Parent'S Custodian'S Consent To Adoption Page 2
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2Form 34F: Parent’s or Custodian’s Consent to Adoption
(page 2)
Court File Number
11. I understand my rights and the rights of other persons with respect to the disclosure of adoption information.
12. No payment or reward of any kind was made, given, received or agreed to be made, given or received by me/us or, to the
best of my/our knowledge, by any other person in connection with,
(a) the adoption of this child;
(b) this child’s placement for adoption;
(c) the giving of any consent to this child’s adoption; or
(d) any negotiations or arrangements leading up to this child’s adoption,
except for what is permitted by the Child and Family Services Act and the regulations made under that Act.
13. I have had a chance to get counselling about this consent.
14. I have had independent legal advice about this consent.
Date of signature
Signature of parent
NOTE: This consent must be witnessed by an independent lawyer who
is to provide an affidavit of execution and independent legal advice
below. If the person giving this consent is less than 18 years old, the
Signature of independent lawyer
consent must be accompanied by Form 34J (Affidavit of Execution and
Independent Legal Advice (Children's Lawyer)), instead of the Affidavit
of Execution and Independent Legal Advice that accompanies this
form.
AFFIDAVIT OF EXECUTION AND INDEPENDENT LEGAL ADVICE
My name is
(full legal name)
and I swear/affirm that the following is true:
1.
I am a member of the Bar of
(name of jurisdiction)
and I am not acting for any other person in this adoption case.
2.
I explained to
about
(parent’s full legal name)
the nature and effect of adoption under the law of Ontario;
the nature and effect of this consent;
the circumstances under which this consent may be withdrawn;
his/her rights and the rights of other persons with respect to the disclosure of adoption information;
the right to counselling.
3.
After my explanation, he/she told me that he/she wanted to sign this consent.
4.
I was present at and witnessed the signing of this consent.
Sworn/Affirmed before me at
municipality
in
Signature
province, state or country
(This form is to be signed in front of a lawyer,
on
justice of the peace, notary public or
date
Commissioner for taking affidavits
commissioner for taking affidavits.)
(Type or print name below if signature is illegible.)
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FLR-34F-E (2009/04)
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