Bill Text: IL SB1999 | 2023-2024 | 103rd General Assembly | Introduced

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Reinserts the provisions of the engrossed bill with the following changes: Further amends the Abandoned Newborn Infant Protection Act. In a provision concerning a relinquished newborn infant under the temporary custody of a hospital, provides that the hospital shall provide all available medical records and information to the Department of Children and Family Services and the child welfare agency that has accepted the referral of the infant. Removes a provision making relinquished infants presumptively eligible for medical assistance under Article V of the Illinois Public Aid Code. Provides that if the person who relinquished or a person claiming to be the parent of a newborn infant (rather than the parent of a newborn infant) returns to reclaim the infant (rather than child) within 30 days after the infant was relinquished to a fire station, emergency medical facility, or police station, then the fire station, emergency medical facility, or police station must inform such person (rather than the parent) of the name and location of the hospital to which the infant was transported. Requires a hospital, police station, fire station, or emergency medical facility that accepts a relinquished infant to offer the relinquishing person information about the relinquishment process and other information. Provides that the failure to provide such information or the failure of the relinquishing person to accept such information shall not invalidate the relinquishment under the Act. In a provision concerning relinquished infants eligibility for medical assistance under Article V of the Illinois Public Aid Code, requires a hospital to complete and submit an application for medical assistance on behalf of a relinquished infant and permits the Department of Healthcare and Family Services to adopt rules. Makes changes concerning searches of the Illinois Putative Father Registry, petitions for return of custody, and other matters. Defines "parent", "biological parent", and "birth parent". Removes amendatory changes made to the Medical Assistance Article of the Illinois Public Aid Code concerning presumptive eligibility under the medical assistance program for relinquished infants.

Spectrum: Moderate Partisan Bill (Democrat 7-1)

Status: (Passed) 2023-08-04 - Public Act . . . . . . . . . 103-0501 [SB1999 Detail]

Download: Illinois-2023-SB1999-Introduced.html

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103RD GENERAL ASSEMBLY State of Illinois 2023 and 2024 SB1999 Introduced 2/9/2023, by Sen. Sara Feigenholtz SYNOPSIS AS INTRODUCED:
See Index
Amends the Abandoned Newborn Infant Protection Act. Replaces all instances of "child-placing agency" or "child placing agency" with "child welfare agency". In provisions concerning the Department of Children and Family Services' State Central Registry of child welfare agencies willing to take legal custody of relinquished newborn infants, provides that within 3 business days after accepting a referral from the Department, the child welfare agency shall file a petition for custody and request that the agency be given the authority to place the infant in an adoptive home, foster home, child care facility, or other facility appropriate for the needs of the infant. Prohibits filing or appearance fees for the petitioner. Provides that any issued custody order shall grant the child welfare agency the authority to make medical and health-related decisions for the infant. Provides that any infant who receives emergency or medical care under the Act shall be deemed presumptively eligible for medicaid assistance under the Illinois Public Aid Code. Provides that any health care provider or child welfare agency that provides medical services to an infant under the Act shall send all bills related to those medical services directly to the Department of Healthcare and Family Services for reimbursement. Makes conforming changes to the Medical Assistance Article of the Illinois Public Aid Code. Requires the Department of Healthcare and Family Services to submit for federal approval any waiver application or State Plan amendment as may be necessary to implement the presumptive eligibility provisions of the amendatory Act. Further amends the Abandoned Newborn Infant Protection Act by requiring a fire station or emergency medical facility that accepts a relinquished infant to inform the infant's parent of the name and location of the hospital to which the infant was transported if the parent returns to reclaim the infant within 30 days (rather than 72 hours) after relinquishing the infant. Amends the Immunization Data Registry Act, the Illinois Parentage Act of 2015, and the Adoption Act by replacing instances of "child-placing agency" or "child placing agency" with "child welfare agency".
LRB103 30669 KTG 57130 b
A BILL FOR
SB1999 LRB103 30669 KTG 57130 b
AN ACT concerning children.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
adding Section 5-1.7 as follows:
(305 ILCS 5/5-1.7 new)
Sec. 5-1.7. Presumptive eligibility; abandoned infants.
Notwithstanding any other provision of this Code, any newborn
infant who is relinquished and receives emergency or medical
care in accordance with the Abandoned Newborn Infant
Protection Act shall be deemed presumptively eligible for
medical assistance under this Article. The Department shall
accept and process all claims for reimbursement submitted by a
health care provider or child welfare agency that provides
medical services to an infant in accordance with the Abandoned
Newborn Infant Protection Act. The Department shall submit to
the Centers for Medicare and Medicaid Services for federal
approval any waiver application or State Plan amendment as may
be necessary to implement the provisions of this Section. As
used in this Section, "newborn infant" and "relinquished" have
the meanings ascribed to those terms in the Abandoned Newborn
Infant Protection Act.

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Section 10. The Abandoned Newborn Infant Protection Act is
amended by changing Sections 5, 10, 20, 22, 35, 37, 40, 50, and
55 as follows:
(325 ILCS 2/5)
Sec. 5. Public policy. Illinois recognizes that newborn
infants have been abandoned to the environment or to other
circumstances that may be unsafe to the newborn infant. These
circumstances have caused injury and death to newborn infants
and give rise to potential civil or criminal liability to
parents who may be under severe emotional distress. It is
recognized that establishing an adoption plan is preferable to
relinquishing a child using the procedures outlined in this
Act, but to reduce the chance of injury to a newborn infant,
this Act provides a safer alternative. This Act is intended to
provide a mechanism for a newborn infant to be relinquished to
a safe environment and for the parents of the infant to remain
anonymous if they choose and to avoid civil or criminal
liability for the act of relinquishing the infant. It is
recognized that establishing an adoption plan is preferable to
relinquishing a child using the procedures outlined in this
Act, but to reduce the chance of injury to a newborn infant,
this Act provides a safer alternative.
A public information campaign on this delicate issue shall
be implemented to encourage parents considering abandonment of
their newborn child to relinquish the child under the

