procedures and practices for adoption in philadelphia · procedures and practices for adoption in...

-,

10 •

Procedures and Practices for Adoption in Philadelphia Andrea Hoffman Jelin Carolyn Moran Zack'

10-1 INTRODUCTION AND GENERAL INFORMATION

Adoption matters basically break down into three different kinds of cases: independent or private matters, kinship adoptions, and agency adoptions.

All adoption matters involve two steps: the termination of the birth parents' rights and the adoption of the child. There can be no adoption without a termination of parental rights. The Adoption Act was recently amended to shorten the period during which a birth parent's consent may be revoked. Act 21, which became effective on May 24, 2004, provides that a birth mother can revoke her consent within 30 days after its execution, and a birth father can revoke his consent the later of 30 days from the birth of the child or 30 days from the date of execution of the consent (which can be executed only by the birth father prior to the child's birth). These changes have been incorporated in revised forms of consent attached to the petition to confirm consent and the report of intention to adopt, available at the adoption branch.

Act 21 also shortens the time period following the placement of a child for adoption to three days before a birth parent may file a petition for voluntary relinquishment, short-

---ens-the-time-period-following-the.execution.of-the.consent . .after-Ylhich.a.l!!:'O.fiPJ)ctive_adop~._. __ .... ___ ._. tive parent can file a petition to confirm consent to 30 days (so as to coincide with the new revocation time period), and proscribes the limited circumstances under which a consent can be challenged after the revocation period has elapsed. These changes have not required the revision of the forms.

Adoption matters in Philadelphia County are governed by 23 Pa.C.S. § 2101 et seq., the Adoption Act, and Local Rules 15 and 16. Philadelphia County adoption matters fall under the jurisdiction of the family court division, as opposed to the other 66 Pennsylvania

1. These materials were originally prepared by Lise A. Fisher and Andrea Hoffman JeHn, from materials authored by Helen Lafferty.

625

, ,

10 Procedures and Practices for Adoption in Philadelphia

counties wherein jurisdiction lies in the orphans' court division. The adoption branch of Family Court in Philadelphia County is located in Room 332, 1801 Vine Street, (215) 686-4012, -4013, -4002, or -4259. Andrea Hoffman Jelin, director of Children and Youth Services, is the branch chief.

> Filing: All filings related to adoption matters are processed at the adoption branch, Room 332, 1801 Vine Street.

When a matter is initiated by a petition for adoption, or the case is one of the special needs child, the filing fee is $221. When a matter is initiated by a report of intention to adopt, the filing fee is $296. Payment must be by certified check or money order. No other form of payment will be accepted.

> Hearings: All matters are heard at 1801 Vine Street in Courtroom L on the third floor.

> Forms: Local Rule 15.10) mandates the use of pre-printed forms for all adoption pleadings, orders, and decrees. These forms are set forth in the rules and are available in Room 332 at 1801 Vine Street free of charge.

As with all other matters, when in doubt, ask! The adoption branch is run by a group of people who are very knowledgeable in this area and their procedures should be complied with in order to avoid unnecessary delay. In order to increase efficiency and expedite processing, the adoption branch has become fully computerized.

10-2 PLEADINGS REQUIRED 10-2.1 Adoptee's Birth Certificate

The caption on all pleadings in adoption matters must conform with the child's birth certificate. In other words, the child's name on pleadings must appear exactly as it appears on his or her birth certificate. The adoptee's original birth certificate must be attached to the initial pleading: Rule 15.2(d) requires that the birth certificate show the names of the mother and the father. To obtain a clalm for, or acknowledgment of, paternity, you must write to the Bureau of Child Enforcement, Division of Central Operations, P.O. Box 8018, Harrisburg, PA 17105. You should obtaln a long form from the Department of Vital Statistics in the state of the child's birth for this purpose. A letter stating that no paternity claim has been made is also required.

10-2.2 Affidavit as to Unknown Father

If the father is unknown, the court can terminate his rights by judicial order. The birth mother sets forth in an affidavit why she cannot identify the birth father, and she may also have to testify in court that the father is unknown. A letter from the Bureau of Child Support Enforcement stating that no claim for paternity as to this child has been filed must also be obtained. The affidavit and letter must be attached to either the petition for adoption, petition for voluntary relinquishment, or petition to confirm consent. It is extremely important that you advise the adoptive parents that there is always a chance, no matter how slight, that a putative father may try to claim the child at some future point in time, if an order is not entered terminating his rights.

626

10-2.8 Hearings

10-2.3 Affidavit as to Putative Father

The procedure for terminating the parental rights of a putative father is set forth in the Adoption Act at section 2504(c). If a putative father will not execute a consent to the adoption but has not filed an acknowledgment or claim of paternity, and he has been given notice of the hearing for relinquishment/termination but fails either to appear at the hearing to object to termination of his parental rights or to file a written objection to the termination, the court may enter a decree/order terminating the parental rights of the putative father pursuant to section 2504(b).

10-2.4 Petition for Involuntary Termination

If either or both parents refuse to execute consents to an adoption, and will not voluntarily relinquish hislher/their rights to the child, you must file a petition for involuntary termination. (See form 10A-4C on page 649.) As the grounds and time frames differ depending upon the circumstances (e.g., an agency case or where abandonment is a factor), refer to the Adoption Act for the time frames and grounds applicable to the circumstances of your case.

10-2.5 Petition for Adoption

See form lOA-6 on page 656, and section 2701 of the Adoption Act. The consent of an adoptee over the age of 12 must be attached to the petition.

10-2.6 Criminal History Record and Application for Child Abuse History

Rule 15.4(d) requires that these documents be submitted for each petitioner (and any other person residing in the household). These forms can be obtained directly from the Commonwealth. (See forms 10A-S and 10A-9 on pages 664 and 665, and addresses on those pages.) Each should be completed by petitioners, one for each adoptive parent and one for each other member of the household, and returned to the appropriate agency with the required fee. When the forms are returned by the agency, they should be attached to the petition for adoption and filed with the court.

Due to the length of time it takes to get these documents back from the respective agencies, you should have your clients complete and mail the forms as soon as possible after the initial consultation.

10-2.7 Affidavit as to Arrests

The petitioners must provide an affidavit as to any arrests or convictions outside of _-7P~e,'?P~lvania._ Affidavits regarning.the..circumstances-surrounding-the-al'Fests-will-also·· --- --... ---

be required.

10-2.8 Hearings

In kinship cases, the termination hearing on the petition for involuntary termination is scheduled along with the adoption hearing. However, if it appears from the outset that the matter is contested, the termination hearing will be scheduled first. In kinship cases, if the natural parent consents to the adoption, there is no need to fIle a petition for voluntary relinquishment or a petition to confirm consent.

627

10 Procedures and Practices for Adoption in PhHadelphia

If the matter does not become contested until the day of the hearing, it will be continued in order to give the birth parent(s) time to retain counsel, and another date will be assigned on which the termination hearing will take place.

10-2.8.1 Notice

Notice of the hearing will be sent to counsel for the moving party (usually counsel for the adoptive parents). It is counsel's responsibility to send at least 10 days' notice of the hearing and a copy of the petition for involuntary termination to the birth parent(s) at hislherltheir last known address by certified mail, return receipt requested, restricted delivery, and by regular mail. Proof of service containing the method of service and the individuals served will be required at the hearing. Note that service of a copy of the notice of the hearing is required to be given even if a parent consented to the adoption. The notice must also be served on any parent or guardian of an underage birth parent. It is strongly recommended that a thorough attempt be made to locate the birth parent even where several years have elapsed.

If the whereabouts of one of the birth parents is unknown, check with the adoption branch to ascertain what will constitute sufficient notice. Also, ascertain from the adoption branch what efforts to locate the birth parent are acceptable. You should also prepare an affidavit setting forth, in detail, the specific efforts you have made to locate the birth parent.

The form of the notice is set forth at sections 2503(b)(2) (see form 10A-4A on page 647) and 2504(c) of the Adoption Act.

10-2.8.2 Procedure at Final Hearing

a. Uncontested Matters

If the matter is uncontested, the adoptive parents must attend the hearing and be prepared to testif'y as to the facts set forth in their petitions. The adoptee must also be present.

If the adoption is based on a consent by the birth parent(s), you should elicit testimony from your clients with regard to the signing of the consent.

If the matter involves an involuntary termination, you must elicit testimony from your clients with regard to the grounds for termination as stated in the Adoption Act. Assuming that the birth parent(s) have not appeared, the court will rule upon the involuntary termination. Once the termination is granted, the court will proceed to the adoption matter. Follow the format of the adoption petition when questioning your clients.

At the conclusion of the hearing, which will take no more than 15 minutes if the matter is uncontested, the court will sign a decree of adoption. Upon finalization, you may proceed to Room 332 to secure a certified copy of the adoption decree. A charge of $30.00 by check or money order made payable to the Prothonotary is required.

b. Contested Hearing

If the birth parent or parents appear and indicate that shelhe/they wish to contest the termination, shelhe/they will be advised to obtain counsel and the matter will be continued to a date certain for a hearing on the termination. (At that point, counsel should begin a thorough review of the case law under the Adoption Act regarding terminations.)

628

10-2. 9 Kinship Mailers

If the matter is contested from the outset, counsel must be prepared to present all relevant testimony supporting the termination and adoption. Again, a thorough review of the case law is in order.

c. Counsel for Adoptee

Section 2313, as amended in 1982, sets forth the requirements and procedures concerning the appointment of an attorney for the child in an adoption proceeding. A child advocate is only appointed if the termination of parental rights is contested.

d. Counsel for Birth Parents

The birth parents are not usually represented in these proceedings unless they wish to contest the matter. If a birth parent does request counsel and is unable to pay for representation, and the court determines that substantial hardship would result, the court may appoint counsel for himlher/them. If a birth parent is under the age of 18 and helshe is unrepresented, the court may appoint a guardian ad litem under Local Rule 15.3 when tennination of rights is an issue.

e. Certification of Counsel Fees

Counsel must complete the statement of fees and costs that is attached to the petition for adoption. See form 10A-lO on page 673.

f. Obtaining Adoption Decree and Amended Birth Certificate

You can obtain a certified copy of the decree from the adoption branch, Room 332, on the day of the hearing, provided that the decree has been signed by the presiding judge. The cost of the decree is $30.00. Approximately 8-10 weeks after the decree is entered, a request should be made of the Vital Statistics Office of the state where the child was born for an amended birth certificate. Each state has its own fonns and charge. Check with the Bureau of Vital Statistics in the county where the child was born prior to mailing. The address of the Pennsylvania Bureau of Vital Statistics is Department of Vital Records, 101 South Mercer Street, P.O. Box 1528, New Castle, PA 16101.

10-2.9 Kinship Matters

These are adoptions of an individual-child or adult-by a relative. See the definition in 23 Pa.C.S. § 2531(c). Most commonly, these cases arise when a birth parent remarries and wishes to terminate the parental rights of the other birth parent in order that the new spouse may adopt. In this case, the remarried birth parent and the stepparent must join in t~e petition for adoption as co-petitioners.

--------'-

Of course, as in any adoption matter, the other birth parent's rights must be tenninated by one of the methods discussed, Le., voluntary relinquishment, consent, or involuntary termination. If the adoptee is over the age of 12, hislher consent must also be attached to the petition. (See form 10A-12 on page 677.)

In kinship matters, if the birth parent consents, the only document to be filed is the petition for adoption. If there is no consent, a petition for involuntary tennination must be filed with the petition for adoption.

A home study is not required in kinship matters. Rather, a court offIce interview is conducted by the social worker at the adoption branch. In addition, the clients/petitioners are required to complete a questionnaire regarding their reasons for pursuing adoption.

629

10 Procedures and Practices for Adoption in Philadelphia

The notice requirements for the hearing are the same as set forth above. Where a consent has been filed, notice is sent by the court to the consenting parent(s) requesting confirmation that helshelthey signed the consent(s). The hearing will proceed as above, and the decree and amended birth certificate are obtained in the same manner.

10-2.10 Second-Parent Adoption

The Pennsylvania Supreme Court recently decided that second-parent adoption is permitted under the Adoption Act. In the case of In re Adoption of R.B.F. and R.C.F., 803 A.2d 1195 (Pa. 2002), the court held that nothing in the Adoption Act prohibits a partner in a same-sex relationship from adopting the biological or adopted child of his or her partner. In Philadelphia, petitions for second-parent adoption are treated as kinship matters.

10-2.11 Gestational Carrier

A gestational carrier arrangement is one in which a woman serves as the gestational carrier for a married couple who are the biological parents of a child conceived through in vitro fertilization. Couples typically pursue this procedure if the biological mother is unable to carry and deliver a child of her own.

The adoption branch, in conjunction with the Pennsylvania Department of Health, has effectuated a procedure to ensure the issuance of a birth certificate that reflects the correct parentage on the child's birth certificate. The gestational carrier is not biologically related to the child, hence, her ·name should not appear on the birth certificate.

The gestational carrier case procedure involves the filing of a petition and the issuance of a decree ordering that the appropriate parentage be placed on the birth certificate. (See the sample decree on form IOA-13, page 678).

630

Appendix 10A Forms1

10A-1 Consent to Adoption by Natural Mother 633 10A-2 Consent to Adoption by Birth Father or Putative Father 634

Petition to Confirm Consent 10A-3A Order 635 10A-3B Decree 636 10A-3C Petition 637 10A-3D Verification 639 10A-3E Consent of Birth Mother 640

10A-3F Consent of Birth Father or Putative Father 642 10A-3G Statement by Parent 644 10A-3H Consent to Accept Custody 645 10A-31 Verification 646

-------------------- -----

Involuntary Termination (Non-Agency Cases) 10A-4A Notice 647 10A-4B Order 648

10A-4C Petition 649

1. [Editor's note: All forms listed in this appendix are included for reference only-users should obtain original forms from the appropriate source.]

631

Appendix 10A Forms

10A-4D Verification 651

10A-4E Decree 652

10A-5 Report of Intention to Adopt 653

10A-6 Petition for Adoption 656 10A-7 Adoption Decree 663 10A-8 Request for Criminal Record Check 664

10A-9 Pennsylvania Child Abuse History Clearance 665 10A-10 Statement of Fees and Costs 673 10A-11 Questions for Kinship Adoption Interview 675 10A-12 Consent of Adoptee over the Age of 12 677 10A-13 Consent of Spouse to Adoption 678 10A-14 Petition to Proceed in Forma Pauperis 679 10A-15 Petitioner's Certification 682 10A-16 Gestational Carrier Decree 684 10A-17 Adoption Branch Filing Fees 685

632

CONSENT OF BffiTH MOTHER

I, , am an adult, having been born on ____ -:-: __ ' I am single/married, and I am the mother/father of __________ , who was born on , at Hospital, The mother/ father ofthe child/children is _________ _

I hereby voluntarily and unconditionally consent to the adoption of the above named child/children,

I understand that hy signing this consent I indicate my intent to permanently give up all rights to said child/children.

I understand said child/children will be placed for adoption.

I understand I may revoke this consent to permanently give up all rights to this child/children by placing the revocation in writing and serving it upon the agency or adult to whom the child/children was relinquished.

