Form Ad 887 - Statement Of Understanding - Parent Who Gave Physical Custody Of The Child To The Petitioner(S) Page 3
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6Any removals of children from care due to child abuse or neglect:
_______________________________________________________________________________
_______________________________________________________________________________
Family:
Length of current marriage/relationship: _______________________________________________
General residence location or, if requested, specific address: ______________________________
_______________________________________________________________________________
_______________________________________________________________________________
Other children and adults residing in the home of the petitioner(s):
_______________________________________________________________________________
RIGHTS OF BIRTH PARENT
_______________________________________________________________________________________
_____ 3. I understand that if I do not wish to have my child adopted by the petitioner(s), I should not sign the
consent to adoption form.
_____ 4. 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).
_____ 5. 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.
_____ 6. 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.
_____ 7. I understand if I am not sure I want to have my child adopted, there are other places the agency
can refer me to that could help me with family, health, money, and other problems.
_____ 8. I understand I may talk about my plan of adoption for my child with other professional people, my
family, and friends.
_____ 9. I understand the consent to adoption form will automatically become an irrevocable consent to
adoption either 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.
_____ 10. 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 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 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.
AD 887 (5/17) Parent Who Gave Physical Custody (Custodial Parent) of the Child to the Petitioner(s)
Page 3 of 6
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