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procedures outlined in this Act, to choose a traditional
adoption plan, or to parent a child themselves rather than
place the newborn infant in harm's way.
(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01.)
(325 ILCS 2/10)
Sec. 10. Definitions. In this Act:
"Abandon" has the same meaning as in the Abused and
Neglected Child Reporting Act.
"Abused child" has the same meaning as in the Abused and
Neglected Child Reporting Act.
"Child welfare Child-placing agency" means an Illinois a
licensed public or private agency that receives a child for
the purpose of placing or arranging for the placement of the
child in a foster pre-adoptive family home or other facility
for child care, apart from the custody of the child's parents.
"Department" or "DCFS" means the Illinois Department of
Children and Family Services.
"Emergency medical facility" means a freestanding
emergency center or trauma center, as defined in the Emergency
Medical Services (EMS) Systems Act.
"Emergency medical professional" includes licensed
physicians, and any emergency medical technician, emergency
medical technician-intermediate, advanced emergency medical
technician, paramedic, trauma nurse specialist, and
pre-hospital registered nurse, as defined in the Emergency

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Medical Services (EMS) Systems Act.
"Fire station" means a fire station within the State with
at least one staff person.
"Hospital" has the same meaning as in the Hospital
Licensing Act.
"Legal custody" means the relationship created by a court
order in the best interest of a newborn infant that imposes on
the infant's custodian the responsibility of physical
possession of the infant, the duty to protect, train, and
discipline the infant, and the duty to provide the infant with
food, shelter, education, and medical care, except as these
are limited by parental rights and responsibilities.
"Neglected child" has the same meaning as in the Abused
and Neglected Child Reporting Act.
"Newborn infant" means a child who a licensed physician
reasonably believes is 30 days old or less at the time the
child is initially relinquished to a hospital, police station,
fire station, or emergency medical facility, and who is not an
abused or a neglected child.
"Police station" means a municipal police station, a
county sheriff's office, a campus police department located on
any college or university owned or controlled by the State or
any private college or private university that is not owned or
controlled by the State when employees of the campus police
department are present, or any of the district headquarters of
the Illinois State Police.

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"Relinquish" means to bring a newborn infant, who a
licensed physician reasonably believes is 30 days old or less,
to a hospital, police station, fire station, or emergency
medical facility and to leave the infant with personnel of the
facility, if the person leaving the infant does not express an
intent to return for the infant or states that he or she will
not return for the infant. In the case of a mother who gives
birth to an infant in a hospital, the mother's act of leaving
that newborn infant at the hospital (i) without expressing an
intent to return for the infant or (ii) stating that she will
not return for the infant is not a "relinquishment" under this
Act.
"Temporary protective custody" means the temporary
placement of a newborn infant within a hospital or other
medical facility out of the custody of the infant's parent.
(Source: P.A. 97-293, eff. 8-11-11; 98-973, eff. 8-15-14.)
(325 ILCS 2/20)
Sec. 20. Procedures with respect to relinquished newborn
infants.
(a) Hospitals. Every hospital must accept and provide all
necessary emergency services and care to a relinquished
newborn infant, in accordance with this Act. The hospital
shall examine a relinquished newborn infant and perform tests
that, based on reasonable medical judgment, are appropriate in
evaluating whether the relinquished newborn infant was abused

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or neglected.
The act of relinquishing a newborn infant serves as
implied consent for the hospital and its medical personnel and
physicians on staff to treat and provide care for the infant.
The hospital shall be deemed to have temporary protective
custody of a relinquished newborn infant until the infant is
discharged to the custody of a child welfare child-placing
agency or the Department.
(a-5) Any infant who receives emergency or medical care
under this Act shall be deemed presumptively eligible for
medicaid assistance under Article V of the Illinois Public Aid
Code. Any health care provider or child welfare agency that
provides medical services to an infant under this Act shall
send all bills related to those medical services directly to
the Department of Healthcare and Family Services for
reimbursement.
(b) Fire stations and emergency medical facilities. Every
fire station and emergency medical facility must accept and
provide all necessary emergency services and care to a
relinquished newborn infant, in accordance with this Act.
The act of relinquishing a newborn infant serves as
implied consent for the fire station or emergency medical
facility and its emergency medical professionals to treat and
provide care for the infant, to the extent that those
emergency medical professionals are trained to provide those
services.

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After the relinquishment of a newborn infant to a fire
station or emergency medical facility, the fire station or
emergency medical facility's personnel must arrange for the
transportation of the infant to the nearest hospital as soon
as transportation can be arranged.
If the parent of a newborn infant returns to reclaim the
child within 30 days 72 hours after relinquishing the child to
a fire station or emergency medical facility, the fire station
or emergency medical facility must inform the parent of the
name and location of the hospital to which the infant was
transported.
(c) Police stations. Every police station must accept a
relinquished newborn infant, in accordance with this Act.
After the relinquishment of a newborn infant to a police
station, the police station must arrange for the
transportation of the infant to the nearest hospital as soon
as transportation can be arranged. The act of relinquishing a
newborn infant serves as implied consent for the hospital to
which the infant is transported and that hospital's medical
personnel and physicians on staff to treat and provide care
for the infant.
If the parent of a newborn infant returns to reclaim the
infant within 72 hours after relinquishing the infant to a
police station, the police station must inform the parent of
the name and location of the hospital to which the infant was
transported.

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(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
93-820, eff. 7-27-04.)
(325 ILCS 2/22)
Sec. 22. Signage Signs. Every hospital, fire station,
emergency medical facility, and police station that is
required to accept a relinquished newborn infant in accordance
with this Act must post, either by physical or electronic
means, a sign in a conspicuous place on the exterior of the
building housing the facility informing persons that a newborn
infant may be relinquished at the facility in accordance with
this Act. The Department shall prescribe specifications for
the signs and for their placement that will ensure statewide
uniformity.
This Section does not apply to a hospital, fire station,
emergency medical facility, or police station that has a sign
that is consistent with the requirements of this Section that
is posted on the effective date of this amendatory Act of the
95th General Assembly.
(Source: P.A. 102-4, eff. 4-27-21.)
(325 ILCS 2/35)
Sec. 35. Information for relinquishing person.
(a) A hospital, police station, fire station, or emergency
medical facility that receives a newborn infant relinquished
in accordance with this Act must offer an information packet

