Form Ad 927 - Statement Of Understanding - Parent Who Places The Indian Child With The Prospective Adoptive Parent(S) Page 6
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8CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
_____ 8.
I understand if I am not sure I want to place my child for adoption, there are other places the agency
can refer me to that could help me with family, health, money, and other problems.
_____ 9.
I understand I may talk about my plan to place my child for adoption with other professional people,
my family, and friends.
_____ 10. I understand I have a right to a minimum of three separate counseling sessions with an Adoption
Service Provider or a licensed psychotherapist of my choice which, at my request, will be paid for by
the prospective adoptive parent(s).
_____ 11. I understand I will remain legally responsible for my child until the adoption is granted by the court.
If the adoption petition is withdrawn, dismissed or denied, the agency will notify me and request that
I make other plans for the child. I understand I must keep the agency informed of my current
address.
_____ 12. I understand that if I ask the agency which investigates the proposed adoption for information at any
future time, the agency must give me all known information about the status of my child’s adoption,
including the approximate date the adoption was completed and if the adoption was not completed
or was vacated for any reason, and whether adoptive placement of my child is again being
considered.
_____ 13. I understand after my child’s adoption has been granted in court, all inheritance rights from any
blood relatives will end unless they have made arrangements in their will or in a trust which
specifically includes my child. My child will legally inherit from his/her adoptive parent(s). However,
my child may still be able to get benefits from his/her tribe or Bureau of Indian Affairs’ services if
he/she is an Indian.
_____ 14. I understand the adoption agency may release identifying information from the adoption case record
only when:
a. It has been requested by certain agencies as named in law because the information is needed to
help my child;
b. My child, when he/she is an adult, and I have signed forms agreeing to the release of identifying
information so that contact can be arranged;
c. My child has reached 21 years of age, asks for my identity and I have agreed in writing to the
release of my identity and most current address in the adoption agency’s records;
d. My child has reached 21 years of age and has indicated in writing that I may have his/her
adopted name and most current address as indicated in the adoption agency’s records, and I
have asked for this information; or
e. My child is under 21 years of age and the adoption agency has found that the release of my
identity and most current address as indicted in the agency’s records is justified according to law.
_____ 15. I understand I will be able, at any time, to add information about myself to the record of the agency
that investigates the independent adoption.
_____ 16. I understand the court may, after considering the request, release identifying information from the
court’s adoption file.
_____ 17. I understand if I think I was deliberately not told the truth about placing my child for adoption, I have
three years after the date the adoption was completed, or within 90 days of discovery of the fraud,
whichever is earlier, to ask the court to set-aside the adoption of my child.
AD 927 (7/17) PARENT OF INDIAN CHILD WHO PLACES THE CHILD WITH THE PROSPECTIVE ADOPTIVE PARENT(S)
PAGE 6 OF 8
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