Form Ad 900 - Statement Of Understanding - Parent Who Gave Physical Custody Of The Indian Child To The Petitioner(S) Page 6
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9STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
_____ (1) I understand the consent to adoption form will automatically become an
irrevocable consent to adoption when the 30-day period has ended, or when
I sign a Waiver of the Right to Revoke Consent (AD 929), whichever occurs
first. The first day of the 30-day period is the day the consent to adoption
form is signed.
_____ (2) If I change my mind after I sign the consent to adoption form, I must sign
and deliver to the California Department of Social Services or to the
delegated county adoption agency, whichever is investigating the proposed
adoption, a written statement revoking the consent and requesting that the
child be returned to me. I may not revoke the consent after the 30-day
period has ended or after I sign a Waiver of the Right to Revoke Consent
(AD 929), whichever occurs first. The first day of the 30-day period is the
day the consent to adoption form is signed.
_____ (3) After the consent to adoption form becomes irrevocable, I may regain
custody of the child only if the petitioner(s) agree(s) to withdraw his/her/their
petition for adoption, or if the court denies the adoption petition.
_____ b. I understand that if this child is later confirmed as covered under the ICWA, then the
investigating agency will notify me and the rights described in numbers 3 and 4,
including the right to withdraw the consent before the adoption is granted by the court,
will apply. I understand I must keep the agency informed of my current address.
RIGHTS IN EVERY CASE
_____ 6. I understand that if I do not wish to have my child adopted by the petitioner(s), I should not sign
this form and the consent to adoption form.
_____ 7. I understand if I do not consent to the adoption, I may sign a Refusal to Give Consent to Adoption
form (AD 20) or write a letter to the adoption agency and the adoption agency will report to the
court that I do not want my child to be adopted by the petitioner(s).
_____ 8. I understand if I do not sign the consent to adoption form, I may request that my child be returned
to me. If the petitioner(s) do not return my child to me, I may ask the court for the return of my
child. I probably will need a lawyer to help me do this.
_____ 9. I understand I have the right to look for a lawyer to help me in the independent adoption process
and that the petitioner(s) may be required to pay the cost, up to $500 unless the petitioner(s) and I
agree to a higher amount, of such legal counsel.
_____10. I understand if I am not sure I want my child adopted, there are other places the agency can refer
me to that could help me with family, health, money, and other problems.
_____11. I understand I may talk about my plan of adoption for my child with other professional people, my
family, and friends.
_____12. 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.
AD 900 (7/17) PARENT WHO GAVE PHYSICAL CUSTODY (CUSTODIAL PARENT) OF THE INDIAN CHILD TO THE PETITIONER(S)
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