If I am the birth mother of the child, I understand that this consent to an adoption is irrevocable unless I revoke it within 30 days after executing it by delivering a written revocation to [insert the name and address of the agency coordinating the adoption or insert the name and address of an attorney who represents the individual relinquishing parental rights or prospective adoptive parent of the child or insert the court of the county in which the vol· untar), relinquishment form was or will be filed].

I have read and understand the above and I am signing it as a free and voluntary act.

Biological parent Date

Home address

Date Location where document was executed (address)

Signature Signature

Address Address

Relationship Relationship

Form 10A-1 633

CONSENT OF BffiTH FATHER OR PUTATIVE FATHER

I, , am an adult, having been born on ____ _

I am single/married, and I am the mother/father of _________ , who was born on at Hospital.

The mother/father of the child/children is _______________ _

I hereby voluntarily and unconditionally consent to the adoption of the above named child/children.

I understand that by signing this consent, I indicate my intent to permanently give up all rights to said child/children.


I understand I may revoke this consent to permanently give up all rights to this child/children by placing the revocation in writing and serving it upon the agency or adult to whom the child/children was relinquished. .

If I am the birth father or putative father of the child, I understand that this consent to an adoption is irrevocable unless I revoke it within 30 days after either the birth of the child or my execution of the consent, whichever occurs later, by delivering a written revocation to ------------c----,----:---:--,-------c---[insert the name and address of the agency coordinating the adoption or insert the name and address of an attorney who represents the individual relinquishing parental rights or prospective adoptive parent of the child or insert the court of the county in which the vol· untary relinquishment form was or will be filed].



Home address


WITNESS: WITNESS:

Signature Signature

Address Address


634 Form 10A-2

Attorney's Name: Attorney's Address:

Attorney's Telephone Number: Attorney's Identification Number:

INRE:

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY FAMILY COURT DIVISION

ADOPTION BRANCH

_______ TERM, 20

ADOPTION OF: NO. ______________ _

ORDER

AND NOW, this day of ________________ , 20_, it is

ORDERED and DECREED that the within Petition be heard on the _______ day of

_________ , 20_, at ___ o'clock, in Courtroom ____ , 1801 Vine Street,

Philadelphia, Pennsylvania.

BY THE COURT

J.

Form 10A-3A 635



INRE:

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY FAMILY COURT DMSION

ADOPTION BRANCH

_______ TERM, 20

ADOPTION OF: NO. _______ __

DECREE

AND NOW, this _______ day of ________ , 20_, upon hear-

ing of the within Petition, and upon motion of ______________ , Attor-

ney for the Petitioner, it appears that there is no legal objection to the granting of the

prayer ofthe said Petition, it is ORDERED AND DECREED:

1. That all parental rights and duties of ____________ , the

parent of ______________ , are hereby terminated.

2. That the custody of _______________ is hereby trans-

ferredto _______________ _

3. That ______________ shall from the date of this Decree

have full authority to give consent to the adoption of with-

out the consent of, or notification to _____________ __

BY THE COURT

J.

636 Form 10A-3B




ADOPTION BRANCH

PETITION TO CONFIRM CONSENT

TO THE HONORABLE JUDGES OF THE SAID COURT:

1. The adoptee, __________ , who was born on ______ , in

________ , was placed by ______________ (intennediary)

on with and has been continuously in their custody since that time.

2. The natural mother of the adoptee is ______________ .

3. The natural mother was born on _________ , in _____ _

4. The natural mother's last known address is ___________ _

5. The natural mother is ofthe _______ race and _____ religion.

6. The natural mother was married/unmarried at the time of the birth of the

adoptee.

7. The natural mother executed a Consent to Adoption in accordance with Sec-

tion 2711 of the Adoption Act on . The original Consent is attached

hereto and marked as Exhibit "A".

8. The circumstances surrounding the signing of the attached Consent are .. a,s ... _____ ~ ._- -_._- ._.. •... . ..-.---.. --.. ~.-

follows:

9. The natural/putative father of the adoptee is __________ _

10. The natural/putative father was born on in

Form 10A-3C 637

Appendix 10A Forms

11. The natural/putative father's last known address is _________ _

12. The naturaVputative father is of the ______ race and ___ religion.

13. The natural/putative father was married/unmarried at the time of the birth

of the adoptee.

14. The natural/putative father did/did not execute a Consent to Adoption. If

naturaVputative father did consent, it is attached hereto and marked as Exhibit "A-I".

15. If naturaVputative father's identity has not been revealed, an affidavit exe

cuted by the natural mother regarding why his identity has not been revealed is attached

hereto and marked as Exhibit "B".

16. A "no claim of paternity" statement is attached and marked hereto as

Exhibit "C".

17. Statement of Parent form executed by natural parent(s) is attached hereto

and marked as Exhibit "D".

18. A period in excess of thirty (30) days subsequent to the execution of the Con

sent has expired and the natural parent has failed to proceed with a Petition for Volun

tary Relinquishment.

19. The Report of Intention to Adopt was filed on __________ _

20. The Report of Intermediary was filed on ____________ _

21. Consent to Accept Custody executed by adopting parents is attached hereto

and marked as Exhibit "E".

WHEREFORE, your Petitioner requests this Honorable Court to hold a hearing to confirm the intention of the natural parent to voluntarily relinquish hislher parental rights and duties to as evidenced by the Consent to the adoption and to grant a Decree of Termination of parental rights and duties.

BY:

Intermediary

638

VERIFICATION

-:-: __ :-----:-__ :-_---, ____ .,----_:---_-,- hereby verifies that helshe is the Petitioner herein and as such verifies that the information contained in the within Petition is true and correct to the best ofhislher knowledge, information, and belief. This verification is made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.

(Petitioner)

(Petitioner)

Form 10A-3D 639

CONSENT OF BIRTH MOTHER

I, ____________ , am an adult, having been born on _____ _

I am single/married, and I am the mother/father of __________ _

who was born on at ____________ Hospital.

The mother/father of the child/children is ______________ _

I hereby voluntarily and unconditionally consent to the adoption of the above

named child/children.

I understand that by signing this consent, I indicate my intent to permanently

give up all rights to said child/children.


I understand I may revoke this consent to permanently give up all rights to this

child/children by placing the revocation in writing and serving it upon the agency or

adult to whom the child/childr,m was relinquished.

If I am the birth mother of the child, I understand that this consent to an adop

tion is irrevocable unless I revoke it within 30 days after executing it by delivering a

written revocation to __________________________ _

{insert the name and address of the agency coordinating the adoption or insert the name

and address of an attorney who represents the individual relinquishing parental rights or

prospective adoptive parent of the child or insert the court of the county in which the vol

untary relinquishment form was or will be filed]

640 Form 10A-3E

Form 10A-3E



Home address


WITNESS: WITNESS:

Signature Signature

Address Address


.. -------_._----- ... _ .... -_ ... -._----_._---_ .. --- ---- ._-----------_._---

641

CONSENT OF BIRTH FATHER OR PUTATIVE FATHER

I, _________________ , am an adult, having been born on

I am single/married, and I am the mother/father of _________ _

who was born on ________ at ____________ Hospital.

The mother/father of the child/children is ______________ _

I hereby voluntarily and unconditionally consent to the adoption of the above

named child/children.

I understand that by signing this consent, I indicate my intent to permanently

give up all rights to said child/children.


I understand I may revoke this consent to permanently give up all rights to this

child/children by placing the revocation in writing and serving it upon the agency or

adult to whom the child/children was relinquished.

If! am the birth father or putative father of the child, I understand that this

consent to an adoption is irrevocable unless I revoke it within 30 days after either the

birth of the child or my execution ofthe consent, whichever occurs later, by delivering a

written revocation to __________________________ _

[insert the name and address of the agency coordinating the adoption or insert the name

and address of an attorney who represents the individual relinquishing parental rights or

prospective adoptive parent of the child or insert the court of the county in which the vol

untary relinquishment form was or will be filed}

642 Form 10A-3F

Form 10A-3F



Home address


WITNESS: WITNESS:

Signature Signature

Address Address


--- _._-----_._---

643

COURT OF COMMON PLEAS OF PHILADELPHIA FAMILY COURT DIVISION

ADOPTION BRANCH

STATEMENT BY PARENT

I, ________________ , voluntarily relinquished my parental

rights to my child, ____________ on ____________ _

If, in the future, my biological child desires to contact me, (please check only one):

____ I do wish to be contacted by my biological child through the auspices of

the Court after he/she reaches 18 years of age.

____ I do not wish to be contacted by my biological child through the aus

pices of the Court after he/she reaches 18 years of age.

Signature: __________ _

Address: __________ ___

Telephone: __________ _

Witness: ___________ _

NOTE: By my signature below, I state the following:

• This form has been explained to me;

• If I do wish to be contacted in the future, I understand it is Illy responsibility to notify the Adoption Branch of Family Court at 1801 Vine Street, Philadelphia, Pennsylvania, 19103 annually of my current address; and

• I have received a copy of this completed form.

Signature: __________ _

644 Form 10A-3G



INRE:


ADOPTION BRANCH

______ TERM,20

ADOPTION OF: NO, __________ _

CONSENT TO ACCEPT CUSTODY

TO THE HONORABLE, THE JUDGES OF THE SAID COURT:

and __________________________ " nee

_____________________ , being duly sworn according to law, depose and say:

1. That your deponents are husband and wife and reside at ________ _

___________________ , where they have resided continuously since

2, That on ____________________ , they received custody of _____________ ,from ___________________ _

3, That they consent to accept custody of the said child, ___________ '

Petitioner

------_._-_.-._--- •.•.. __ ._-- .... -------_ .... --.

Form 10A·3H 645

VERIFICATION

__________________ hereby verifies that helshe is the Petitioner herein and as such verifies that the information contained in the within Petition is true and correct to the best ofhislher knowledge, information, and belief. This verification is made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.

(Petitioner)

(Petitioner)

646 Form 10A-31

By: Attorney No.: Attorney Address:

Telephone No.:

INRE:

PETITION OF:

Notice

A Petition has been fIled asking the Court to put an end to aU rights you have to your child ___ _

That hearing will be held in ______ _ ______ on_~----------at ______ a.m.lp.m.

IF YOU DO NOT APPEAR AT THIS HEARING, THE COURT MAY DECIDE THAT YOU ARE NOT INTERESTED IN RETAINING YOUR RIGHTS TO YOUR CHILDREN AND YOUR FAlLURE TO APPEAR MAY AFFECT THE COURT'S DECISION ON WHETHER TO END YOUR RIGHTS TO YOUR CHILD. YOU ARE WARNED THAT EVEN IF YOU FAlL TO APPEAR AT THE SCHEDULED HEARING, THE HEARING WILL GO ON WITHOUT YOU AND YOUR RIGHTS TO YOUR CHILD MAY BE ENDED BY THE COURT WITHOUT YOUR BEING PRESENT.

You have a right to be represented at the hearing by a lawyer. You should take this paper to your lawyer at once.lfyou do not have a lawyer or cannot afford one, go to or telephone the office set forth below to find out where you can get legal help.

Lawyer Referral & Information Service 1101 Market Street, 11th Floor

Philadelphia, PA 19107 Telephone: 215-238-6333

Attorney for Plaintiff

COURT OF COMMON PLEAS PHILADELPHIA COUNTY

FAMILY DIVISION

TERM,20

. NO.

INVOLUNTARY TERMINATION OF PARENTAL RIGHTS

TERMINACION INVOLUNTARIA DE DERECHOSPATERNALES

Aviso

Una peticion ha sida radicada pidiendole a Ia Corte que termine todoo los derechos que usted tiene con respecto a BU hijo(a), . La vista sera nevada a cabo en el _ ________ aIM _____ _

a.mip.m.

SI USTED NO COMPARECE A ESTA VISTA, LA CORTE PUEDE DECIDIR QUE USTED NO ESTA INTERESADO(A) EN MANTENER SUS DERECHOS CON SU HIJO(A) Y SU FALTA DE COMPARENCIA PUEDE AFECTAR LA DECISION DE LA CORTE EN TERMINAR LOS DERECHOS QUE USTED TIENE HACIA SU HIJO(A). USTED ESTA A VISADO(A) QUE AUNQUE USTED FALTEYNOVAYAALA VISTA,LA VISTASE CELEBRARA SIN SU PRESENCIA, Y LA CORTE PUEDETERMINARLOSDERECHOSQUE USTED TIENE CON RESPECTO A SU HIJO(A) AUNQUE USTED NO ESTE PRESENTE.

Dsted tiene el derecho de estar representado(n) en In vista atraves de un abogado. Si usted no tiene un abogado 0 no puede pagar por un abogado, Hame 0

vaya en persona a las oficina indicada abajo para 8veriguar donde usted puede recibir ayuda.

Referido de Abogados y Servicio de Informacion 1101 Market Street, 11th Floor

Filadelfia, PA 19107 TelCfono: 215-238-6333

Form 10A-4A 647



INRE:


ADOPTION BRANCH

______ TERM,20

ADOPTION OF: NO. ______________ __

ORDER

AND NOW, this ________ day of ___________ _

20_, it is ORDERED that the within Petition be heard on the _________ _

day of _____________ 20_, at _________ o'clock in Room

_______ , 1801 Vine Street, Philadelphia, Pennsylvania.

BY THE COURT

J.

648 Form 10A-4B



INRE:


ADOPTION BRANCH

______ TERM, 20

ADOPTION OF: NO. _______ _

PETITION FOR INVOLUNTARY TERMINATION


The Petition of ____________________ respectfully

represents:

1. That the Petitioner is ________ ~ years of age, having been born on __________ ill _________ _

2. That the Petitioner resides at ______________ _

3. That the Petitioner's relationship to the adoptee is that of _____ _

4. That the Petitioner married __________________ , a co-

petitioner in the adoption proceedings, on ______________ in

5. That the adoptee is a minor, having been born on _________ in

7. That Petitioner and her husband have had custody of adoptee since __ _

8. That the natural/putativellegal father of the adoptee is ______ _

9. That the natural/putativellegal father is _____ years of age and was born on ___________ in _________ ___

Form 10A-4C 649

Appendix 10A Forms

10. That the naturallputativellegal father resides at __________ '

11. That the naturallputative/legal father has not seen or contacted the adoptee since

12. That the naturallputativellegal father has not contributed towards the support of

the adoptee since ________________ _

13. That the naturallputative/legal father, by his conduct, has for a period in excess of

six (6) months, clearly indicated a settled purpose of relinquishing parental claim to

the adoptee. He has refused and failed to perform any parental duties whatsoever.

WHEREFORE, Petitioner prays your Honorable Court to terminate all rights and

duties of as parent to and

that custody of the said adoptee shall remain with Petitioner.

BY:

Petitioners

Attorney

650

VERIFICATION

____________ hereby verifies that he/she is the Petitioner

herein and as such verifies that the information contained in the within Petition is true

and correct to the best of his/her knowledge, information, and belief. This verification is

made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsification

to authorities.

Petitioner

Petitioner

Form 10A-4D 651



INRE:


ADOPTION BRANCH

______ TERM, 20

ADOPTION OF: NO. ______________ __

DECREE

AND NOW, this _______ day of __________ , 20_, upon

consideration of the within petition and hearing held thereon, it is hereby ORDERED

and DECREED:

1. The parental rights of _______________ are hereby

terminated.