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to the relinquishing person and, if possible, must clearly
inform the relinquishing person that his or her acceptance of
the information is completely voluntary. The information
packet must include all of the following:
(1) (Blank).
(2) Written notice of the following:
(A) No sooner than 60 days following the date of
the initial relinquishment of the infant to a
hospital, police station, fire station, or emergency
medical facility, the child welfare child-placing
agency or the Department will commence proceedings for
the termination of parental rights and placement of
the infant for adoption.
(B) Failure of a parent of the infant to contact
the Department and petition for the return of custody
of the infant before termination of parental rights
bars any future action asserting legal rights with
respect to the infant.
(3) A resource list of providers of counseling
services including grief counseling, pregnancy counseling,
and counseling regarding adoption and other available
options for placement of the infant.
Upon request of a parent, the Department of Public Health
shall provide the application forms for the Illinois Adoption
Registry and Medical Information Exchange.
(b) The information packet given to a relinquishing parent

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in accordance with this Act shall include, in addition to
other information required under this Act, the following:
(1) A brochure (with a self-mailer attached) that
describes this Act and the rights of birth parents,
including an optional section for the parent to complete
and mail to the Department of Children and Family
Services, that shall ask for basic anonymous background
information about the relinquished child. This brochure
shall be maintained by the Department on its website.
(2) A brochure that describes the Illinois Adoption
Registry, including a toll-free number and website
information. This brochure shall be maintained on the
Office of Vital Records website.
(3) A brochure describing postpartum health
information for the mother.
The information packet shall be designed in coordination
between the Office of Vital Records and the Department of
Children and Family Services, with the exception of the
resource list of providers of counseling services and adoption
agencies, which shall be provided by the hospital, fire
station, police station, sheriff's office, or emergency
medical facility.
(Source: P.A. 96-1114, eff. 7-20-10; 97-333, eff. 8-12-11.)
(325 ILCS 2/37)
Sec. 37. Public disclosure of information prohibited.

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Emergency medical professionals, employees, or other persons
engaged in the administration or operation of a fire station,
police station, hospital, emergency medical facility, child
welfare child placing agency, or the Department where a
newborn infant baby has been relinquished or transferred under
this Act, are prohibited from publicly disclosing any
information concerning the relinquishment of the infant and
the individuals involved, except as otherwise provided by law.
(Source: P.A. 95-549, eff. 6-1-08.)
(325 ILCS 2/40)
Sec. 40. Reporting requirements.
(a) Within 12 hours after accepting a newborn infant from
a relinquishing person or from a police station, fire station,
or emergency medical facility in accordance with this Act, a
hospital must report to the Department's State Central
Registry for the purpose of transferring physical custody of
the infant from the hospital to either a child welfare
child-placing agency or the Department.
(b) Within 24 hours after receiving a report under
subsection (a), the Department must request assistance from
law enforcement officials to investigate the matter using the
National Crime Information Center to ensure that the
relinquished newborn infant is not a missing child.
(c) Once a hospital has made a report to the Department
under subsection (a), the Department must arrange for a

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licensed child welfare child-placing agency to accept physical
custody of the relinquished newborn infant.
(d) If a relinquished child is not a newborn infant as
defined in this Act, the hospital and the Department must
proceed as if the child is an abused or neglected child.
(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
93-820, eff. 7-27-04.)
(325 ILCS 2/50)
Sec. 50. Child welfare Child-placing agency procedures.
(a) The Department's State Central Registry must maintain
a list of licensed child welfare child-placing agencies
willing to take legal custody of newborn infants relinquished
in accordance with this Act. The child welfare child-placing
agencies on the list must be contacted by the Department on a
rotating basis upon notice from a hospital that a newborn
infant has been relinquished in accordance with this Act.
(b) Upon notice from the Department that a newborn infant
has been relinquished in accordance with this Act, a child
welfare child-placing agency must accept the newborn infant if
the agency has the accommodations to do so. The child welfare
child-placing agency must seek an order for legal custody of
the infant upon its acceptance of the infant.
(c) Within 3 business days after accepting the referral
from the Department assuming physical custody of the infant,
the child welfare child-placing agency shall file a petition

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for custody in the division of the circuit court in which
petitions for adoption would normally be heard. The petition
for custody shall allege that the newborn infant has been
relinquished in accordance with this Act and shall request
state that the child welfare child-placing agency be given the
authority intends to place the infant in an adoptive home,
foster home, child care facility, or other facility
appropriate for the needs of the infant. No filing or
appearance fees shall be charged to any petitioner.
(d) If no licensed child welfare child-placing agency is
able to accept the relinquished newborn infant, then the
Department must assume responsibility for the infant as soon
as practicable.
(e) A custody order issued under subsection (b) shall
grant the child welfare agency the authority to make medical
and health-related decisions for the infant. The order shall
remain in effect until a final adoption order based on the
relinquished newborn infant's best interests is issued in
accordance with this Act and the Adoption Act.
(f) When possible, the child welfare child-placing agency
must place a relinquished newborn infant in a prospective
adoptive home.
(g) The Department or child welfare child-placing agency
must initiate proceedings to (i) terminate the parental rights
of the relinquished newborn infant's known or unknown parents,
(ii) appoint a guardian for the infant, and (iii) obtain

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consent to the infant's adoption in accordance with this Act
no sooner than 60 days following the date of the initial
relinquishment of the infant to the hospital, police station,
fire station, or emergency medical facility.
(h) Before filing a petition for termination of parental
rights, the Department or child welfare child-placing agency
must do the following:
(1) Search its Putative Father Registry for the
purpose of determining the identity and location of the
putative father of the relinquished newborn infant who is,
or is expected to be, the subject of an adoption
proceeding, in order to provide notice of the proceeding
to the putative father. At least one search of the
Registry must be conducted, at least 30 days after the
relinquished newborn infant's estimated date of birth;
earlier searches may be conducted, however. Notice to any
potential putative father discovered in a search of the
Registry according to the estimated age of the
relinquished newborn infant must be in accordance with
Section 12a of the Adoption Act.
(2) Verify with law enforcement officials, using the
National Crime Information Center, that the relinquished
newborn infant is not a missing child.
(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;
93-820, eff. 7-27-04.)

