0250-07-13-.15
Adoption Consent Form For Minor Who Is Fourteen (14) Years Of
Cite as Tenn. Comp. R. & Regs. 0250-07-13-.15
AGE.
(1)
The following form is used to obtain the consent of a child who is fourteen (14) years of age
or older to his or her adoption as required by T.C.A. § 36-1-117(i).
(2)
This information shall be confidential and shall only be disclosed as provided by T.CA. §§ 36-
1-101 et seq.
(3)
Form:
ADOPTION PROCESS FORMS
CHAPTER 0250-07-13
CONSENT TO ADOPTION BY MINOR WHO IS FOURTEEN (14) YEARS OF
AGE OR OLDER
TENNESSEE CODE ANNOTATED, § 36-1-117(i)
STATE OF TENNESSEE
COUNTY OF ________________
Being duly sworn according to law, affiant would state:
1.
I am __________________________________________, (Use the Name of Minor Child Prior to Any Name Change
Requested in the Petition, Fourteen (14) Years of Age or Older), Born ___________________ (Date of Birth).
2.
I
understand
that
________________________________,
(Name
of
Prospective
Adoptive
Mother),
and
__________________________________, (Name of Prospective Adoptive Father) have filed a Petition to adopt me.
3.
I understand that if the Court enters an order of adoption based upon the Petition, that I will become the legal child of
_______________________________, (Name of Prospective Adoptive Mother), and ________________________________,
(Name of Prospective Adoptive Father), and that they will become my parent(s) for all purposes, just the same as if I had
originally been born to them (him/her).
4.
I understand that, while I remain under eighteen (18) years of age, my adoptive parent(s) will have the right to determine if I
should contact or visit with anyone in my birth family.
5.
I understand that I will have the right to inherit property from my adoptive parent(s), and their (his/her) descendants will have
the right to inherit property from me or my descendants but only for property I acquire after the adoption order is entered. After
the order of adoption is entered, I will not inherit property from my birth family, nor will they inherit property from me after the
order of adoption is entered. I may inherit from or through a parent whose rights were not terminated before his or her death.
6.
No one has pressured me to agree to this adoption, and I believe that my adoption by _______________________________,
(Name of Prospective Adoptive Mother), and ______________________________, (Name of Prospective Adoptive Father), is
in my best interests. I wish for the adoption to take place.
7.
I freely and voluntarily, without pressure from anyone, consent to this adoption.
This the _____ day of ____________, 20______
FURTHER AFFIANT SAITH NOT
Please Print: ____________________________________
Name of Minor Child
Signature: ____________________________________
Sworn to and subscribed before me this _____ day of __________, 20_____
Please Print:____________________________________
___ Chancellor ___ Circuit Judge of the
____________ Court for ________________
County, Tennessee.
Signature: ____________________________________