2. The Petitioners are awarded custody of _________ <

BY THE COURT

J.

652 Form 10A-4E




ADOPTION BRANCH

INRE: ______ TERM, 20

ADOPTION OF: NO. _____________ __

REPORT OF INTENTION TO ADOPT


1. The names(s) and addresses) of the person or persons making this report:

Name: ________ ~------- Name:

Address: Address:

2. When a person receives or retains custody or physical care of a child from an agency, the report shall set forth the name and address of the agency and the circumstances surrounding such person receiving or retaining custody of physical care of the child.

------3,---State-the-eircumstances-that-surrounded-thepersons-making-this-report--receiv·------------ ------ing physical custody of the adoptee.

Form 1OA-5 653

Appendix 10A Forms

4. Facts as to the child are:

Name:

Sex:

Age:

Racial Background:

Religious Affiliation:

Date and Place of Birth:

5. Facts as to the intermediary are:

Name:

Address:

IIWE ACKNOWLEDGE THAT IIWE HAVE BEEN ADVISED OR KNOW AND UNDERSTAND THAT THE BIRTH FATHER OR PUTATIVE FATHER MAY REVOKE THE CONSENT TO THE ADOPTION OF THIS CHILD WITHIN 30 DAYS AFTER THE LATER OF THE BIRTH OF THE CHILD OR THE DATE HE HAS EXECUTED THE CONSENT TO AN ADOPTION AND THAT THE BIRTH MOTHER MAY REVOKE THE CONSENT TO AN ADOPTION OF THIS CHILD WITHIN 30 DAYS AFTER THE DATE SHE HAS EXECUTED THE CONSENT.

Signature

Signature

654

Form IDA-5

VERIFICATION

_~_-:-_-:-__ -:-_=_-:-_-:--:--:-_ hereby verifies that he/she is the Petitioner herein and as such verifies that the information contained in the within Petition is true and correct to the best ofhislher knowledge, information, and belief. This verification is made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities.

(Petitioner)

(Petitioner)

... _.------_._---_ .. _-----_.-- -----

655




ADOPTION BRANCH

INRE: ______ TERM, 20

ADOPTION OF: NO, _________ __

PETITION FOR ADOPTION


The Petition of and ______________________________ ,nee ___________________________ , under

Section 2701 of the Adoption Act of 1981 as amended, respectfully represents:

1. Petitioner(s) are adult individuals and presently reside at __________ __

_____________________ and for the past five years have resided at the following

addresses during the periods specified:

2, Petitioners are (not) husband and wife, having been lawfully joined in

marriage on the _____________________ day of ___________________ 20_, in

_____________________________________ , A true and correct copy of their mar

riage certificate is attached hereto and made part hereof, and marked Exhibit "A",

3, If either Petitioner was previously married, explain how marriage was ter-

minated, A certified copy of divorce decree is attached hereto and marked Exhibit "B",

656 Form 10A-6

Form 10A-6

4. The facts as to __________________ , the male peti-

tioner, are as follows:

5.

A. Date and place of birth:

B. Racial background and religious affiliation:

C. Occupation:

D. Relationship to Adoptee by blood or marriage:

E. Names and ages of children of male petitioner. State if natural or

adopted:

The facts as to ___________________ , the female

petitioner, are as follows:


B. Racial background and religious affiliation:

C. Occupation:

D. Relationship to Adoptee by blood or marriage:

657

Appendix 10A Forms

E. Names and ages of children of female petitioner. State if natural or

adopted:

6. The Report of Intention to Adopt has been filed on _____ ~

___________ 20_. (If not required, state reason.)

7. The Report of Intermediary was filed on

20_. The name and address of the Intermediary is:

(If not required, state reason.)

8. The Criminal History Record and Application for Child Abuse History

have been obtained and are attached hereto and marked Exhibit "C".

9. Facts as to the Adoptee:


B. The Adoptee has resided with the Petitioners since:

C. Religious affiliation and race:

D. Birth certificate is attached hereto, marked Exhibit "D".

658

Form 10A-6

E. No birth certificate can be obtained at time of filing of this Petition

because:

F. Relationship of each Petitioner to Adoptee is:

G. Describe fully and state value of all property belonging to the

Adoptee:

10. Facts as to the natural parent(s) of Adoptee. (Required where there is no

Report of Intermediary.)

A. Natural Mother:

(1) Name:

(2) Birth date and birthplace:

(3) Residence or, if unknown, last known address:

(4) Racial background:

---~~--.•.. ~~--.----.~~.~.~ ..... --.~ .~~ .. ---~-~~~-.~.~--.- ... ~.-.-.---.... ~-... ~~-.~.--- .~ .. ~ .•......• --~-~~~ ... ~~'.'~"--~--~

(5) Religious affiliation:

(6) Living or deceased:

(7) Marital status at time of birth of child:

659

Appendix 10A Forms

(8) Marital status during one year prior to the birth of child:

B. NaturallPutativelLegal Father:

(1) Name:

(2) Birth date and birthplace:

(3) Residence or, if unknown, last known address:

(4) Racial background:

(5) Religious affiliation:

(6) Living or deceased:

(7) Marital status at time of birth of child:

(8) Marital status during one year prior to the birth of child:

11. Identify proceedings in which any Decree of Termination of Parental

Rights with respect to the Adoptee has been entered:

660

Form 10A-IJ

12. No provision of any act regulating the importation of dependent, delin-

quent or defective children has been violated with respect to the placing of the Adoptee.

13. Petitioners desire to change the name of the Adoptee, _______ _ ______________ w ______________________ _

14. All consents required by Section 2711 of the Act are attached as Exhibits

or are not required for the reasons set forth below:

15. The consent of the natural parent(s) of the Adoptee is attached to this peti-

tion or waS attached to the Intermediary Report. Also attached is a copy of the natural

parent(s) social security card and driver's license marked Exhibit "En. If this has not

been done, the reasons are set forth below:

16. All notice requirements under Section 2721 of the Act have been satisfied,

and, if not, the reasons for same are set forth below:

17. It is the desire of the Petitioner(s) that the relationship of parent and child

be established between himlher/them and the Adoptee.

Petitioners

Petitioners

661

Appendix lOA Forms

VERIFICATION

________________ hereby verifies that he/she is the Petitioner

herein and as such verifies that the information contained in the within Petition is true

and correct to the best of hislher knowledge, information, and belief. This verification is

made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to

authorities.

Petitioners

Petitioners

662

Commonwealth of Pennsylvania

First Judicial District of Pennsylvania In the Court of Common Pleas

Philadelphia County

FAMILY DIVISION

IN RE ADOPTION OF: TERM,20

NO.

DECREE OF ADOPTION

AND NOW, to wit, this _______ day of _________ , A.D.,

~ upon consideration of the Petition of , and

nee his

wife, for the adoption of _____________________ , a

minons), and after hearing held thereon by the Court on __________ _

at which time the said minor was present, together with Petitioners, the Court finds that

the statements made in the Petition are true, and that the welfare of the child proposed

to be adopted will be promoted by such adoption.

All requirements of the Acts of Assembly have been fulfilled and complied with. -----------.~~ .. ------

-----·-----··-----It is ORDEREti-;;;;X DECREED tr;;'tth'; said adoptee shall have all the legal

rights of a child and heir of the said Petitioners.

It is further DECREED that the said ________ shail hereafter be

knownbythenameof ______________ ___

BY THE COURT:

Form 10A-7 663

SP 4·164 (12·!l9) FOR CENTRAL REPOSITORY USE ONLY PENNSYLVANIA STATE POLICE (LEAVE BLANK)

REQUEST FOR CRIMINAL RECORD CHECK

PART I: TO BE COMPLETED BY REQUESTER o , DATE OF REQUEST

(INFORMAoil?>f:I.WIL~: ~E M.AILED TOoREQU~~rE~ ONL YJ ...

"' TYPE OR PRINT LEGIBLY WITH INK "' NOTE: If THIS FORI-A IS NOT LEGISLE OR NOT PRO PERL Y COMPLETED. IT WILL BE RETtJRNEo UNPROCESSED TO THE

REauesTER. A RESPONSE MAY TAKE THREE WEEKS OR LONGER TO PROCESS.

WARNING: A PERSON COMMITS A MISDEMEANOR OF THE THIRD DEGREE IF HEISHE MAKES A WRITIEN FALSE STATEMENT. WHICH HE/SHE DOES NOT BeLIEVE TO ae TRUE.

REQUESTER NAME

ADDReSS

CITYj STATE ZIP

i

CONTACT TELEPHONE NUMBER (INCLUDING AREA CODE)

I I I - I I I I -I I I I I ReQUESTER IOENTIFlCATION (ONI Y CHECK ONE BlOCK)

0 INDIVIDUALINONCRIMINAL JUSTICE AGENCY - ENCLOSE A CERTIfIEO CHECKfMONEY ORDER IN lliE AMOUNT OF $10.00 PAYABLE TO "GOMMO!WrfAllliOf PfNNSYI VANIA ~ THE FEE IS NONREFUNDABLE.

0 FEE EXEMPT NONCRIMINAL JUSTICE AGENCY '" DO NOT SENO CASH OR PERSONAL CHECK "'

NAME/SUBJECT OF RECORD CHECK (LAST)

I (FIRST) (MIDDLE)

MAIDEN NAME AND/OR ALlASES

I SOCIAL SECURITY NUMBER (SOC) DATE OF BIRTH (OOB) SEX

I RACE

REASON FOR REQUEST (CHECK ONE BLOCK}

o o o

EMPLOYMENT (IF APPLICABLE, CHECK ONE OF THE FOLLOWING)

ADOPT10NIFOSTER CARE

o ELDERGARE o CHILD CARE o SCHOOL DISTRICT

OTHER (SPECIFY)

ONLY CHECK THIS BLOCK IF YOU WANT TO REVIEW YDtlR ENTiBE CR!MINAL HISTORY

o INDIVIDUAl ACCESS AND RCVIEW OR FIREARMS CHALLENGE_ENTIRE CRIMINAL HISTORY (AVAILABLE ONLY TO SUBJECT OF RECORD CHECK OR lEGAL REPRESENTATIVE WITH LEGAL AFFIDAVIT OF LEGAL REPRESENTATIVE ATIACHED)

REQUESTER CHECKLIST AFTER COMPLETION MAIL TO

DID YOU ENTER THE FULL NAME, OOB, AND SOC? PENNSYLVANIA STATE POLICE D!D YOU ENCLOSE THE $10.00 FEE (CERTIF!ED CHECKIMONEY ORDER)? CENTRALREPOSrrORY-1~

,~ DO NOT SEND CASH OR PERSONAL CHECK '" 1800 ELMERTON AVENUE HARRISBURG, PA 17110-9758

DID YOU ENTER YOUR COMPLETE ADDRESS INCLUDING ZIP CODE AND 717-783-9973 TELEPHONE NUMBER IN THE BLOCKS PROVIDED? BUSINESS HOURS 8:15 am - 4:15 pm (Monday-Fritlay}

PART II; CENTRAL REPOSITORY RESPONSE ONLY .. . ·"'DO NOT WRITE BELOW THIS LlNEm

INfORMATION DISSEM!NATED INOUIRY DISSEMINATED BY I SID NUMBER

o NO RECORD o CRIMINAL RECORD ATTACHED

THE INfORMATION DISSEWNATED BY THE CENTRAL REPOSITORY IS BASED ON THE CERTIFIED BY FOLLOWING IDENTIFIERS THAT MATCH mOSE fURNISHED BY ll-IE REaUESTER

0 NAME 0 SOCIAL SECURITY NUMBER

0 DATE OF BIRTH 0 RACE

0 SEX 0 MAIDEN/ALIAS NAME (DIRECTOR. CENTRAL REPOSITORY)

This response is based on ao·companson of d~ta provided by the requester in Part°, against the' information contained in the files of t.he pe'nnsyl~ania State .Polic~· Central Repository only, and da:es not preclude the existence of criminal records which might be c.ontained In t~e ·reposito~~s·of other I~cal. s~te"or federal criminal justlce agencies. . .

664 Form 10A-8

PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE COMPLETE SECTION I ONLY. PRINT CLEARLY IN INK. ENCLOSE $10.00 MONEY ORDER CHILDLINE USE ONLY

ONLY. PAYABLE TO DEPARTMENT OF PUBLIC WELFARE. DO NOT SEND CASH OR DATE RECENEO BY CHILDLINE

PERSONAL CHECK. SEND TO CHILOllNE AND ABUSE REGISTRY, DEPARTMENT OF PUBLIC WELFARE, P.O. BOX 8170 HARRISBURG, PA 17105-8170

APPLICATIONS THAT ARE INCOMPLETE, ILLEGIBLE OR RECEIVED WITHOUT FEE WILL BE RETURNED UNPROCESSED. IF YOU HAVE QUESTIONS CALL 717·783~6211

",' "V". IN THIS SPACE PRINT APPLICANTS FUll NM1E AND ADDRESS (DO NOT USE lNITLAlS)

NAME r I SOC~SECURITYNUMBER

STREET AGE DATE OF BIRTH I DAYTIME PHONE NO.

CITY,STATE SEX COUNTY YOU LIVE IN ZIP CODE

L OM OF

-.l

PREVIOUS NAMES USED SINCE 1975 (Include Maiden Name, Nicknames, Aliases) ...

1 , . lAST) \' , . lAST) \ 3 (FIRST. MIDDLE, LAST)

Pit 'OF '.(Check ONE block ONLy)

. U CHILD CARE o VOLUNTEERS-A copy of your PROCESSED "Request o ewEP (Community Wolk Experience Program

o FOSTER CARE for Criminal Record~ (Form SP4-164) must be Participanl)

o ADOPTION attached. Out-of-state residents must also attach a copy of their PROCESSED FBI clearance (Form o SCHOOL FO-2S8). SIGNA lURE OF CAO REP CAOPHONENO

; .SINCE1975 (Attach; I pages if,

3.

HOUSEHOLD MEMBERS (Ust eve'Yooe who lived with you ; lIti., ~ since 1975 to the present).

NAME (First, Middle. Last) 00 not use initials. RELATIONSHIP I PR~~~NT SEX

11. I,. 13. 14.

:r~:rt~~dt~~~::t ~~~~ ~~~~;;;~~'I~~ , and , to the best of my , and belief and i as 14904 of the Pennsylvania Crimes Code).

are required to show th~ .

ct;'d Ad!"lnist,.,,,,, are o~~ ~~~.~ ~~~~:~~\; "'~te;~-~f ~~'O<Y reco1 ma~ ~ ""1$011 .. .

, action. APPUCANrS SIGNATURE OA1<

~ DO NOT WRITE IN THIS ",," nON" , USE ONLY

RESULTS OF nt~ t UI<" CHECK

o APPLICANT IS NOT LlSTEO IN A REPORT OF CHILD ABUSE 0 APPLICANT IS LISTED IN A REPORT OF CHILD ABUSE ORA OR A REPORT FOR SCHOOL EMPLOYEE. REPORT FOR SCHOOL EMPLOYEE (SEE BELOW).

