Form Ad 900b - Statement Of Understanding - Alleged Father Of An Indian Child Page 2
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6STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
STATEMENT OF UNDERSTANDING
Alleged Father of an INDIAN Child
_____ 1. I have carefully considered the reasons for consenting to the adoption of
_____________________________________ by ______________________________________.
NAME(S) OF THE PETITIONER(S)
NAME OF CHILD
_____ 2.
The adoption agency has told me why they think I am the alleged father of this child, and I
understand that I may:
a. File a petition in court to prove that I am the father of this child;
b. Deny I am the father;
c. Give up my rights to any other notice of the adoption proceedings;
d. Sign a consent to the adoption; or
e. Take no action.
RIGHTS UNDER THE INDIAN CHILD WELFARE ACT (ICWA)
This Child:
I
Has been confirmed as covered under the ICWA.
Has not been confirmed as covered under the ICWA, but may be covered. Therefore, I am being
I
advised of these rights. I understand that until this child is confirmed as covered under the ICWA, the
rights described below in numbers 3 through 6 do not apply. Complete number 7 as well.
_____ 3. I understand because this child is or may be an Indian child, the requirements of the ICWA will apply
to the adoption of this child.
If Known, Name of Child’s Tribe: _____________________________________________________
If Known, Tribal Membership or Enrollment Number: _____________________________________
_____ 4. I understand this child is or may be subject to the ICWA and that if I want any rights under this Act I
must have a court order declaring that I am this child’s father.
_____ 5. I understand that if this child is subject to the ICWA, that any other legal parent has the right under
the ICWA to withdraw consent before the decree of adoption is signed. If the legal parent should
change his/her mind about the adoption after signing the consent to adoption form, he/she may
withdraw the consent before the adoption is granted by the court and this child will be returned to
him/her.
_____ 6. I understand that in a case of a child who has been confirmed as covered under the ICWA the
following rights apply:
_____ a. According to the ICWA, the best place for this child to live if he/she cannot be with a
parent would be with a member of his/her extended family. If that is not possible, the next
choice would be other members of this child’s tribe. If placement with the tribe is not
possible, the third choice would be with another Indian family.
AD 900B (5/17) ALLEGED FATHER OF INDIAN CHILD
PAGE 2 OF 6
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