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(325 ILCS 2/55)
Sec. 55. Petition for return of custody.
(a) A parent of a newborn infant relinquished in
accordance with this Act may petition for the return of
custody of the infant before the termination of parental
rights with respect to the infant.
(b) A parent of a newborn infant relinquished in
accordance with this Act may petition for the return of
custody of the infant by contacting the Department for the
purpose of obtaining the name of the child welfare
child-placing agency and then filing a petition for return of
custody in the circuit court in which the proceeding for the
termination of parental rights is pending.
(c) If a petition for the termination of parental rights
has not been filed by the Department or the child welfare
child-placing agency, the parent of the relinquished newborn
infant must contact the Department, which must notify the
parent of the appropriate court in which the petition for
return of custody must be filed.
(d) The circuit court may hold the proceeding for the
termination of parental rights in abeyance for a period not to
exceed 60 days from the date that the petition for return of
custody was filed without a showing of good cause. During that
period:
(1) The court shall order genetic testing to establish
maternity or paternity, or both.

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(2) The Department shall conduct a child protective
investigation and home study to develop recommendations to
the court.
(3) When indicated as a result of the Department's
investigation and home study, further proceedings under
the Juvenile Court Act of 1987 as the court determines
appropriate, may be conducted. However, relinquishment of
a newborn infant in accordance with this Act does not
render the infant abused, neglected, or abandoned solely
because the newborn infant was relinquished to a hospital,
police station, fire station, or emergency medical
facility in accordance with this Act.
(e) Failure to file a petition for the return of custody of
a relinquished newborn infant before the termination of
parental rights bars any future action asserting legal rights
with respect to the infant unless the parent's act of
relinquishment that led to the termination of parental rights
involved fraud perpetrated against and not stemming from or
involving the parent. No action to void or revoke the
termination of parental rights of a parent of a newborn infant
relinquished in accordance with this Act, including an action
based on fraud, may be commenced after 12 months after the date
that the newborn infant was initially relinquished to a
hospital, police station, fire station, or emergency medical
facility.
(Source: P.A. 92-408, eff. 8-17-01; 92-432, eff. 8-17-01;

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93-820, eff. 7-27-04.)
Section 15. The Immunization Data Registry Act is amended
by changing Section 20 as follows:
(410 ILCS 527/20)
Sec. 20. Confidentiality of information; release of
information; statistics; panel on expanding access.
(a) Records maintained as part of the immunization data
registry are confidential.
(b) The Department may release an individual's
confidential information to the individual or to the
individual's parent or guardian if the individual is less than
18 years of age.
(c) Subject to subsection (d) of this Section, the
Department may release information in the immunization data
registry concerning an individual to the following entities:
(1) The immunization data registry of another state.
(2) A health care provider or a health care provider's
designee.
(3) A local health department.
(4) An elementary or secondary school that is attended
by the individual.
(5) A licensed child care center in which the
individual is enrolled.
(6) A licensed child welfare child-placing agency.

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(7) A college or university that is attended by the
individual.
(8) The Department of Healthcare and Family Services
or a managed care entity contracted with the Department of
Healthcare and Family Services to coordinate the provision
of medical care to enrollees of the medical assistance
program.
(d) Before immunization data may be released to an entity,
the entity must enter into an agreement with the Department
that provides that information that identifies a patient will
not be released to any other person without the written
consent of the patient.
(e) The Department may release summary statistics
regarding information in the immunization data registry if the
summary statistics do not reveal the identity of an
individual.
(Source: P.A. 97-117, eff. 7-14-11; 98-651, eff. 6-16-14.)
Section 20. The Illinois Parentage Act of 2015 is amended
by changing Section 602 as follows:
(750 ILCS 46/602)
Sec. 602. Standing. A complaint to adjudicate parentage
shall be verified, shall be designated a petition, and shall
name the person or persons alleged to be the parent of the
child. Subject to Article 3 and Sections 607, 608, and 609 of

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this Act, a proceeding to adjudicate parentage may be
maintained by:
(a) the child;
(b) the mother of the child;
(c) a pregnant woman;
(d) a man presumed or alleging himself to be the
parent of the child;
(e) a woman presumed or alleging herself to be the
parent of the child;
(f) the support-enforcement agency or other
governmental agency authorized by other law;
(g) any person or public agency that has physical
possession of or has custody of or has been allocated
parental responsibilities for, is providing financial
support to, or has provided financial support to the
child;
(h) the Department of Healthcare and Family Services
if it is providing, or has provided, financial support to
the child or if it is assisting with child support
collections services;
(i) an authorized adoption agency or licensed child
welfare child-placing agency;
(j) a representative authorized by law to act for an
individual who would otherwise be entitled to maintain a
proceeding but who is deceased, incapacitated, or a minor;
or

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(k) an intended parent.
(Source: P.A. 99-85, eff. 1-1-16; 99-769, eff. 1-1-17.)
Section 25. The Adoption Act is amended by changing
Sections 4.1 and 10 as follows:
(750 ILCS 50/4.1) (from Ch. 40, par. 1506)
Sec. 4.1. Adoption between multiple jurisdictions. It is
the public policy of this State to promote child welfare in
adoption between multiple jurisdictions by implementing
standards that foster permanency for children in an
expeditious manner while considering the best interests of the
child as paramount. Ensuring that standards for
interjurisdictional adoption are clear and applied
consistently, efficiently, and reasonably will promote the
best interests of the child in finding a permanent home.
(a) The Department of Children and Family Services shall
promulgate rules regarding the approval and regulation of
agencies providing, in this State, adoption services, as
defined in Section 2.24 of the Child Care Act of 1969, which
shall include, but not be limited to, a requirement that any
agency shall be licensed in this State as a child welfare
agency as defined in Section 2.08 of the Child Care Act of
1969. Any out-of-state agency, if not licensed in this State
as a child welfare agency, must obtain the approval of the
Department in order to act as a sending agency, as defined in

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Section 1 of the Interstate Compact on Placement of Children
Act, seeking to place a child into this State through a
placement subject to the Interstate Compact on the Placement
of Children. An out-of-state agency, if not licensed in this
State as a child welfare agency, is prohibited from providing
in this State adoption services, as defined by Section 2.24 of
the Child Care Act of 1969; shall comply with Section 12C-70 of
the Criminal Code of 2012; and shall provide all of the
following to the Department:
(1) A copy of the agency's current license or other
form of authorization from the approving authority in the
agency's state. If no license or authorization is issued,
the agency must provide a reference statement, from the
approving authority, stating that the agency is authorized
to place children in foster care or adoption or both in its
jurisdiction.
(2) A description of the program, including home
studies, placements, and supervisions, that the child
welfare child placing agency conducts within its
geographical area, and, if applicable, adoptive placements
and the finalization of adoptions. The child welfare child
placing agency must accept continued responsibility for
placement planning and replacement if the placement fails.
(3) Notification to the Department of any significant
child welfare child placing agency changes after approval.
(4) Any other information the Department may require.