STATUS OF r<trVf< , DATE OF .".~' vd()F DATE OF " I'· I' I'· I'

VERIFIER DATE VERIFIER'S SUPERVISOR DATE

O,,'OC t..:'!' 113. 1;Y9~

Form 10A-9 665

DO NOT WRITE IN THIS SECTION - CHILDLINE USE ONLY

,..,---::-_____ -:--:-::--,--::--:--:-__ -, has requested a certification which includes a clearance of his/her name against the child abuse, school employee, and criminal history reports.

The results of the child abuse and school employee report clearances are listed in Section II on the reverse side. The results of the criminal history reports are listed below. Out-of-state residents must have criminal history clearance from both the Pennsylvania State Police and the FBI. The voluntary certification may be obtained every two years.

It is the responsibility of parents and guardians to review this information to determine the suitability of the applicant as a sUbstitute caregiver.

D Applicant is named as the perpetrator of a "Founded" child abuse or school employee report which occurred in the last five years.

D Applicant is named as the perpetrator of a "Founded" child abuse or school employee report which occurred over five years ago.

D Applicant is named as the perpetrator of an "Indicated" child abuse or school employee report.

D Applicant is not named as the perpetrator of any child abuse or school employee report contained in the Statewide Central Register.

D Record exists and contains convictions which prohibit hire in a child care position. Report attached.

D Record exists, but convictions do not prohibit hire in a child care position. Report attached.

D Record exists, but no convictions are shown. This does not prohibit hire in a child care position. Report attached.

D No record exists. Report attached.

D Record exists and contains convictions which prohibit hire in a child care position. Report attached.

D Record exists, but convictions do not prohibit hire in a child care position. Report attached.

D Record exists, but no convictions are shown. This may not prohibit hire in a child care position. Report attached.

D No record exists. Report attached.

D No FBI clearance required.

VERIFIER DATE VERIFIER'S SUPERVISOR

666

DATE

Form 10A-9

INSTRUCTIONS FOR THE COMPLETION OF THE PENNSYLVANIA CHILD ABUSE HISTORY CLEARANCE

The Child Protective Services Law requires that the child abuse history of applicants to child care programs be verified within 80 days from the date of hire. The clearance is also required for persons wishing to be foster or adoptive parents. In addition, individuals may request voluntary certification which indicates the status of child abuse history and criminal history.

To request the clearance, the applicant must complete, in ink, Section I only of the attached "Pennsylvania Child Abuse History Clearance" and submit it to the Department of Public Welfare with a $10.00 check or money order. Cash will not be accepted. Incomplete or illegible applications will be returned unprocessed.

Another fonn must be completed for Criminal History Clearance through the Pennsylvania State Police. Out-ofstate residents must also obtain clearance through the FBI files. You may write or call ChildLine (717-783-6211) for all of the necessary fonus.

Please refer to the information below when completing the application or when reviewing the Departments's response. Please tYPe or print except where signature is required. The completed clearance is valid for one year for employment, adoption, foster care, or CWEP purposes. A Voluntary Certification is valid for two years.

SEcTION 1:-APPU6ANTSiDENTIFICATlON(To be oompleied by applicant)

Check one box which best describes the reason for requesting the clearance:

• EMPLOYMENT - Check block #l if you need the clearance as a candidate for child care program employment/operation. -

• ADOPTION - Check block #2 if you need the clearance for purposes of adopting a child who is a nonrelative_ The clearance is not required if you are adopting a child who is already related to you by birth or m.arriage.

• FOSTER CARE - Check block #3 if you need the clearance in order to be approved as a foster parent_

• VOLUNTARY - Check block #4 if you need a voluntary clearance as a participant in a service such as a Big BrothersIBig Sisters program_ You must include a copy of the "Request For Criminal History Record information" obtained from the Pennsylvania State Police_ Out-of-state residents must also include a copy of their FBI clearance_

• CWEP - Check block #5 if you are a Community Work Experience Program participant who will be assigned to a child care program. An official of your County Assistaitce Office must sign the application_ No fee is required_

RETURN ADDRESS BLOCK

-------- ·-·-·"---~-.·--·----------Pffiit·YQUrlU1ne-grunameTnrst, mi"crdle, last; do not use initials) a..rlffyour entire current address_ yo~~---" ... --~-------- .. ---~---P.O_ Box No., Apt. No., and Zip Code must be included_

SOCIAL SECURITY NUMBER

• Enter your complete social security number. The disclosure of your Social Security Number is voluntarily sought to verify your identity pursuant to the authority of the Child Protective Services Law,11 P_S_ § 2214(i).

667

Appendix 10A Forms

AGE AND DATE OF BIRTH

• Enter your current age and exact date of birth.

SEX

Check the appropriate block.

COUNTY OF CURRENT RESIDENCE

• Enter the name of the county where you currently live.

LENGTH OF TIME AT CURRENT ADDRESS

• Enter the number of years and months you have resided at your current address.

DAYTIME TELEPHONE NO.

Enter the telephone number where you can be reached between 8:00 a.m. and 4:00 p.m. Include area code.

OTHER NAMES USED BY APPI.JCANT SINCE 1975

• Enter all other names you have used since 1975. Include maiden name, nicknames, and aJiases.

FORMER ADDRESSES

• List all fonner addresses where you lived or received mail since November 1975.

List the most recent address first. Do not include current address.

Include approximate dates you resided at each address.

• Use a second page if necessary.

MEMBERS OF APPLICANTS HOUSEHOLD

Enter the full name (no initials please), relationship to you, age, and sex of all persons who live with you at your current address or who have lived with you at any of your fonner addresses.

Use a second page if necessary.

APPLICANTS SIGNATURE AND DATE

• Read the sentence preceding the signature line.

• Sign and date the application. The application must contain your original signature; copies are unacceptable. Your application will be returned unprocessed if signed by anyone other than the applicant.

• Detach instructions and mail the completed application along with a $10.00 check or money order payable to the "Department of Public Welfare." Do not send cash. Mail to:

668

Department of Public Welfare P.O. Box 8170 Harrisburg, PA 17105-8170

Form IOA-9

SPECIAL NOTES

DUE TO THE NATURE AND CONFIDENTIAIJTY OF YOUR OIUGlNAL PENNSYLVANIA cmw ABUSE THE INFORMATION REQUESTED, cmw ABUSE mSTORYCLEARANCE WILL BE RETURNED TO YOU CLEARANCES MUST BE RETURNED DIRECTLY TO WITH AN OFFICIAL SIGNATURE IN SECTION II. THE APPLICANT. BEFORE MAILING YOUR HAVE A COPY OF THE CLEARANCE MADE AND APPLICATION TO THE DEPARTMENT OF PUBLIC GIVE THE COPY TO THE AGENCY TO RETAlN IN I'i'S WELFARE PLEASE MARE ONE COPY AND GIVE FILE. THE AGENCY MUST ALSO VIEW THE TO YOUR EMPLOYER IF YOU ARE BEING HIRED ORIGINAL BUT THE APPLICANT RETAINS THE ON A PROVISIONAL BASIS. OIUGINAL.

SECTION II ~ RESULTS OF mSTORY CHECK(To be compl~ted by ChildLine staffonlyl

The appropriate block will be checked by CbildLine staff stating whether the applicant's name is contained in the Statewide Central Register as a perpetrator of child abuse.

RIGHTS IDENTIFIED

• The status (Founded or indicated) and date of incident of all reports will he entered.

• Founded means that a court has determined that a child was abused.

• Indicated means that the Child Protective Services Agency has determined that a child was abused.

VEIUFIER'S SIGNATURE AND DATE

• The Department employee who performed the history clearance will sign and date the fonn at the time of its completion.

SUPERVISOR'S SIGNATURE AND DATE

• When an applicant's name is located in the Statewide Central Register, a supervisor will confinn the information and sign the form.

SECTIONrn'- YOLUNTARYCERTlFICATlC)N (To be compl~ted by.ChiIdLine staff only)

The following section will be completed by Child Line Staff for those applicants who_request voluntary certification and have submitted a copy of the clearance(s) obtained from the Pennsylvania State Police and the FBI (out-of· state residents only.

Although child abuse and/or criminal convictions may prohibit hire into a child care position pursuant to the Child Protective Services Law (11 P.S. 2223.l(e». It is the decision of the current or guardian who reviews this

. infQrmationj;~:tdeJexmine_.w.hethecto_useJ.he_.ser:vices--OUhe_applicant. ~ .. -... ~-~.~~."~--.--~--~~~---------

VERIFIER'S SIGNATURE AND DATE

• The Department employee who perfo£D.led t.he history clearance will sign and date the form at the time of its completion.

SUPERVISOR'S SIGNATURE AND DATE

• When an applicant's name is located on either of the three applications, a supervisor will confirm the signature and sign the fonn.

669

Appendix 10A Forms

COMPLETE SECTION 1 ONLY. PRINT CLEARLY IN lNK ENCWSE $10.00 CIDLDL!NE USE ONLY MONEY ORDER ONLY. PAYABLE TO DEPARTMENT OF PUBUC WELFARE. DO NOT SEND CASH OR PERSONAL CHECK. DATE RECEfVED BY CHILDUNE

SEND TO CHILDLJNE AND ABUSE REGISTRY, DEPARTMENT OF PUBLIC WELFARE, P.O. BOX 8170 HARRISBURG, PA 17105-8170

APPLICATIONS THAT ARE INCOMPLETE, ILLEGIBLE OR RECEIVED WITHOUT FEE WILL BE RETURNED UNPROCESSED. IF YOU HAVE QUESTIONS CALL 717-783-6211

SECTION I APPLICANT IDENTIFICATION

IN TIllS SPACE PRINl' APPUCANr"S FULL NAME AND ADDRESS (DO NOT USE lNITlALS).

NAME , , SOCIAL SECURITY NUMBER

STREET AGE DATE OF BIRTH DAYTIME PHONE NO.

CITY,srATE ZIP CODE

SEX COUNTY YOU LIVE IN

OM OF , J

," PREVIOUS NAMES USED SINCE 1975 (fuclude Maiden Nam~, Nicknames, Aliases) ,

i. FIRsT; MIJ:)DLE, LAsT , ,', 2., FIRST, MiDDLE, LAST" 3. FIRsT, MIDDLE, LAST , .,' , " ,>." . ~', .

" " "

PURPOSE OF CLEARANCE (CheckONE block ONLY)

o ClillD CARE EMPLOYMENr 0 VOLUNTEERS- A copy of your 0 eWEP (Community Work Experience PROCESSED "Request for Criminal Program Participant)

o FOSTER CARE Record" (Form SP4·164) must be attached. Outrof-state residents must

o ADOPTION also attach a copy of their SIGNATURE OF CAO REP CAO PHONE NO.

PROCESSED FBI clearance (Form o SCHOOL EMPWYMENT FD-258)

'PREVIOUS'Al)DRESSES~INCE1975 (Attach additional pages ifnecessary)

1.

2.

3.

4.

670

Form 10A-9

l.

2.

3.

4.

5.

6.

. ~QVSEFiOLD :MEMBE~ (Li~t ~~eryone who lived with you at anytime sil:lce 1975 to the pre~ent)

NAME (First, Middle, Last) Do not use initials RELATIONSIDP PRESENT AGE

I certify that the above information is 8ttUrate and romplete to the best of my knowledge and belief and submitted as true and tol'TlX:t under penalty oflaw (Section ,,904 of the Pennsylvania Crimea Code).

SEX

Applicants arc required to show the Administrator the original document.. Administrntors are required to keeps copy ofthischild abuse history rewt'd on file. Any person altering the eontents of this documenlnmy be subject to civil, criminal or administrative action. APPLICANTS SIGNATURE DATE

DO NOT WRITE IN THIS SECTION CIDLDLINE USE ONLY

SECTIONn RESULTS OF HISTORY CHECK

o APPLJCANT IS NOT LISTED IN A REPORT OF CHILD 0 ABUSE OR A REPORT FOR SCnOOL EMPLOYEE.

APPLICANT IS USTED IN A REPORT OF CHILD ABUSE OR A REPORT FOR SCHOOL EMPLOYEE (SEE BELOW)

STATUS OF REPORT DATE OF INCIDENT STATUS OF REPORT DATE OF INCIDENT

1. 3.

2. 4.

VERIFIER DATE VERIFIER'S SUPERVISOR DATE

671

Appendix lOA FOI"ms

DO NOT WRITE IN THIS SECTION - CHILDLINE USE ONLY

SECTIONnI VOLUNTARY CERTIFICATION FOR CinLD CARE SERVICES

has requested a certification which includes a clearance ofhisJher name against the child abuse, school employee, and criminal history reports.

The results of the child abuse and school employee report clearances are listed in Section II on the reverse side. The resulls of the criminal history reports are listed below. Out·of-state residents must have criminal hifltory clearance from both the Pennsylvania State Police and the FBI. The voluntary certification may be obtained every two years.

It is the responsibility of parents and guardians to review this information to determine the suitability ofthe applicant as a substitute caregiver.

.. PENNsYLVANIA OHILD ARUSE HISTORY CLEARANCE

0 Applicant is named as the perpetrator of a "Founded" child abuse or school employee report which occurred in the last five years.

0 Applicant is named as the perpetrator ofa "'Founded" child abuse or school employee report which occurred over five years ago.

0 Applicant is named as the perpetrator of an '1ndicated~ child abuse or school employee report.

0 Applicant is not named as the perpetrator of any child abuse or school employee report contained in the Statewide Central Register .

... . : . PENNSYLVANIA STATE POLICE CLEARANCE ..

0 Record exists and contains convictions which prohibit bire in a child care position. Report attached.

0 Record exists, but convictions do not prohibit hire in Ii child care position. Report attached.

0 Record exists, but no convictions are shown. This does not prohibit hire in Ii child care position. Report attached.

0 No record exists. Report attached.

. . . FBI CLEARANCE

0 Record exists and contains convictions which prohibit bire in a child care position. Report attached.

0 Record exists, but convictions do not prohibit hire in a child care position. Report attached.

0 Record exists, but no convictions are shown. This may not prohibit hire in a child care position. Report attached.

0 No record exists. Report attached.

0 No FBI clearance required.

. VERIFIER DATE . VERIFIER'S SUPERVI~OR DATE

672




ADOPTION BRANCH

INRE: ______ TERM, 20

ADOPTION OF: NO. ______________ __

STATEMENT OF FEES AND COSTS

__________________ , ESQUIRE

Attorney's name

ATJ'ORNEY'S FEE:

Itemization of Costs

Total Fee and Costs

(Signature)I _______________ -==== ESQUIRE

(Signature)' __ ==========. :-:: ... :::: .. :::: .. :::c ........... _ ----~---~- . PETITIONER ..

(Signature) __ ===~=-___________ ~ PETITIONER

Form 10A-10 673

Appendix lOA Forms

VERIFICATION

________________ hereby verifies that helshe is the Peti

tioner herein and as such verifies that the information contained in the within Petition is

true and correct to the best of hislher knowledge, information, and belief. This verifica

tion is made subject to the penalties of 18 Pa.C.S. Section 4904 relating to unsworn falsi

fication to authorities.

