Form Ad 900 - Statement Of Understanding - Parent Who Gave Physical Custody Of The Indian Child To The Petitioner(S) Page 5
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9STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
_____ 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, 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.
TO BE COMPLETED BY THE BIRTH PARENT WHOSE CHILD HAS NOT BEEN CONFIRMED
AS COVERED UNDER THE ICWA
_____ 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.
_____ 5. BIRTH PARENT WILL ONLY INITIAL THE BELOW STATEMENTS, IF the child has not been
confirmed as covered under the ICWA.
_____ a. I understand that if my child is later determined NOT to be subject to the ICWA, then the
below rights described in (1)-(3) will apply to my child and the above rights described in
numbers 3 and 4 will not apply to my child.
AD 900 (7/17) PARENT WHO GAVE PHYSICAL CUSTODY (CUSTODIAL PARENT) OF THE INDIAN CHILD TO THE PETITIONER(S)
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