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The rules shall also provide that any agency that places
children for adoption in this State may not, in any policy or
practice relating to the placement of children for adoption,
discriminate against any child or prospective adoptive parent
on the basis of race.
(a-5) (Blank).
(b) Interstate adoptions.
(1) All interstate adoption placements under this Act
shall comply with the Child Care Act of 1969 and the
Interstate Compact on the Placement of Children. The
placement of children with relatives by the Department of
Children and Family Services shall also comply with
subsection (b) of Section 7 of the Children and Family
Services Act. The Department may promulgate rules to
implement interstate adoption placements, including those
requirements set forth in this Section.
(2) If an adoption is finalized prior to bringing or
sending a child to this State, compliance with the
Interstate Compact on the Placement of Children is not
required.
(3) Approval requirements. The Department shall
promulgate procedures for interstate adoption placements
of children under this Act. No later than September 24,
2017 (30 days after the effective date of Public Act
100-344), the Department shall distribute a written list
of all preadoption approval requirements to all Illinois

SB1999 - 23 - LRB103 30669 KTG 57130 b
licensed child welfare agencies performing adoption
services, and all out-of-state agencies approved under
this Section, and shall post the requirements on the
Department's website. The Department may not require any
further preadoption requirements other than those set
forth in the procedures required under this paragraph. The
procedures shall reflect the standard of review as stated
in the Interstate Compact on the Placement of Children and
approval shall be given by the Department if the placement
appears not to be contrary to the best interests of the
child.
(4) Time for review and decision. In all cases where
the child to be placed is not a youth in care in Illinois
or any other state, a provisional or final approval for
placement shall be provided in writing from the Department
in accordance with the Interstate Compact on the Placement
of Children. Approval or denial of the placement must be
given by the Department as soon as practicable, but in no
event more than 3 business days of the receipt of the
completed referral packet by the Department's Interstate
Compact Administrator. Receipt of the packet shall be
evidenced by the packet's arrival at the address
designated by the Department to receive such referrals.
The written decision to approve or deny the placement
shall be communicated in an expeditious manner, including,
but not limited to, electronic means referenced in

SB1999 - 24 - LRB103 30669 KTG 57130 b
paragraph (b)(7) of this Section, and shall be provided to
all Illinois licensed child welfare agencies involved in
the placement, all out-of-state child placing agencies
involved in the placement, and all attorneys representing
the prospective adoptive parent or biological parent. If,
during its initial review of the packet, the Department
believes there are any incomplete or missing documents, or
missing information, as required in paragraph (b)(3), the
Department shall, as soon as practicable, but in no event
more than 2 business days of receipt of the packet,
communicate a list of any incomplete or missing documents
and information to all Illinois licensed child welfare
agencies involved in the placement, all out-of-state child
placing agencies involved in the placement, and all
attorneys representing the adoptive parent or biological
parent. This list shall be communicated in an expeditious
manner, including, but not limited to, electronic means
referenced in paragraph (b)(7) of this Section.
(5) Denial of approval. In all cases where the child
to be placed is not a youth in the care of any state, if
the Department denies approval of an interstate placement,
the written decision referenced in paragraph (b)(4) of
this Section shall set forth the reason or reasons why the
placement was not approved and shall reference which
requirements under paragraph (b)(3) of this Section were
not met. The written decision shall be communicated in an

SB1999 - 25 - LRB103 30669 KTG 57130 b
expeditious manner, including, but not limited to,
electronic means referenced in paragraph (b)(7) of this
Section, to all Illinois licensed child welfare agencies
involved in the placement, all out-of-state child placing
agencies involved in the placement, and all attorneys
representing the prospective adoptive parent or biological
parent.
(6) Provisional approval. Nothing in paragraphs (b)(3)
through (b)(5) of this Section shall preclude the
Department from issuing provisional approval of the
placement pending receipt of any missing or incomplete
documents or information.
(7) Electronic communication. All communications
concerning an interstate placement made between the
Department and an Illinois licensed child welfare agency,
an out-of-state child placing agency, and attorneys
representing the prospective adoptive parent or biological
parent, including the written communications referenced in
this Section, may be made through any type of electronic
means, including, but not limited to, electronic mail.
(c) Intercountry adoptions. The adoption of a child, if
the child is a habitual resident of a country other than the
United States and the petitioner is a habitual resident of the
United States, or, if the child is a habitual resident of the
United States and the petitioner is a habitual resident of a
country other than the United States, shall comply with the

SB1999 - 26 - LRB103 30669 KTG 57130 b
Intercountry Adoption Act of 2000, as amended, and the
Immigration and Nationality Act, as amended. In the case of an
intercountry adoption that requires oversight by the adoption
services governed by the Intercountry Adoption Universal
Accreditation Act of 2012, this State shall not impose any
additional preadoption requirements.
(d) (Blank).
(e) Re-adoption after an intercountry adoption.
(1) Any time after a minor child has been adopted in a
foreign country and has immigrated to the United States,
the adoptive parent or parents of the child may petition
the court for a judgment of adoption to re-adopt the child
and confirm the foreign adoption decree.
(2) The petitioner must submit to the court one or
more of the following to verify the foreign adoption:
(i) an immigrant visa for the child issued by
United States Citizenship and Immigration Services of
the U.S. Department of Homeland Security that was
valid at the time of the child's immigration;
(ii) a decree, judgment, certificate of adoption,
adoption registration, or equivalent court order,
entered or issued by a court of competent jurisdiction
or administrative body outside the United States,
establishing the relationship of parent and child by
adoption; or
(iii) such other evidence deemed satisfactory by