PETITIONER

PETITIONER

674

FIRST JUDICIAL DISTRICT OF PENNSYLVANIA COURT OF COMMON PLEAS

Paul P. Panepinto Administrative Judge Family Division

Dear Petitioner,

FAMILY DMSION ADOPTION BRANCH 1801 VINE STREET

PHILADELPHIA, PA 19103

ANDREA HOFFMAN JELIN Director, Children and Youth Services

Chief Adoption Branch

Welcome to the wonderful world of adoption! The members of the Adoption Branch are here to serve you and to insure that the adoption process is a pleasant and meaningful experience.

The Court's primary consideration in granting a Petition for Adoption is to insure that the best interests of the adoptee are being served. Accordingly, the Presiding Adoption Judge has requested that you complete the attached questionnaire, which will be reviewed by her prior to .the finalization of the adoption. Kindly bring this completed questionnaire to your interview with the Court social worker.

Thank you for your kind cooperation.

Very truly yours,

Andrea Hoffman Jelin Director, Children and Youth Services

ANJ/raf

attch.

Form 10A-11 675

Appendix 10A Forms

Questions for Kinship Adoption Interview

• When did you come into this child's life?

• How did you come into this child's life?

• When did you first consider adopting this child?

• Why do you think this adoption would be in the best interest of the child?

• Did you observe any difference in the child's behavior, once you came into hislher

life?

• How long have you known the other petitioner?

• What is your relationship with the co-petitioner?

• How do you share responsibility in caring for the adoptee with the co-petitioner?

• What role do you play in the family unit?

• Are there any other children in your family?

• How will this adoption affect these children?

• Have you discussed adoption with them?

• How do you view the adoptee in relation to the other children?

• How do you discipline your child(ren)? Are you aware of alternatives?

• How will this adoption affect the adoptee?

• lfthe Court grants this petition, how will your life change?

• How will you explain adoption to the adoptee?

• How have you explained the relationship or lack ofrelationship with the biologi

cal parent?

• Where will you go to seek help if you or the adoptee need guidance regarding

adoption issues?

• How will you respond if the adoptee presents you with special needs?

• Do you freely discuss the meaning of adoption with the adoptee?

676

CONSENT OF ADOPTEE OVER THE AGE OF 12

I, , born , age __ , in ___ , hereby volun~

tarily and unconditionally consent to my adoption by _________ _

I understand by signing this Consent that I indicate my intent to be adopted by

I have read and understand the above and am signing it as a free and voluntary

act.

Form 10A-12 677

CONSENT OF SPOUSE TO ADOPTION

I, , of legal age, hereby voluntarily and uncondi-

tionally consent to the adoption by my wife, , of _______ _

(name of child), born _____ ~

I have read and understand the above and am signing it as a free and voluntary

act.

678 Form 10A-13

INRE:


ADOPTION BRANCH

_________ TERM, ___

ADOPTION OF: NO .. ____________ __

PETITION TO PROCEED IN FORMA PAUPERIS


The Petition of ________________________ and

___________________ respectfully states that:

1. Petitioner's Social Security number:

2. Petitioner's address

3. Petitioner's income and source are as follows:

(a) Monthly income:

(b) Source:

4. In addition to the Petitioner, the following are dependent on such income:

(a) Children:

(b) Others:

..... ____ ._._ ... .......... ____ 5:_ ..... lCe!itioner'".Uloll~l1Jy.~xp~nclitll:r:e,,: (a) Housing:

Utilities:

(b) Other:

6. Petitioner neither owns nor has equity in any assets.

o YES 0 NO

Form 10A-14 679

Appendix lOA Forms


ADOPTION BRANCH

INRE: _____ TERM, _

ADOPTION OF; NO.

AFFIDAVIT

____ ,--_---:-___ .,-_ and , being duly sworn according to law, hereby depose and say that Jiwe am/are the Petitioner(s) in the foregoing Petition to Proceed in Forma Pauperis and that the facts as set forth therein are true and correct to the best of my/our knowledge, information, and belief.

Sworn to and subscribed before me this ______ day of _______ , __ .

NOTARY PUBLIC

680

Form 10A-14

INRE:


ADOPTION BRANCH

_____ TERM, _

ADOPTION OF: NO. ____ _

ORDER

AND NOW, to wit, this ______ day of __________ , __ , it is

hereby ORDERED that __________________ may proceed in forma

pauperisonbehrufof _____________________ __

BY THE COURT,

Administrative Judge

681

IN THE COURT OF COMMON PLEAS OF PHILADELPHIA COUNTY

Petitioner FAMILY COURT DIVISION

v. _____ TERM,19_ No. ________ _

Respondent DR#.~~~~~~~ IN DIVORCE/SUPPORT/CUSTODY

PETITIONER'S CERTIFICATION

I, ______________________ , am the petitioner in

the foregoing Petition to Proceed In Forma Pauperis. I hereby certify that my present source ofincoIIle is ______________________ _

I further certifY that there is no real estate or personal property of value owned by

me or my spouse except: ______________________ _

Date: _________ ___

Petitioner

682 Form 10A-15

Form lOA-IS

INRE:


ADOPTION BRANCH

__________ TERM, ___

ADOPTION OF: NO. ___ _

CERTIFICATION IN SUPPORT OF PETITIONER'S PETITION FOR LEAVE TO PROCEED IN FORMA PAUPERIS

I, __________________ , Esquire, in consideration of the

information provided by Petitioner(s), am of the opinion that Petitioner(s) meet(s) the

financial qualifications for free legal services. I further certify that Petitioner(s) will not

be charged, either directly or indirectly, for services rendered in this action.

DATE: ___________ _ Attorney for Petitioner(s)

683

INRE:

BABY ____________ __

IN THE COURT OF COMMON PLEAS PHILADELPHIA COUNTY

FAMILY COURT DMSION

NO. ___ _

DECREE

And Now, this _____ day of ________ . 20_, upon consideration

ofthe foregoing Petition, and the Affidavits, Acknowledgments, and Stipulation attached

thereto, it is the detennination of this Court that {Genetic Parents], husband and wife,

are the parents of a child anticipated to be born on or about ________ , 20_, at

{Hospital, with address}, through [Gestational Carrier] acting as embryo carrier for

{Genetic Parents] as natural parents.

It is hereby Ordered and Decreed that any certified copies of the birth records of

said child shall reflect the parentage of {Genetic Parents] whenever parentage appears on

such documents.

BY THE COURT

J.

684 Form 10A-16

ADOPTION BRANCH

FILING FEES

I. Report ofIntention to Adopt (w/Counseling) $ 296.00 (Independent Cases)

II. Report of Intention to Adopt (Department $ 221.00 of Human Services Cases)

III. Petition for Adoption $ 221.00

IV. Registration of Foreign Birth $ 209.00

V. Gestational Carrier-Birth Certificate Procedure $ 209.00

VI. Report of Intermediary No Charge

VII. Terrnination'ofParental Rights Petition No Charge

VIII. Certified Copy of Adoption Decree $ 30.00

Note: If filing a Report of Intention to Adopt with a Petition for Adoption, a charge of $296.00 is assessed.

Form 10A-17 685

23 PA.C.S. PART III. ADOPTION

Appendix 10B Statutes

CHAPTER 21. PRELIMINARY PROVISIONS

§ 2101

§ 2102

Short title of part 691

Definitions 691

CHAPTER 23. JURISDICTION AND PARTIES

SUBCHAPTER A. JURISDICTION

§ 2301 Court 692

§2302 Venue 692

SUBCHAPTER B. PARTIES

§ 2311

§ 2312

§ 2313

Who may be adopted 692

Who may adopt 692

Representation 692

687

Appendix 108 Statutes

CHAPTER 25. PROCEEDINGS PRIOR TO PETITION TO ADOPT

SUBCHAPTER A. VOLUNTARY RELINQUISHMENT

§ 2501

§2502

§ 2503

§2504

§ 2504.1

§2505

Relinquishment to agency 693

Relinquishment to adult intending to adopt child 693

Hearing 693

Alternative procedure for relinquishment 695

Confidentiality 695

Counseling 696

SUBCHAPTER B. INVOLUNTARY TERMINATION

§ 2511

§ 2512

§ 2513

Grounds for involuntary termination 697

Petition for involuntary termination 698

Hearing 698

SUBCHAPTER C. DECREE OF TERMINATION

§ 2521 Effect of decree of termination 699

SUBCHAPTER D. REPORTS AND INVESTIGATION

§ 2530

§ 2531

§2532

§ 2533

§2534

§ 2535

Home study and preplacement report 700

Report of intention to adopt 701

Filing of report 701

Report of intermediary 702

Exhibits 703

Investigation 703

SUBCHAPTER E. PENNSYLVANIA ADOPTION COOPERATIVE EXCHANGE

§ 2551

§2552

§2553

§ 2554

§ 2555

§ 2556

§ 2557

§ 2558

688

Definitions 704

Pennsylvania Adoption Cooperative Exchange 704

Registration of children 704

Responsibilities of PACE 704

Responsibilities of public and private agencies 705

Related activities of agencies unaffected 705

Regulations and staff 705

Retroactive application of subchapter 705

CHAPTER 27. PETITION FOR ADOPTION

SUBCHAPTER A. PETITION

§ 2701

§ 2702

Contents of petition for adoption 705

Exhibits 706

SUBCHAPTER B. CONSENTS

§ 2711

§ 2712

§ 2713

§ 2714

Consents necessary to adoption 706

Consents not naming adopting parents 708

When other consents not required 708

When consent of parent not required 709

SUBCHAPTER C. HEARINGS

§ 2721 Notice of hearing 709

§2722 Place of hearing 709

§ 2723 Attendance at hearing 709

§2724 Testimony and investigation 709

§2725 Religious belief 710

CHAPTER 29. DECREES AND RECORDS

§ 2901

§2902

§ 2903

§2904

§2905

§2906

lime of entry of decree of adoption 710

Requirements and form of decree of adoption 710

Retention of parental status 710

Name of adoptee 711

Impounding of proceedings and access to records 711

Docket entries 713

________ ~. ___ . ____ ._.~ § __ 2~J)1 _______ C_6_r:tiflcate.ofadoption.713__.

§2908

§ 2909

§ 2910

Foreign decree of adoption 713

Medical history information 713

Penalty for unauthorized disclosure 714

689

23 Pa.C.S. Part III. Adoption

Chapter 21. Preliminary Provisions

§ 2101 Short title of part

This part shall be known and may be cited as the "Adoption Act."

§ 2102 Definitions

The following words and phrases when used in this part shall have, unless the context clearly indicates otherwise, the meanings given to them in this section:

"Adoptee." An individual proposed to be adopted.

"Agency." Any incorporated or unincorporated organization, society, institution or other entity, public or voluntary, which may receive or provide for the care of children, supervised by the Department of Public Welfare and providing adoption services in accordance with standards established by the department.

"Clerk." The clerk of the division of the court of common pleas having jurisdiction over voluntary relinquishment, involuntary termination and adoption proceedings.

"Court." The court of common pleas.

"Intermediary." Any person or persons or agencY acting between the parent or parents and the proposed adoptive parent or parents in arranging an adoption placement.

"Medical history information." Medical records and other information concerning an adoptee or an adoptee's natural family which is relevant to the adoptee's present or fu-ture health care or medical treatment. The term includes: .

(1) otherwise confidential or privileged information provided that identifying contents have been removed pursuant to section 2909 (relating to medical history information); and

. (2) information about the natural parents which may be relevant to a potential hereditary or congenital medical problem.

"Newborn child." A child who is six months of age or younger at the time of the filing of , __ .. ,_~ .. _ ...... __ ~,any.petitionpursuant,to,Chapter25'(relatingtoptoceeamgs'pnof'topetitioritoad"ptr-"

"Parent." Includes adoptive parent.

691

Appendix 1 DB Statutes

Chapter 23. Jurisdiction and Parties

SUBCHAPTER A. JURISDICTION

§ 2301 Court

The court of common pleas of each county shall exercise through the appropriate division original jurisdiction over voluntary relinquishment, involuntary termination and adoption proceedings.

§ 2302 Venue

Proceedings for voluntary relinquishment, involuntary termination and adoption may be brought in the court of the county:

(1) Where the parent or parents or the adoptee or the person or persons who have filed a report of intention to adopt required by section 2531 (relating to report of intention to adopt) reside.

(2) In which is located an office of an agency having custody of the adoptee or in the county where the agency having placed the adoptee is located.

(3) With leave of court; in which the adoptee formerly resided.

SUBCHAPTER B. PARTIES

§ 2311 Who may be adopted

Any individual may be adopted, regardless of his age or residence.

§ 2312 Who may adopt

Any individual may become an adopting parent.

§ 2313 Representation

(a) Child.-The court shall appoint counsel to represent the child in an involuntary termination proceeding when the proceeding is being contested by one or both of the parents. The court may appoint counselor a guardian ad litem to represent any child who has not reached the age of 18 years and iR subject to any other proceeding under this part whenever it is in the best interests of the child. No attorney or law firm shall represent both the child and the adopting parent or parents.

(a.l) Parent.-The court shall appoint counsel for a parent whose rights are subject to termination in an involuntary termination proceeillng if, upon petition of the parent, the court determines that the parent is unable to pay for counselor if payment would result in substantial fmancial hardship.

692

§ 2503

(b) Payment of eosts.-The court, in its discretion, may order all or part of the costs attendant to a proceeding under this part to be paid by the county wherein the case is heard, the adopting parents or apportioned to both, provided that if the adopting parents shall be ordered to bear all or a portion ofthe costs of this part that:

(1) the court may direct that the payment of the fees or a portion thereof may be paid by a court ordered schedule of payments extending beyond the date ofthe involuntary termination hearing; and

(2) the fee shall not exceed $150.

Chapter 25. Proceedings Prior to Petition to Adopt

SUBCHAPTER A. VOLUNTARY RELINQUISHMENT

§ 2501 Relinquishment to agency

(a) Petition.-When any child under the age of 18 years has been in the care of an agency for a miIumum period of three days or, whether or not the agency has the physical care of the child, the agency has received a written notice of the present intent to transfer to it custody of the child, executed by the parent, the parent or parents of the child may petition the court for permission to relinquish forever all parental rigbts and duties with respect to their child.

(b) Consents.-The written consent of a parent or guardian of a petitioner who has not reached 18 years of age shall not be required. The consent of the agency to accept custody of the child until such time as the child is adopted shall be required.

§2502 Relinquishment to adult intending to adopt child

(a) Petition.-When any child under the age of 18 years has been for a minimum period of three days in the exclusive care of an adult or adults who have filed a report of intention to adopt required by section 2531 (relating to report of intention to adopt), the parent or parents of the child may petition the court for permission to relinquish forever all parental rights to their child.

--·-·····-·--------------(D)-Consents. 'l'hewrittenconsenColaparentorguarciiail of a-petitioner who has' not reached 18 years of age shall not be required. The adult or adults having care of the child shall file a separate consent to accept custody of the child.

§2503 Hearing

(a) General rule.-Upon presentation of a petition prepared pursuant to section 2501 (relating to relinquishment to agency) or section 2502 (relating to relinquishment to adult intending to adopt child), the court shall fix a time for hearing which shall not be less than ten days after filing of the petition. The petitioner must appear at the hearing.

693


(b) Notice.-

(1) At least ten days' notice of the hearing shall be given to the petitioner, and a copy of the notice shall be given to the other parent, to the putative father whose parental rights could be terminated pursuant to subsection (d) and to the parents or guardian of a petitioner who has not reached 18 years of age.

