Form Ad 900b - Statement Of Understanding - Alleged Father Of An Indian Child Page 5
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6STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
_____ 12. 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 is
signed.
_____ 13. 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. I understand this child will not be returned to me unless I have
a court order that says I am this child’s father and gives me physical custody of this child.
_____ 14. I understand after the consent to adoption form becomes irrevocable, I may establish paternity of
this child in court only if the petitioner(s) agree(s) to withdraw his/her/their petition for adoption or if
the court denies the adoption petition.
_____ 15. I understand if this child is not adopted, the agency will notify me. I understand I must keep the
agency informed of my current address.
_____ 16. 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 this 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 this child is again being considered.
_____ 17. I understand after this child’s adoption has been granted in court, all inheritance rights from any
blood relatives will end unless they have made arrangements in their will or in a trust which
specifically includes this child. This child will legally inherit from his/her adoptive parent(s).
However, this child may still be able to get benefits from his/her tribe or Bureau of Indian Affairs’
services if he/she is an Indian.
_____ 18. I understand the adoption agency may release identifying information from the adoption case
record only when:
a. It has been requested by certain agencies as named in law because the information is needed
to help this child;
b. This child, when he/she is an adult, and I have signed forms agreeing to the release of
identifying information so that contact can be arranged;
c. This child has reached 21 years of age, asks for my identity and I have agreed in writing to the
release of my identity and most current address in the adoption agency’s record;
d. This child has reached 21 years of age and has indicated in writing that I may have his/her
adopted name and most current address as indicated in the adoption agency’s records, and I
have asked for this information; or
e. This child is under 21 years of age and the adoption agency has found that the release of my
identity and most current address as indicated in the agency’s records, is justified according to
law.
_____ 19. I understand I will be able, at any time, to add information about myself to the records of the agency
that investigates the independent adoption.
_____ 20. I understand the court may, after considering a request, release identifying information from the
court’s adoption file.
AD 900B (5/17) ALLEGED FATHER OF INDIAN CHILD
PAGE 5 OF 6
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