adoption proceedings.
_____ e. If any agency or person goes to court to take away the parental rights of my child’s other
parent, my child’s tribe will be noticed and may participate in the proceedings.
_____ f. The adoption agency has to tell me if the adoption is set-aside or the adoptive parent(s)
agree(s) to the ending of his/her/their rights as a parent(s) to my child. I know that the notice
will be given to me in writing. I understand I must keep the adoption agency informed of my
current address if I want to receive this notice.
_____ g. If my child’s tribe has a tribal court, as defined by the ICWA, or other administrative body
that is able to hear child proceedings, I, my child’s other parent, or the tribe may ask the
court to have all court proceedings about my child moved to the tribal court. This will not
take place if I, or the other parent, or the tribe does not want it to, or if the court finds good
reason not to move the proceedings.
_____ h. Information about the adoption may be released when:
(1) My child reaches 18 years of age and asks the court that granted the adoption for
information about my tribal affiliation and any other information needed to protect any
tribal rights, including entitlement to enrollment that he/she may have.
(2) The Secretary of the Interior has asked for the information.
(a) I understand if I want to stay unknown, I must file a paper with the court asking that
information about me not be released.
(b) I understand even though the ICWA requires the Secretary of the Interior to
make sure the information on the adoption of my child stays confidential, tribes
do not always keep this information confidential if they find out about the adoption.
(3) My child is over 18 years of age, his/her adoptive parent(s) or tribe asks the Secretary of
the Interior to release information to enroll my child in the tribe, or to decide if my child
has any rights or benefits from the tribe.
(a) I understand if I have filed a paper with the court asking that information about me
not be released, the Secretary of the Interior will certify that my child may be enrolled
in the tribe instead of releasing the information.
____ i. The adoption agency will take the necessary steps to obtain a Certificate of Degree of Indian
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Blood for my child and may enroll my child in his/her tribe or register him/her for any
Bureau of Indian Affairs’ benefits that he/she may be able to get.
_____ j. The clerk of the Superior Court must provide a copy of the final decree of adoption, along
with information about myself, tribal information, biological parent, adoptive parent and the
adoption agency to the Secretary of Interior.
PAGE 4 OF 8
AD 927 (7/17) PARENT OF INDIAN CHILD WHO PLACES THE CHILD WITH THE PROSPECTIVE ADOPTIVE PARENT(S)
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