(2) The notice to the petitioner shall state the following:

"To: [insert petitionerJs name]

A petition has been filed asking the court to put an end to all rights you have to your child [insert name of child]. The court has set a hearing to consider ending your rights to your child. That hearing will be held in [insert place, giving reference to exact room and building number or designation] on [insert date] at [insert time)]. Your presence is required at the hearing. You have a right to be represented at the hearing by a lawyer. You should take this paper to your lawyer at once. If you do not have a lawyer or cannot afford one, go to or telephone the office set forth below to fmd out where you can get legal help.

(Name) __________ _

(Address) _________ _

(Telephone Number ______ "

(3) The copy of the notice which is given to the putative father shall state that his rights may also be subject to termination pursuant to subsection (d) ifhe fails to file either an acknowledgment of paternity or claim of paternity pursuant to section 5103 (relating to acknowledgment and claim of paternity) and fails to either appear at the hearing for the purpose of objecting to the termination of his rights or file a written objection to such termination with the court prior to the hearing.

(c) Decree.-Mter hearing, which shall be private, the court may enter a decree of termination of parental rights in the case of their relinquishment to an adult or a decree of termination of parental rights and duties, including the obligation of support, in the case oftheir relinquishment to an agency.

(d) Putative father.-If a putative father will not file a petition to voluntarily relinquish his parental rights pursuant to section 2501 (relating to relinquishment to agency) or 2502 (relating to relinquishment to adult intending to adopt child), has been given notice of the hearing being held pursuant to this section and fails to either appear at that hearing for the purpose of objecting to termination of his parental rights or file a written objection to such termination with the court prior to the hearing and has not filed an acknowledgment of paternity or claim of paternity pursuant to section 5103, the court may enter a decree terminating the parental rights of the putative father pursuant to subsection (c).

(e) Right to file personal and medical history information.-At the time the decree of termination is transmitted to the parent whose rights are terminated, the court shall advise that parent, in writing, of his or her continuing right to place and update personal and medical history information, whether or not the medical condition is in ex-

694

§ 2504.1

istence or discoverable at the time of adoption, on file with the court and with the Department of Public Welfare pursuant to section 2905(d) (relating to impounding of proceedings and access to records).

§2504 Alternative procedure for relinquishment

(a) Petition to confirm consent to adoption.-If the parent or parents of the child have executed consents to an adoption, upon petition by the intermediary or, where there is no intermediary, by the adoptive parent, the court shall hold a hearing for the purpose of confirming a consent to an adoption upon expiration of the time periods under section 2711 (relating to consents necessary to adoption). The original consent or consents to the adoption shall be attached to the petition.

(h) Hearing.-Upon presentation of a petition filed pursuant to this section, the court shall flx a time for a hearing which shall not be less than ten days after filing of the petition. Notice of the hearing shall be by personal service or by registered mail or by such other means as the court may require upon the consenter and shall be in the form provided in section 2513(b) (relating to hearing). Notice of the hearing shall be given to the other parent or parents, to the putative father whose parental rights could be terminated pursuant to subsection (c) and to the parents or guardian of a consenting parent who has not reached 18 years of age. The notice shall state that the consenting parent's or putative father's rights may be terminated as a result of the hearing. After hearing, which shall be private, the court may enter a decree of termination of parental rights in the case of a relinquishment to an adult or a decree oftermination of parental rights and duties, including the obligation of support, in the ease of a relinquishment to an agency.

(e) Putative father.-If a putative father will not execute a consent to an adoption as required by section 2711, has been given notice of the hearing being held pursuant to this section and fails to either appear at that hearing for the purpose of objecting to termination of his parental rights or file a written objection to such termination with the court prior to the hearing and has not med an acknowledgment of paternity or claim of paternity pursuant to section 5103 (relating to acknowledgment and claim of paternity), the court may enter a decree terminating the parental rights ofthe putative father pursuant to subsection (b).

(d) Right to file personal and medical history information.-At the time the decree of termination is transmitted to the parent, the court shall also advise, in writing, the parent whose rights have been terminated of his or her continuing right to place and update personal and medical history information, whether or not the medical condition is

--_ ......... _-- ---in-existence-oniiscoverable-at·tlre-time-(lf-adoption,-onfilewitb:tli,q;cHirt ana-with'"l", Department of Public Welfare pursuant to section 2905(d) (relating to impounding of proceedings and access to records).

§ 2504.1 Confidentiality

The court shall take such steps as are reasonably necessary to assure that the identity of the adoptive parent or parents is not disclosed without their consent in any proceeding under this subchapter or Subchapter B (relating to involuntary termination). The Supreme Court may prescribe uniform rules under this section relating to such confldentiality.

695

Appendix lOB Statutes

§ 2505 Counseling

(a) List of counselors.-Any hospital or other facility providing maternity care shall provide a list of available counselors and counseling services compiled pursuant to subsection (b) to its maternity patients who are known to be considering relinquishment or termination of parental rights pursuant to this part. The patient shall sign an acknowledgment of receipt of such list prior to discharge, a copy of which receipt shall be provided to the patient.

(b) Compilation of list.-The court shall compile a list of qualified counselors and counseling services (including all adoption agencies) which are available to counsel natural parents within the county who are contemplating relinquishment or termination of parental rights pursuant to this part. Such list shall be distributed to every agency, hospital or other facility providing maternity care within the county and shall be made available upon request to any intermediary or licensed health care professional.

(c) Court reCerraI.-Prior to entering a decree of termination of parental rights pursuant to section 2503 (relating to hearing) or 2504 (relating to alternative procedure for relinquishment), if the parent whose rights are to be terminated is present in court, the court shall inquire whether he or she has received counseling concerning the termination and the alternatives thereto from an agency or from a qualified counselor listed by a court pursuant to subsection (b). If the parent has not received such counseling, the court may, with the parent's consent, refer the parent to an agency or qualified counselor listed by a court pursuant to subsection (b) for the purpose of receiving such counseling. In no event shall the court delay the completion of any hearing pursuant to section 2503 or 2504 for more than 15 days in order to provide for suchcounseling.

(d) Application for counseling.-Any parent who has filed a petition to relinquish his or her parental rights, or has executed a consent to adoption, and is in need of counseling concerning the relinquishment or consent, and the alternatives thereto, may apply to the court for referral to an agency or qualified counselor listed by a court pursuant to subsection (b) for the purpose of receiving such counseling. The court, in its discretion, may make such a referral where it is satisfied that this counseling would be of benefit to the parent.

(e) Counseling fund.-Except as hereinafter provided, each report of intention to adopt filed pursuant to section 2531 (relating to report of intention to adopt) shall be accompanied by a filing fee in the amount of $75 which shall be paid into a segregated fund established by the county. The county may also make supplemental appropriations to the fund. All costs of counseling provided pursuant to subsection (c) or (d) to individuals who are unable to pay for such counseling shall be paid from the fund. No filing fee may be exacted under this subsection with respect to the adoption of a special needs child who would be eligible for adoption assistance pursuant to regulations promulgated by the Department of Public Welfare. In addition, the court may reduce or waive the fee in cases of demonstrated financial hardship.

696

§ 2511

SUBCHAPTER B. INVOLUNTARY TERMINATION

§ 2511 Grounds for involuntary termination

(a) General rule.-The rights of a parent in regard to a child may be terminated after a petition filed on any of the following grounds:

(1) The parent by conduct continuing for a period of at least six months immediately preceding the filing of the petition either has evidenced a settled purpose of relinquishing parental claim to a child or has refused or failed to perfonn parental duties.

(2) The repeated and continued incapacity, abuse, neglect or refusal of the parent has caused the child to be without essential parental care, control or subsistence necessary for his physical or mental well-being and the conditions and causes of the incapacity, abuse, neglect or refusal cannot or will not be remedied by the parent.

(3) The parent is the presumptive but not the natural father of the child.

(4) The child is in the custody of an agency, having been found under such circumstances that the identity or whereabouts of the parent is unknown and cannot be ascertained by diligent search and the parent does not claim the child within three months after the child is found.

(5) The child has been removed from the care of the parent by the court or under a voluntary agreement with an agency for a period of at least six months, the conditions which led to the removal or placement of the child continue to exist, the parent cannot or will not remedy those conditions within a reasonable period of time, the services or assistance reasonably available to the parent are not likely to remedy the conditions which led to the removal or placement of the child within a reasonable period of time and termination of the parental rights would best serve the needs and welfare of the child.

(6) In the case of a newborn child, the parent knows or has reason to know of the child's birth, does not reside with the child, has not married the child's other parent, has failed for a period offour months immediately preceding the filing of the petition to make reasonable efforts to maintain substantial and continuing contact with the child and has failed during the same four-month period to provide substantial financial support for the child.

___ ._._ ...... _ ... __ ... _._(7.L. The .. parent.is.theJather-eLa.childconceived·as·a·result··of·arape{}r·incesL···············- .----.-..

(8) The child has been removed from the care of the parent by the court or under a voluntary agreement with an agency, 12 months or more have elapsed from the date of removal or placement, the conditions which led to the removal or placement of the child continue to exist and tennination of parental rights would best serve the needs and welfare of the child.

(b) Other c{}nsiderations.-The court in terminating the rights of a parent shall give primary consideration to the developmental, physical and emotional needs and welfare of the child. The rights of a parent shall not be tenninated solely on the basis of environmental factors such as inadequate housing, furnishings, income, clothing and medical care if found to be beyond the control of the parent. With respect to any petition filed pur-

697


suant to subsection (a)(1), (6) or (8), the court shall not consider any efforts by the parent to remedy the conditions described therein which are first initiated subsequent to the giving of notice of the filing of the petition.

(e) Right to file personal and medical history information.-At the time the decree of termination is transmitted to the parent whose rights have been terminated, the court shall advise the parent, in writing, of his or her continuing right to place and update personal and medical history information, whether or not the medical condition is in existence or discoverable at the time of adoption, on file with the court and with the Department of Public Welfare pursuant to section 2905(d) (relating to impounding of proceedings and access to records).

§ 2512 Petition for involuntary termination

(a) Who may file.-A petition to terminate parental rights with respect to a child under the age of 18 years may be filed by any of the following:

(1) Either parent when termination is sought with respect to the other parent.

(2) An agency.

(3) The individual having custody or standing in loco parentis to the child and who has filed a report of intention to adopt required by section 2531 (relating to report of intention to adopt).

(4) An attorney representing a child or a guardian ad litem representing a child who has been adjudicated dependent under 42 Pa.C.S. § 6341(c) (relating to adjudication).

(b) Contents.-The petition shall set forth specifically those grounds and facts alleged as the basis for terminating parental rights. The petition filed under this section shall also contain an averment that the petitioner will assume custody of the child until such time as the child is adopted. If the petitioner is an agency it shall not be required to aver that an adoption is presently contemplated nor that a person with a present intention to adopt exists.

(e) Father not identified.-If the petition does not identifY the father of the child, it shall state whether a claim of paternity has been filed under section 8303 (relating to claim of paternity).

§2513 Hearing

(a) Time.-The court shall fix a time for hearing on a petition filed under section 2512 (relating to petition for involuntary termination) which shall be not less than ten days after filing of the petition.

(h) Notice.-At least ten days' notice shall be given to the parent or parents, putative father, or parent of a minor parent whose rights are to be terminated, by personal service or by registered mail to his or their last known address or by such other means as the court may require. A copy of the notice shall be given in the same manner to the other parent, putative father or parent or guardian of a minor parent whose rights are to be terminated. A putative father shall include one who has filed a claim of paternity as provided in section 5103 (relating to acknowledgment and claim of paternity) prior to the institution of proceedings. The notice shall state the following:

698

§ 2521

"A petition has been filed asking the court to put an end to all rights you have to your child [insert name of child). The court has set a hearing to consider ending your rights to your child. That hearing will be held in [insert place, giving reference to exact room and building number or designation] on [insert date] at [insert time]. You are warned that even if you fail to appear at the scheduled hearing, the hearing will go on without you and your rights to your child may be ended by the court without your being present. You have a right to be represented at the hearing by a lawyer. You should take this paper to your lawyer at once. If you do not have a lawyer or cannot afford one, go to or telephone the office set forth below to find out where you can get legal help.

(Name) _______________________ __

(Address) ____________________ _

(Telephone Number _________ "

(c) Mother competent witness on paternity issue.-The natural mother shall be a competent witness as to whether the presumptive or putative father is the natural father ofthe child.

(d) Decree.-After hearing, which may be private, the court shall make a finding relative to the pertinent provisions of section 2511 (relating to grounds for involuntary termination) and upon such fm!ling may enter a decree of termination of parental rights.

SUBCHAPTER C. DECREE OF lERMINATION

§ 2521 Effect of decree of termination

(a) Adoption proceeding rights extinguished.-A decree terminating all rights of a parent or a decree terminating all rights and duties of a parent entered by a court of competent jurisdiction shall extinguish the power or the right of the parent to object to or receive notice of adoption proceedings.

(b) Award of custody.-The decree shall award custody of the child to the agency or the person consenting to accept custody under section 2501 (relating to relinquishment to agency) or section 2502 (relating to relinquishment to adult intending to adopt child)

···----·~~-~--_____orthe-l>etitioner_m~th~n~aSEn)f~a-·proceeaing-Uiioer -sectioii--Z5T~nrela Hng to-peti£loii-for--~'involuntary termination).

(0) Authority of agency or person receiving custody.-An agency or person receiving custody of a child shall stand in loco parentis to the child and in such capacity shall have the authority, inter alia, to consent to marriage, to enlistment in the armed forces and to major medical, psychiatric and surgical treatment and to exercise such other authority concerning the child as a natural parent could exercise.

699


SUBCHAPTER D. REPORTS AND INVESTIGATION

§ 2530 Home study and preplacement report

(a) General rule.-No intermediary shall place a child in the physical care or custody of a prospective adoptive parent or parents unless a home study containing a favorable recommendation for placement of a child with the prospective parent or parents has been completed within three years prior thereto and which has been supplemented within one year prior thereto. The home study shall be conducted by a local public child-care agency, an adoption agency or a licensed social worker designated by the court to perform such study.

(b) Preplaeement report.-A preplacement report shall be prepared by the agency or person conducting the home study.

(1) The preplacement report shall set forth all pertinent information relating to the fitness of the adopting parents as parents.

(2) The preplacement report shall be based upon a study which shaIl include an investigation ofthe home environment, family life, parenting skills, age, physical and mental health, social, cultural and religious background, facilities and resources of the adoptive parents and their ability to manage their resources. The preplacement report shall also include the information required by section 6344(b) (relating to information relating to prospective child-care personnel). .

(3) The preplacement report shall include a determination regarding the fitness of the adopting parents as parents.

(4) The preplacement report shall be dated and verified.

(e) Interim plaeement.-Where a home study required under this section is in process, but not yet completed, an intermediary may place a child in the physical care or custody of a prospective adoptive parent or parents if all of the following conditions are met:

700

(1) The intermediary has no reason to believe that the prospective adoptive parent or parents would not receive a favorable recommendation for placement as a result of the home study.

(2) The individual or agency conducting the home study assents to the interim placement.

