Form Ad 900a - Statement Of Understanding - Parent Who Did Not Give Physical Custody Of The Indian Child To The Petitioner(S) Page 3
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7STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
_____ 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 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 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, 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 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.
_____ k. I may ask the court to stop any action ending my rights as a parent if the action did not
follow the ICWA.
_____ l.
I must sign the consent to adoption form before a Judge of the Superior Court in
California, or if signed outside the State of California, a Judge of an equivalent state court.
AD 900A (6/17) PARENT WHO DID NOT GIVE PHYSICAL CUSTODY (NON-CUSTODIAL) OF THE INDIAN CHILD TO THE PETITIONER(S)
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