Form Ad 887a - Statement Of Understanding - Parent Who Did Not Give Physical Custody Of The Child To The Petitioner(S) Page 2
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4STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATEMENT OF UNDERSTANDING
Parent Who Did Not Give Physical Custody of the
Child to the Petitioner(s)
___ 1.
I have carefully considered the reasons for consenting to the adoption of_______________________________
NAME OF CHILD
by___________________________________________________________________ .
NAME(S) OF THE PETITIONER(S)
___ 2.
I understand 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.
3. 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).
4. I understand if I do not sign the consent to adoption form, I may request the right to physical custody of the child
in court. I probably will need a lawyer to help me do this.
5. 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.
6. 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.
7. I understand I may talk about my plan of adoption for my child with other professional people, my family and
friends.
8. 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 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.
9. I understand 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. I may not revoke the consent after the 30-day period has
ended or after I sign a Waiver of 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.
10. I understand after the consent to adoption form becomes irrevocable, I may attempt to gain 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. However, the only way I may regain custody of the child is if I request the right to physical custody of the
child in court. I probably will need a lawyer to help me do this.
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 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, whether
adoptive placement of my child is again being considered.
AD 887A (6/17) Parent Who Did Not Give Physical Custody (Non-Custodial Parent) of the Child to the Petitioner(s)
Page 2 of 4
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