(3) The intermediary immediately notifies the court of the interim placement and the identity of the individual or agency conducting the home study. If at any time prior to the completion of the home study the court is notified by the individual or agency conducting the home study that it withdraws its assent to the interim placement, the court may order the placement of the child in temporary foster care with an agency until a favorable recommendation for placement is received.

§2532

§ 2531 Report of intention to adopt

(a) General rule.-Every person now having or hereafter receiving or retaining cus· tody or physical care of any child for the purpose or with the intention of adopting a child under the age of 18 years shall report to the court in which the petition for adoption will be filed.

(b) Contents.-The report shall set forth:

(1) The circumstances surrounding the persons receiving or retaining custody or physical care of the child, including the date upon which a preplacement in· vestigation was concluded.

(2) The name, sex, racial background, age, date and place of birth and religious affiliation of the child.

(3) The name and address of the intermediary.

(4) An itemized accounting of moneys and consideration paid or to be paid to the intermediary.

(5) Whether the parent or parents whose parental rights are to be terminated have received counseling with respect to the termination and the alternatives thereto. If so, the report shall state the dates on which the counseling was provided and the name and address of the counselor or agency which provided the counseling.

(6) The name, address and signature of the person or persons making the report. Immediately above the signature of the person or persons intending to adopt the child shall appear the following statement:

I acknowledge that I have been advised or know and understand that the birth father or putative father may revoke the consent to the adoption of this child within 30 days after the later of the birth of the child or the date he has executed the consent to an adoption and that the birth mother' may revoke the consent to an adoption of this child within 30 days after the date she has executed the consent.

(7) A copy of the preplacement report prepared pursuant to section 2530 (relating to home study and preplacement report).

When a person receives or retains custody or physical care of a child from an agency, the report shall set forth only the name and address of the agencY, the circumstances sur·

.... __ !:()llI.1ding .. s.!!.;b ... p.!'.rson xe_ceJving.oLretaining .. custodYDr_physical_care.oLthe.childand.a.--copy of the preplacement report prepared pursuant to section 2530.

(c) When report not rcquired.-No report shall be required when the child is the child, grandchild, stepchild, brother or sister of the whole or half blood, or niece or nephew by blood, marriage or adoption of the person receiving or retaining custody or physical care.

§ 2532 Filing of report

The report required by section 2531 (relating to report of intention to adopt) shall be filed within 30 days after the date ofreceipt of the custody or physical care of the child.

701

§ 2535

(1) Medical and hospital expenses incurred by the natural mother for prenatal care and those medical and hospital expenses incurred by the natural mother and child incident to birth.

(2) Medical, hospital and foster care expenses incurred on behalf of the child prior to the decree of adoption.

(3) Reasonable expenses incurred by the agency or a third party for adjustment counseling and training services provided to the adoptive parents and for home studies or investigations.

(4) Reasonable administrative expenses incurred by the agency, to include overhead costs and attorney fees.

§ 2534 Exhibits

The report of the intermediary shall have attached to it the following exhibits:

(1) A birth certificate or certification of registration of birth of the child ifit can be obtained.

(2) All consents to adoption required by section 2711 (relating to consents necessary to adoption).

(3) A certified copy of any decree of termination of parental rights or parental rights and duties made by a court other than the court in which the petition for adoption will be filed.

§ 2535 Investigation

(a) General rule.-When a report required by section 2531 (relating to report of in tention to adopt) has been filed, the court shall cause an investigation to be made and a report filed by a local public child care agency, a voluntary child care agency with its consent or an appropriate person designated by the court. In lieu of the investigation, the court may accept an investigation made by the agency which placed the child and the report of investigation in such caseS may be incorporated into the report of the intermediary required by section 2533 (relating to report ofintermediary).

(b) Matters covered.-The investigation shall cover all pertinent information regarding the child's eligibility for adoption and the suitability of the placement, including the physical, mental and emotional needs and welfare of the child, and the child's and the

______ ad()p~ingparel1ts'_a!;",-s.",:,,!,ealth _!ll1~J:"cial, etbni c and!~Egio_",-s.!)_ackground.__ __ _

(c) Payment of costs.-The court may establish the procedure for the payment of investigation costs.

703


§2533 Report of intermediary

(a) General rule.-Within six months after filing the report of intention to adopt, the intermediary who or which arranged the adoption placement of any child under the age of 18 years shall make a written report under oath to the court in which the petition for adoption will be filed and shall thereupon forthwith notif'y in writing the adopting parent or parents of the fact that the report has been filed and the date thereof.

(b) Contents.-The report shall set forth:

(1) The name and address of the intermediary.

(2) The name, sex, racial background, age, date and place of birth and religious affiliation of the child.

(3) The date of the placement of the child with the adopting parent or parents.

(4) The name, racial background, age, marital status as of the time of birth of the child and during one year prior thereto, and religious affiliation of the parents of the child.

(5) Identification of proceedings in which any decree of termination of parental rights, or parental rights and duties, with respect to the child was entered.

(6) The residence of the parents or parent of the child, if there has been no such decree of termination.

(7) A statement that all consents required by section 2711 (relating to consents necessary to adoption) are attached as exhibits or the basis upon which the consents are not required.

(8) An itemized accounting of moneys and consideration paid or to be paid to or received by the intermediary or to or by any other person or persons to the knowledge of the intermediary by reason of the adoption placement.

(9) A full description and statement of the value of all property owned or possessed by the child.

(10) A statement that no provision of any statute regulating the interstate placement of children has been violated with respect to the placement of the child.

(11) If no birth certificate or certification ofregistration of birth can be obtained, a statement of the reason therefor.

(12) A statement that medical history information was obtained and if not ob-tained, a statement of the reason therefor.

(e) Appropriate relief.-The court may provide appropriate relief where it finds that the moneys or consideration reported or reportable pursuant to subsection (b)(8) are excessive.

(d) Permissible reimbursement of expenses.-Payments made by the adoptive parents to an intermediary or a third party for reimbursement of the following expenses, calculated without regard to the income of the adoptive parents, are permissible and are not in violation of 18 Pa.C.S. § 4305 (relating to dealing in infant children):

702

§ 2701

the House of Representatives, to the Public Health and Welfare and Judiciary Committees of the Senate and to the Governor.

(6) Coordination of its functions with other state, regional and national adoption exchanges.

§ 2555 Responsibilities of public and private agencies

All public and licensed private child service agencies shall register all children with PACE for whom parental rights have been terminated for 90 days and for whom no report of intention to adopt has been filed in the court of common pleas. A public or licensed private agency may register other children as set forth in section 2553(b) (relating to registration of children).

§ 2556 Related activities of agencies unaffected

This subchapter shall not be construed to limit or delay actions by agencies or institutions to arrange for adoptions or other related matters on their own initiative and shall not alter or restrict the duties, authority and confidentiality of the agencies and institutions in those matters.

§2557 Regulations and staff

The department shall promulgate necessary regulations and shall hire the staff which is necessary to implement this subchapter.

§ 2558 Retroactive application of subchapter

This subchapter shall apply retroactively to all children for whom:

(1) Parental rights have been terminated and for whom no report of intention to adopt has been filed in the court of common pleas.

(2) Restoration to the biological family is neither possible nor appropriate, a petition to terminate parental rights has been filed and adoption is planned pending identification of an adoptive parent or parents.

SUBCHAPTER A. PETITION

§ 2701 Contents of petition for adoption

A petition for adoption shall set forth:

(1) The full name, residence, marital status, age, occupation, religious affiliation and racial background of the adopting parent or parents and their relationship, if any, to the adoptee.

705


SUBCHAPTER E. PENNSYLVANIA ADOPTION COOPERATIVE EXCHANGE

§ 2551 Definitions

The following words and phrases when used in this subchapter shall have the meanings given to them in this section unless the context clearly indicates otherwise:

"Department." The Department of Public Welfare of the Commonwealth.

"PACE." The Pennsylvania Adoption Cooperative Exchange.

§2552 Pennsylvania Adoption Cooperative Exchange

There shall be a Pennsylvania Adoption Cooperative Exchange in the Office of Children, Youth and Families of the Department of Public Welfare.

§2553 Registration of children

(a) Mandatory registration.-PACE shall register and be responsible for the review and referral of children for whom parental rights have been terminated for 90 days and for whom no report of intention to adopt has been filed in the court of common pleas.

(b) Optional registration.-PACE may also register children where restoration to the biological family is neither possible nor appropriate, a petition to terminate parental rights has been filed and adoption is planned pending identification of an adoptive parent or parents. However, information about these children shall not be publicized without prior approval by the department, which shall ensure the anonymity of these children until such time as parental rights are terminated.

(c) Children excluded from registration.-A child for whom termination of parental rights is being appealed in a court shall not be registered with PACE as available for adoption. IdentifYing information of such children shall be forwarded to PACE by the agency, with reference to the specific reason for which the child is not to be placed on the listing service.

§2554 Responsibilities of PACE

PACE shall be responsible for the following:

704

(1) Registration of adoptive parent applicants who have been approved by agencies.

(2) Accumulation and dissemination of statistical information regarding all children registered with PACE.

(3) Creation and administration of a public information program designed to inform potential adoptive parents of the need for adoptive homes for children registered with PACE.

(4) Preparation and distribution of a photographic listing service on children registered with PACE.

(5) Preparation of annual reports concerning functions of PACE regarding the children and the prospective parents listed with PACE. The reports shall be submitted annually to the Health and Welfare and Judiciary Committees of

§ 2711

(5) The guardian of the person of an adoptee under the age of 18 years, if any there be, or of the person or persons having the custody of the adoptee, if any such person can be found, whenever the adoptee has no parent whose consent is required.

(b) Husband of natural mother.-The consent of the husband of the mother shall not be necessary if, after notice to the husband, it is proved to the satisfaction of the court by evidence, including testimony of the natural mother, that the husband of the natural mother is not the natural father of the child. Absent such proof, the consent of a former husband of the natural mother shall be required if he was the husband of the natural mother at any time within one year prior to the birth of the adoptee.

(c) Validity of consent.-No consent shall be valid if it was executed prior to or within 72 hours after the birth of the child. A putative father may execute a consent at any time after receiving notice of the expected or actual birth of the child. Any consent given outside this Commonwealth shall be valid for purposes of this section if it was given in accordance with the laws of the jurisdiction where it was executed. A consent to an adoption may only be revoked as set forth in this subsection. The revocation of a consent shall be in writing and shall be served upon the agency or adult to whom the child was relinquished. The following apply:

(1) Except as otherwise provided in paragraph (3):

(i) For a consent to an adoption executed by a birth father or a putative father, the consent is irrevocable more than 30 days after the birth of the child or the execution of the consent, whichever occurs later.

(ii) For a consent to an adoption executed by a birth mother, the consent is irrevocable more than 30 days after the execution of the consent.

(2) An individual may not waive the revocation period under paragraph (1).

(3) Notwithstanding paragraph (1), the following apply:

(i) An individual who executed a consent to an adoption may challenge the validity of the consent only by filing a petition alleging fraud or duress within the earlier of the following time frames:

(A) Sixty days after the birth of the child or the execution of the consent, whichever occurs later.

(E) Thirty days after the entry ofthe adoption decree.

(ii) A consent to an adoption may be invalidated only if the alleg~.,f'ri'll(L()I'., __ ,, __ -, .. ,'-"--------, .. --'------,--,--dure-sB'under suoparagraph'U)"is proven IJY:'-'--

(A) A preponderance of the evidence in the case of consent by a person 21 years of age or younger; or

(E) Clear and convincing evidence in all other cases.

(d) Contents of consent.-

(1) The consent of a parent of an adoptee under 18 years of age shall set forth the name, age and marital status of the parent, the relationship of the consenter to the child, the name of the other parent or parents of the child and the following:

707


(2) That the reports under sections 2530 (relating to home study and preplacement report), 2531 (relating to report of intention to adopt) and 2533 (relating to report of intermediary) have been filed, if required.

(3) The name and address of the intermediary, if any.

(4) The full name of the adoptee and the fact and length oftime of the residence of the adoptee with the adopting parent or parents.

(5) If there is no intermediary or if no report of the intermediary has been filed or if the adoptee is over the age of 18 years, all vital statistics and other information enumerated and required to be stated of record by section 2533, so far as applicable.

(6) If a change in name of the adoptee is desired, the new name.

(7) That all consents required by section 2711 (relating to consents necessary to adoption) are attached as exhibits or the basis upon which such consents are not required.

(8) That it is the desire of the petitioner or the petitioners that the relationship of parent and child be established between the petitioner or petitioners and the adoptee.

(9) If no birth certificate or certification of registration of birth can be obtained, a statement of the reason therefor and an allegation of the efforts made to obtain the certificate with a request that the court establish a date and place of birth at the adoption hearing on the basis of the evidence presented.

§ 2702 Exhibits

The petition shall have attached to it the following exhibits:

(1) The consent or consents required by section 2711 (relating to consents necessary to adoption).

(2) If not already filed with a report of an intermediary, the exhibits enumerated in section 2534 (relating to exhibits).

SUBCHAPTER B. CONSENTS

§ 2711 Consents necessary to adoption

(a) General rule.-Except as otherwise provided in this part, consent to an adoption shall be required of the following:

706

(1) The adoptee, if over 12 years of age.

(2) The spouse ofthe adopting parent, unless they join in the adoption petition.

(3) The parents or surviving parent of an adoptee who has not reached the age of 18 years.

(4) The guardian of an incapacitated adoptee.

§ 2724

§ 2714 When consent of parent not required

Consent of a parent to adoption shall not be required if a decree of termination with regard to such parent has been entered. When parental rights have not previously been terminated, the court may find that consent of a parent of the adoptee is not required if, after notice and hearing as prescribed in section 2513 (relating to hearing), the court fmds that grounds exist for involuntary termination under section 2511 (relating to grounds for involuntary termination).

SUBCHAPTER C. HEARINGS

§2721 Notice of hearing

The court shall fIx a time and place for hearing. Notice of the hearing shall be given to all persons whose consents are required and to such other persons as the court shall direct. Notice to the parent or parents of the adoptee, if required, may be given by the intermediary or someone acting on his behalf. Notice shall be by personal service or by registered mail to the last known address of the person to be notifIed or in such other manner as the court shall direct.

§2722 Place of hearing

The hearing shall be private or in open court as the court deems appropriate.

§2723 Attendance at hearing

The adopting parent or parents and the adoptee must appear at and, if required, testify at the hearing under oath unless the court determines their presence is unnecessary. In addition, the court may require the appearance and testimony of all persons whose consents are required by this part and representatives of agencies or individuals who have acted as an intermediary if their appearance or testimony would be necessary or helpful to the court.

§2724 Testimony and investigation

(a) Testimony.-The court shall hear testimony in support of the petition and such ~~ ___ ~_~.~ ... ~.~.~~.~-.~-··-·additional~testimony.as~it.deems·necessary·~to·inform~it·as~to·the~desirabilitY-ilHhe~pro·~~

posed adoption. It shall require a disclosure of all moneys and consideration paid or to be paid to any person or institution in connection with the adoption.