SB1999 - 27 - LRB103 30669 KTG 57130 b
the court.
(3) The child's immigrant visa shall be prima facie
proof that the adoption was established in accordance with
the laws of the foreign jurisdiction and met United States
requirements for immigration.
(4) If the petitioner submits documentation that
satisfies the requirements of paragraph (2), the court
shall not appoint a guardian ad litem for the minor who is
the subject of the proceeding, shall not require any
further termination of parental rights of the child's
biological parents, nor shall it require any home study,
investigation, post-placement visit, or background check
of the petitioner.
(5) The petition may include a request for change of
the child's name and any other request for specific relief
that is in the best interests of the child. The relief may
include a request for a revised birth date for the child if
supported by evidence from a medical or dental
professional attesting to the appropriate age of the child
or other collateral evidence.
(6) Two adoptive parents who adopted a minor child
together in a foreign country while married to one another
may file a petition for adoption to re-adopt the child
jointly, regardless of whether their marriage has been
dissolved. If either parent whose marriage was dissolved
has subsequently remarried or entered into a civil union

SB1999 - 28 - LRB103 30669 KTG 57130 b
with another person, the new spouse or civil union partner
shall not join in the petition to re-adopt the child,
unless the new spouse or civil union partner is seeking to
adopt the child. If either adoptive parent does not join
in the petition, he or she must be joined as a party
defendant. The defendant parent's failure to participate
in the re-adoption proceeding shall not affect the
existing parental rights or obligations of the parent as
they relate to the minor child, and the parent's name
shall be placed on any subsequent birth record issued for
the child as a result of the re-adoption proceeding.
(7) An adoptive parent who adopted a minor child in a
foreign country as an unmarried person may file a petition
for adoption to re-adopt the child as a sole petitioner,
even if the adoptive parent has subsequently married or
entered into a civil union.
(8) If one of the adoptive parents who adopted a minor
child dies prior to a re-adoption proceeding, the deceased
parent's name shall be placed on any subsequent birth
record issued for the child as a result of the re-adoption
proceeding.
(Source: P.A. 99-49, eff. 7-15-15; 100-344, eff. 8-25-17;
100-863, eff. 8-14-18.)
(750 ILCS 50/10) (from Ch. 40, par. 1512)
Sec. 10. Forms of consent and surrender; execution and

SB1999 - 29 - LRB103 30669 KTG 57130 b
acknowledgment thereof.
A. The form of consent required for the adoption of a born
child shall be substantially as follows:
FINAL AND IRREVOCABLE CONSENT TO ADOPTION
I, ...., (relationship, e.g., mother, father, relative,
guardian) of ...., a male or female (circle one) child, state:
That such child was born on .... at ....
That I reside at ...., County of .... and State of ....
That I am of the age of .... years.
That I hereby enter my appearance in this proceeding and
waive service of summons on me.
That I hereby acknowledge that I have been provided with a
copy of the Birth Parent Rights and Responsibilities-Private
Form before signing this Consent and that I have had time to
read, or have had read to me, this Form. I understand that if I
do not receive any of the rights as described in this Form, it
shall not constitute a basis to revoke this Final and
Irrevocable Consent.
That I do hereby consent and agree to the adoption of such
child.
That I wish to and understand that by signing this consent
I do irrevocably and permanently give up all custody and other
parental rights I have to such child.
That I understand such child will be placed for adoption

SB1999 - 30 - LRB103 30669 KTG 57130 b
and that I cannot under any circumstances, after signing this
document, change my mind and revoke or cancel this consent or
obtain or recover custody or any other rights over such child.
That I have read and understand the above and I am signing it
as my free and voluntary act.
Dated (insert date).
.........................
If under Section 8 the consent of more than one person is
required, then each such person shall execute a separate
consent.
A-1. (1) The form of the Final and Irrevocable Consent to
Adoption by a Specified Person or Persons: Non-DCFS Case set
forth in this subsection A-1 is to be used by legal parents
only. This form is not to be used in cases in which there is a
pending petition under Section 2-13 of the Juvenile Court Act
of 1987.
(2) The form of the Final and Irrevocable Consent to
Adoption by a Specified Person or Persons in a non-DCFS case
shall have the caption of the proceeding in which it is to be
filed and shall be substantially as follows:
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
A SPECIFIED PERSON OR PERSONS; NON-DCFS CASE
I, ...., (relationship, e.g., mother, father) of ...., a

SB1999 - 31 - LRB103 30669 KTG 57130 b
male or female (circle one) child, state:
1. That such child was born on ...., at ....., in the
City/Town of ... and State of ....
2. That I reside at ...., County of .... and State of ....,
my email address (if I have one) is .... my cell phone number
where I can receive text messages (if I have one) is .... and
my land line phone number (if I have one) is ...., and any
other contact information is ....
3. That I am of the age of .... years.
4. That I hereby enter my appearance in this proceeding
and waive service of summons on me.
5. That I hereby acknowledge that I have been provided a
copy of the Birth Parent Rights and Responsibilities-Private
Form before signing this Consent and that I have had time to
read, or have had read to me, this Form and that I understand
the Rights and Responsibilities described in this Form. I
understand that if I do not receive any of my rights as
described in said Form, it shall not constitute a basis to
revoke this Final and Irrevocable Consent to Adoption by a
Specified Person.
6. That I do hereby consent and agree to the adoption of
such child by .... (specified person or persons) only. If only
first names are used for the specified person or persons, I
voluntarily sign this specified consent form without
disclosure to me of the last name of the specified person or
persons. However, I understand that if I wish to know the last