(b) Investigation.-The court may request that an investigation be made by a person or public agency or, with its consent, a voluntary agency, specifIcally designated by the court to verify the statements of the petition and such other facts that will give the court full knowledge of the desirability of the proposed adoption, or the court may rely in whole or in part upon a report earlier made under section 2535 (relating to investigation). In any case, the age, sex, health, social and economic status or racial, ethnic or religious

709


I hereby voluntarily and unconditionally consent to the adoption of the above named child.

I understand that by signing this consent I indicate my intent to permanently give up all rights to this child.

I understand such child will be placed for adoption.

I understand I may revoke this consent to permanently give up all rights to this child by placing the revocation in writing and serving it upon the agency or adult to whom the child was relinquished.

If I am the birth father or putative father of the child, I understand that this consent to an adoption is irrevocable unless I revoke it within 30 days after either the birth of the child or my execution of the consent, whichever occurs later, by delivering a written revocation to [insert the name and address of the agency coordinating the adoption] or [insert the name and address of an attorney who represents the individual relinquishing parental rights or prospective adoptive parent of the child] or [insert the court of the county in which the voluntary relinquishment form was or will be filedl.

If! am the birth mother ofthe child, I understand that this consent to an adoption is irrevocable unless I revoke it within 30 days after executing it by delivering a written revocation to [insert the name and address of the agency coordinating the adoption] or {insert the name and address of an attorney who represents the individual relinquishing parental rights or prospective adoptive parent of the child] or [insert the court of the county in which the voluntary relinquishment form was or will be filed].


(2) The consent shall include the date and place of its execution and names and addresses and signatures of at least two persons who witnessed its execution and their relationship to the consenter.

§ 2712 Consents not naming adopting parents

A consent to a proposed adoption meeting all the requirements of this part but which does not name or otherwise identifY the adopting parent or parents shall be valid if it contains a statement that it is voluntarily executed without disclosure of the name or other identification of the adopting parent or parents.

§ 2713 When other consents not required

The court, in its discretion, may dispense with consents other than that of the adoptee to a petition for adoption when:

708

(1) the adoptee is over 18 years of age; or

(2) the adoptee is under 18 years of age and has no parent living whose consent is required.

§ 2905

§ 2904 Name of adoptee

If requested by the petitioners, the decree may provide that the adoptee shall assume the name of the adopting parent or parents and any given first or middle names that may be chosen.

§ 2905 Impounding of proceedings and access to records

(a) General rule.-All petitions, exhibits, reports, notes of testimony, decrees, and other papers pertaining to any proceeding under this part or former statutes relating to adoption shall be kept in the files of the court as a permanent record thereof and withheld from inspection except on an order of court granted upon cause shown or except as otherwise provided in this section. In the case of an adult adoptee who is assuming a name under section 2904 (relating to name of adoptee), an order of court is not required for the court to forWard to the Pennsylvarua State Police documentation in accordance with 54 Pa.CB. section 702 (relating to change by order of court). Any report required to be filed under sections 2530 (relating to horne study and preplacement report), 2531 (relating to report of intention to adopt) and 2535 (relating to investigation) shall be made available to parties to an adoption proceeding only after all identifying names and addresses in the report have been extirpated by the court.

(b) Petition to court for limited information.-Upon petition by any adoptee at least 18 years of age or, ifless than 18, his adoptive parent or legal guardian to the court in the judicial district in which the permanent records relating to the adoption have been impounded, the court shail furnish to the adoptee as much information concerning the adoptee's natural parents as will not endanger the anonymity of the natural parents. The information shall first be reviewed, in camera, by the court to insure that no information is revealed which would endanger the anonymity of the natural parents. The court shall, upon motion of the adoptee, examine the entire record to determine if any additional information can safely be revealed without endangering the anonymity of the natural parents.

(c) Access to identity of natural parents.-

(1) Upon petition of an adoptee at least 18 years of age or, if less than 18, his adoptive parent or legal guardian, the court may also, through its designated agent, attempt to contact the natural parents, if known, to obtain their consent to release their identity and present place of residence to the adoptee. The petition may state the reasons why the adoptee desires to contact his natural parents, which reasons shall be disclosed to the natural parents if con-

. ____ .... ___ .. _____ ···-·-·-··tacted~However,the-court-1lm:l-its··a:gentB·"Sll:ltll·take. care that none Duf"the·· natural parents themselves are informed of the adoptee's existence and relationship to them. The court may refuse to contact the natural parents if it believes that, under the circumstances, there would be a substantial risk that persons other than the natural parents would learn of the adoptee's existence and relationship to the natural parents. The court shall appoint either the county children and youth agency, or a private agency which provides adoption services in accordance with standards established by the Department of Public Welfare, to contact the natural parents as its designated agent.

(2) In addition to petitioning the court to contact the natural parents, an adoptee at least 18 years of age or, if less than 18, his adoptive parent or legal guard-

711


background ofthe child or adopting parents shall not preclude an adoption but the court shall decide its desirability on the basis of the physical, mental and emotional needs and welfare of the child.

(c) Payment of investigation costs.-The court may establish a procedure for the payment of investigation costs by the petitioners or by such other persons as the court may direct.

§2725 Religious belief

The intermediary may honor the preference of the natural parents as to the religious faith in which the adoptive parents intend to rear the adopted child. No person shall be denied the benefits of this part because of a religious belief in the use of spiritual means or prayer for healing.

Chapter 29. Decrees and Records

§ 2901 Time of entry of decree of adoption

Unless the court for cause shown determines otherwise, no decree of adoption shall be entered unless the natural parent or parents' rights have been terminated, the investigation required by section 2535 (relating to investigation) has been completed, the report of the intermediary has been filed pursuant to section 2533 (relating to report of intermediary) and all other legal requirements have been met. If all legal requirements have been met, the court may enter a decree of adoption at any time.

§2902 Requirements and form of decree of adoption

(a) General rule.-If satisfied that the statements made in the petition are true, that the needs and welfare of the person proposed to be adopted will be promoted by the adoption and that all requirements of this part have been met, the court shall enter a decree so finding and directing that the person proposed to be adopted shall have all the rights of a child and heir of the adopting parent or parents and shall be subject to the duties of a child to him or them.

(b) Withdrawal or dismissal of petition.-In any case in which the petition is withdrawn or dismissed, the court shall enter an appropriate order in regard to the custody of the child.

§ 2903 Retention of parental status

Whenever a parent consents to the adoption of his child by his spouse, the parent-child relationship between him and his child shall remain whether or not he is one of the petitioners in the adoption proceeding.

710

§ 2909

§ 2906 Docket entries

Upon the filing of any decree under this part, the clerk shall enter on the docket an entry showing the date of the decree. Information identifying the natural parents shall not be entered on the docket.

§ 2907 Certificate of adoption

The clerk shall issue to the adopting parent or parents a certificate reciting that the court has granted the adoption. The certificate shall not disclose the name of any natural parent or the original name of the person adopted. The certificate shall be accepted in any legal proceedings in this Commonwealth as evidence of the fact that the adoption has been granted.

§ 2908 Foreign decree of adoption

When a decree of adoption of a minor is made or entered in conformity with the laws of another state or a foreign country whereby a child is adopted by a resident of this Commonwealth, a copy of the final decree, properly authenticated, may be filed with the clerk in the county of residence of the adopting parents. The decree and such other documents as may be filed therewith shall be kept in the files of the court as a permanent record thereof and shall be withheld from inspection except on order of court granted upon cause shown. Upon the filing of a foreign decree of adoption, the clerk shall enter upon the docket an entry showing the foreign court, identification of the proceedings therein and the date of the decree. Information identifying the natural parents shall not be required.

§ 2909 Medical history information

(a) Delivery of infonnation.-Prior to the fmalization of an adoption, medical history information shall, where practicable, be delivered by the attending physician or other designated person to the intermediary who shall deliver such information to the adopting parents or their physician. In cases where there is no intermediary, medical history information shall be delivered directly to the adopting parents or their physician.

(b) Editing of infonnation.-Except as provided in section 2905 (relating to impounding of proceedings and access to records), medical history information shall be edited before delivery or release by the Department of Public Welfare so as to remOve any contents which would identifY the adoptee's natural family.

(c) Availability of information fonns.-The Department of Public Welfare shall, upon request, make available to courts, adoption agencies and individuals medical history information forms that enable parents whose rights have been terminated to register and update medical history information with the Department of Public Welfare and with the court which entered the decree oftermination.

(d) Regulations.-The Department of Public Welfare shall, in consultation with the Department of Health, prescribe by regulation the procedure to be utilized and to develop the content of medical history information forms.

713


ian may request the agency that placed the adoptee to contact his natural parents. If the agency agrees to attempt to contact the natural parents, it shall do so pursuant to the same safeguards provided for court inquiries in paragraph (1).

(3) If the court or an agency contacts the natural parents of an adoptee pursuant to a petition or request made under paragraph (1) or (2), except as hereinafter provided, information relating to both natural parents shall only be disclosed to the adoptee if both natural parents agree to the disclosure. If both of the natural parents are deceased, their identities may be disclosed. If one parent is deceased, his or her identity may be disclosed. If only one parent agrees to the disclosure, then only the information relating to the agreeing parent shall be disclosed.

(4) The Department of Public Welfare may, by regulation, prescribe procedures related to contact of natural parents by designated agents of the court.

(d) Disclosure ofinformation.-

712

(1) No disclosure of information shall be made by the court, an agency, the Department of Health or any other Commonwealth agency regarding the adopted person's original certificate of birth or regarding the documents of proof on which the amended certificate of birth is based or relating in any way to the natural parents unless the disclosure is made pursuant to the provisions ofthis section.

(2) Notwithstanding any other provision in this section to the contrary, the natural parents may, at the time of the termination of their parental rights pursuant to Chapter 25 (relating to proceedings prior to petition to adopt) or at any time thereafter, place on fIle, with the court and with the Department of Health, a consent form granting permission for the court or the department to disclose the information contained in the adoptee's original certificate of birth, or any other identifying or nonidentifying information pertaining to the natural parents, at any time after the adoptee attains the age of 18 or, if less than 18, to his adoptive parent or legal guardian. If both parents give their consent, the information on the birth certificate may be disclosed. If only one parent gives consent, only the identity of the consenting parent shall be disclosed. The natural parents shall be entitled to update those records, as necessary, to reflect the natural parent's current address or any other information pertaining to the natural parents. The information may only be disclosed upon the request of the adoptee or his adoptive parent or legal guardian, and the consent of the natural parents may be withdrawn at any time by filing a withdrawal of consent form with the court and the department. The department shall prescribe by regulation the procedure and forms to be utilized for the giving, updating and withdrawal of the consent.

(3) An adoptee at least 18 years of age or, ifless than 18 years of age, the parent or legal guardian of the adoptee shall have access to any original or updated medical history information on file with the court which entered the decree of termination or the Department of Public Welfare. Not medical history information shall be released which would endanger the anonymity of the natural parents.

Appendix 10C Suggested Reading List

on Adoption

------ ~ , .. _._-------------- .. , ..•.... _._._- - --- - --- .-.----.-~-.,,--... --.---------------------------.--

715


§ 2910 Penalty for unauthorized disclosure

Any officer or employee of the court, other than a judge thereof, the Department of Health, the Department of Public Welfare, or any agency who willfully discloses impounded or otherwise confidential information relating to an adoption, other than as expressly authorized and provided in this chapter, commits a misdemeanor of the third degree.

714

Suggested Reading List on Adoption

Baker, Nancy C., Babyselling: The Scandal of Black-Market Adoption, New York: Vanguard Press, 1978

Becker, Kayla, and Heckert, Connie, To Keera With Love, Rowman & Littlefield Publishers, Inc., 1989

Bourguignon, Jean-Pierre, Towards Successful Adoptions: A Study of Predictors in Special Needs Placements, Illinois DCFS, 1990, available from the National Resource Center for Special Needs Adoption, Chelsea, MI

Brodzinsky, Anne Braff, The Mulberry Bird: Story of an Adoption, Perspectives Press, 1986

Brodzinsky and Schechter, The Psychology of Adoption, 1990, available from National Resource Center for Special Needs Adoption, Chelsea, MI

Churchill, Sallie, Carlson, Bonnie, and Nybell, Lynn, No Child is Unadoptable, Beverly Hills, CA: Sage Publications, 1979

Fahlberg, Vera, "Putting the Pieces Together" (series of four books) • Helping Children When They Must Move, 1980 • Attachment and Separation, 1979 • The Child in Placement: Common Behavior Problems, 1981 • Child Development, 1981 Available through the National Resource Center for Special Needs Adoption, Chelsea, MI

Festinger, Trudy, Necessary Risk: A Study of Adoption and Disrupted Adoptive Placements, Washington, D.C.: Child Welfare League of America, Inc., 1986

Gabel, Susan, Filling in the Blanks: A Guided Look at Growing Up Adopted, Perspectives Press, 1988

Grow, Lucille J. and Shapiro, Deborah, Transracial Adoption Today: Views of Adoptive Parents and Social Workers, New York: Child Welfare League of America, Inc., 1975

Hartman, Ann, Working with Adoptive Families Beyond Placement, New York: Child Welfare League of America, Inc., 1984

Jewett, Claudia L., Adopting the Older Child, Cambridge, Massachusetts: The Harvard ·-----C(jrn:m(jfiPtess~197W~-------------- ---._--- . --- ........ ------------- ........... .

Jones, Mary Ann, The Sealed Record Controversy: Report of Agency Policy, Practice and Opinions, New York: Child Welfare League of America, Inc., 1976

Joy, Deborah Berry, Benjamin Bear, 1933 (children's book), available from the National Resource Center for Special Needs Adoption, Chelsea, MI

Kadushin, A., Adopting Older Children, New York: Columbia University Press, 1970

Kirk, H. David, Exploring Adoptive Family Life, Ben-Simon Publications, 1988

Klein, Carol, The Single Parent Experience, New York: Avon Books, 1975

717

,

Appendix 1 DC Suggested Reading Ust on Adoption

Koch, Janice, and Goldberg, Patricia, Our Baby: A Birth and Adoption Story, Perspectives Press, 1985

Lindsay, Jeanne, and Monserrat, Catherine, Adoption Awareness: A Guide for Teachers, Counselors, Nurses and Caring Others, Morning Glory Press, 1989

Macmanus, Sheila, The Adoption Book, Paulist Press, New York, 1984

Marindin, Hope, The Handbook for Single Adoptive Parents, write to: National Council for Single Adoptive Parents, P.O. Box 55, Wharton, NJ 07885

McNamara and McNamara, Adoption and the Sexually Abused Child, 1990, available from the National Resource Center for Special Needs Adoption, Chelsea, MI

Melina, Lois Ruskai, Raising Adopted Children: A Manual for Adoptive Parents, Harper and Row, write: Harper and Row, Book Order, 2350 Virginia Avenue, Hagerstown,MD21740

Nickman, Steven, The Adoption Experience, Simon and Schuster, write to: Prentice Hall, Inc., 200 Old Tappan Road, Old Tappan, NJ 07675

U.S. Department of Health, Education and Welfare, Intercountry Adoption Guidelines, Washington, D.C., prepared by American Public Welfare Association for Children's Bureau, ACYF, OHDS, U.S. Department of Health, Education and Welfare, 1980

718

procedures and practices for adoption in philadelphia · procedures and practices for adoption in...

Documents