SB1999 - 32 - LRB103 30669 KTG 57130 b
name of the specified person or persons, I may request it
before signing the form. If I do not receive the last name, I
may choose not to sign the specified consent form.
7. That I wish to and understand that upon signing this
consent I do irrevocably and permanently give up all custody
and other parental rights I have to such child if such child is
adopted by .... (specified person or persons). I hereby
transfer all of my rights to the custody, care and control of
such child to ............................. (specified person
or persons).
8. That I understand such child will be adopted by
....................... (specified person or persons) and that
I cannot under any circumstances, after signing this document,
change my mind and revoke or cancel this consent or obtain or
recover custody or any other rights over such child if
............................ (specified person or persons)
adopt(s) such child; PROVIDED that each specified person has
filed or shall file, within 60 days from the date hereof, a
petition for the adoption of such child.
9. That if the specified person or persons designated
herein do not file a petition for adoption within the
time-frame specified above, or, if said petition for adoption
is filed within the time-frame specified above but the
adoption petition is dismissed with prejudice or the adoption
proceeding is otherwise concluded without an order declaring
the child to be the adopted child of the specified person or

SB1999 - 33 - LRB103 30669 KTG 57130 b
persons, then I understand that I will be sent written notice
of such circumstances at the mailing address, at the email
address, through a text message to my cell phone number, and to
any other contact information I have provided in paragraph 2
within 5 business days of this occurrence. I understand that
the notice will be directed to me using the contact
information I have provided in this consent. I understand that
I will have 15 business days from the date that the written
notice is sent to me to respond in the manner described in the
notice, within which time I may request the Court to declare
this consent voidable and return the child to me. I further
understand that the Court will make the final decision of
whether or not the child will be returned to me. If I do not
make such request within 15 business days of the date the
notice was sent, then I expressly waive any other notice or
service of process in any legal proceeding regarding the
child, including a legal proceeding for someone other than
..... (specified person or persons) to adopt the child, and
that I will have no parental rights as to the child. The person
sending the notice shall file an affidavit of notice as proof
of the date sent.
10. That I expressly acknowledge that nothing in this
Consent impairs the validity and absolute finality of this
Consent under any circumstance other than those described in
paragraph 9 of this Consent.
11. That I understand that I have a remaining duty and

SB1999 - 34 - LRB103 30669 KTG 57130 b
obligation to keep .............. (insert name and address of
the attorney for the specified person or persons) informed of
my current address or other preferred contact information
until this adoption has been finalized. My failure to do so may
result in the termination of my parental rights and the child
being placed for adoption in another home.
12. That I do expressly waive any other notice or service
of process in any of the legal proceedings for the adoption of
the child as long as the adoption proceeding by the specified
person or persons is pending.
13. That I have read and understand the above and I am
signing it as my free and voluntary act.
14. That I acknowledge that this consent is valid even if
the specified person or persons separate or divorce or one of
the specified persons dies prior to the entry of the final
judgment for adoption.
Dated (insert date).
.............................................
Signature of parent.
.............................................
Address of parent.
.............................................
Phone number(s) of parent.
.............................................
Personal email(s) of parent.
.............................................

SB1999 - 35 - LRB103 30669 KTG 57130 b
(3) The form of the certificate of acknowledgement for a
Final and Irrevocable Consent for Adoption by a Specified
Person or Persons: Non-DCFS Case shall be substantially as
follows:
STATE OF ..............)
) SS.
COUNTY OF .............)
I, .................... (Name of Judge or other person),
..................... (official title, name, and address),
certify that ............., personally known to me to be the
same person whose name is subscribed to the foregoing Final
and Irrevocable Consent for Adoption by a Specified Person or
Persons; non-DCFS case, appeared before me this day in person
and acknowledged that (she)(he) signed and delivered the
consent as (her)(his) free and voluntary act, for the
specified purpose. I am further satisfied that, before signing
this Consent, ........ has read, or has had read to him or her,
the Birth Parent Rights and Responsibilities-Private Form.
A-2. Birth Parent Rights and Responsibilities-Private
Form. The Birth Parent Rights and Responsibilities-Private
Form must be read by, or have been read to, any person
executing a Final and Irrevocable Consent to Adoption under
subsection A, a Final and Irrevocable Consent to Adoption by a

SB1999 - 36 - LRB103 30669 KTG 57130 b
Specified Person or Persons: Non-DCFS Case under subsection
A-1, or a Consent to Adoption of Unborn Child under subsection
B prior to the execution of said Consent. The form of the Birth
Parent Rights and Responsibilities-Private Form shall be
substantially as follows:
Birth Parent Rights and Responsibilities-Private Form
THIS FORM DOES NOT CONSTITUTE LEGAL ADVICE. LEGAL ADVICE IS
DEPENDENT ON THE SPECIFIC CIRCUMSTANCES OF EACH SITUATION AND
JURISDICTION. THE INFORMATION IN THIS FORM CANNOT REPLACE THE
ADVICE OF AN ATTORNEY LICENSED IN YOUR STATE.
As a birth parent in the State of Illinois, you have the
right:
1. To have your own attorney represent you. The
prospective adoptive parents may agree to pay for the cost of
your attorney in a manner consistent with Illinois law, but
they are not required to do so.
2. To be treated with dignity and respect at all times and
to make decisions free from coercion and pressure.
3. To request to receive counseling before and after
signing a Final and Irrevocable Consent to Adoption
("Consent"), a Final and Irrevocable Consent to Adoption by a
Specified Person or Persons: Non-DCFS Case ("Specified
Consent"), or a Consent to Adoption of Unborn Child ("Unborn
Consent"). The prospective adoptive parents may agree to pay

SB1999 - 37 - LRB103 30669 KTG 57130 b
for the cost of counseling in a manner consistent with
Illinois law, but they are not required to do so.
4. To ask to be involved in choosing your child's
prospective adoptive parents and to ask to meet them.
5. To ask your child's prospective adoptive parents any
questions that pertain to your decision to place your child
with them.
6. To see your child before signing a Consent or Specified
Consent if you are the custodial parent, and to request to see
your child if you are not the custodial parent.
7. To request contact with your child and/or the child's
prospective adoptive parents, with the understanding that any
promises regarding contact with your child or receipt of
information about the child after signing a Consent, Specified
Consent, or Unborn Consent cannot be enforced under Illinois
law.
8. To receive copies of all documents that you sign and
have those documents provided to you in your preferred
language.
9. To request that your identifying information remain
confidential, unless required otherwise by Illinois law or
court order, and to voluntarily share your medical,
background, and identifying information, including information
on the original birth certificate of your child. This can be
done through the Illinois Adoption Registry and Medical
Information Exchange or through completing the Birth Parent

SB1999 - 38 - LRB103 30669 KTG 57130 b
Preference Form. Please visit http://dph.illinois.gov or
www.newillinoisadoptionlaw.com.
10. To access the Confidential Intermediary Program which
provides a way for a court appointed person to connect and/or
exchange information between adoptees, adoptive parents and
birth parents, and other biological family members, provided
in most cases that mutual consent is given. Please visit
www.ci-illinois.org or call [phone](x29).
11. To work with an adoption agency or attorney of your
choice, or change said agency or attorney, provided you
promptly inform all of the parties currently involved.
12. To receive, upon request, a written list of any
promised support, financial or otherwise, from your attorney
or the attorney for your child's prospective adoptive parents.
13. To delay signing a Consent, Specified Consent, or
Unborn Consent if you are not ready to do so.
14. To decline to sign a Consent, Specified Consent, or
Unborn Consent even if you have received financial support
from the prospective adoptive parents.
If you do not receive any of the rights described in this
Form, it shall not be a basis to revoke a Consent, Specified
Consent, or Unborn Consent.
As a Birth Parent in the State of Illinois, you have the
responsibility:
1. To carefully consider your reasons for choosing
adoption.

SB1999 - 39 - LRB103 30669 KTG 57130 b
2. (Birth mothers only) To accurately complete an
Affidavit of Identification, which identifies the father of
the child when known, with the understanding that a birth
mother has a right to decline to identify the birth father.
3. To provide the necessary documentation regarding
financial need to make an appropriate determination of
reasonable pregnancy-related expenses.
4. To not accept financial support or reimbursement of
pregnancy related expenses simultaneously from more than one
source or if you are not pregnant, as doing so is a crime.
5. To voluntarily provide all known medical, background,
and family information about yourself and your immediate
family to your child's prospective adoptive parents or their
attorney. For the health of your child, you are strongly
encouraged, but not required, to do so as set forth on the
following form:
Birth Parent Medical Information
The purpose of this form is to gather your health history,
genetic history, and social background information to share
with the adoptive parents. It is important the adoptive family
provide this information to the child's physician. It will
become a part of the child's medical and family history. This
form, in its entirety, will be given to the adoptive
parent(s).
The following information is true and complete to the best
of my knowledge and belief.

SB1999 - 40 - LRB103 30669 KTG 57130 b
Birth parent name:
......................................
Signature:
..............................................
Date:....................................................
YES or NO (circle one) I agree to release my full name on
this form to the adoptive family. If NO is circled then the
birth parent's name shall be redacted on this form.
MOTHER'S PHYSICAL CHARACTERISTICS:
Eyes: ... Hair: .... Complexion: .... Height: ....
Weight: .... Body build: ..... Race: .....
Nationality/Descent: ....... Blood type: .... Rh factor: ....
Eye glasses or contact lenses? Yes /.../ No /.../
Right /.../ Left /.../ handed
Age: .... or Date of birth: ..... Religion: .................
Please list your highest education level, occupation,
hobbies, interests, and talents:
............................
Existence of any disabilities? Yes /.../ No /.../
If yes, explain:.............................................
If you have other children, list them below. Include any
children previously placed for adoption.
....................
Describe your relationship with the birth father: .......
FATHER'S PHYSICAL CHARACTERISTICS:
Eyes: ... Hair: .... Complexion: .... Height: ....

SB1999 - 41 - LRB103 30669 KTG 57130 b
Weight: .... Body build: ..... Race: .....
Nationality/Descent: ....... Blood type: .... Rh factor: ....
Eye glasses or contact lenses? Yes /.../ No /.../
Right /.../ Left /.../ handed
Age: .... or Date of birth: ..... Religion: .................
Please list your highest education level, occupation,
hobbies, interests, and talents:
............................
Existence of any disabilities? Yes /.../ No /.../
If yes, explain:.............................................
If you have other children, list them below. Include any
children previously placed for adoption.
....................
PREGNANCY HISTORY INVOLVING THIS CHILD
Month prenatal care began during this pregnancy:.........
Complications during pregnancy: Yes ... No ... If yes,
explain: ....................................................
.............................................................
MEDICATION AND OTHER SUBSTANCES USED DURING
PREGNANCY OR YEAR PRIOR TO PREGNANCY
FREQUENCY/ FREQUENCY/
AMOUNT AMOUNT
DURING PRIOR TO
YES NO PREGNANCY PREGNANCY
Alcohol /../ /../ ................. ...............
Amphetamines /../ /../ ................. ...............

SB1999 - 42 - LRB103 30669 KTG 57130 b
Barbiturates /../ /../ ................. ...............
Cocaine /../ /../ ................. ...............
Heroin /../ /../ ................. ...............
LSD /../ /../ ................. ...............
Marijuana /../ /../ ................. ...............
Caffeine
(Coffee,
tea, etc) /../ /../ ................. ...............
Prescription
drugs /../ /../ ................. ...............
Non-
prescription
drugs /../ /../ ................. ...............
Other /../ /../ ................. ...............
In addition to this form, a birth parent shall also be
provided the forms for the Illinois Adoption Registry and
Medical Information Exchange.
B. The form of consent required for the adoption of an
unborn child shall be substantially as follows:
CONSENT TO ADOPTION OF UNBORN CHILD
I, ...., state:
That I am the father of a child expected to be born on or
about .... to .... (name of mother).

SB1999 - 43 - LRB103 30669 KTG 57130 b
That I reside at .... County of ...., and State of .....
That I am of the age of .... years.
That I hereby enter my appearance in such adoption
proceeding and waive service of summons on me.
That I hereby acknowledge that I have been provided with a
copy of the Birth Parent Rights and Responsibilities-Private
Form before signing this Consent, and that I have had time to
read, or have had read to me, this Form. I understand that if I
do not receive any of the rights as described in this Form, it
shall not constitute a basis to revoke this Consent to
Adoption of Unborn Child.
That I do hereby consent and agree to the adoption of such
child, and that I have not previously executed a consent or
surrender with respect to such child.
That I wish to and do understand that by signing this
consent I do irrevocably and permanently give up all custody
and other parental rights I have to such child, except that I
have the right to revoke this consent by giving written notice
of my revocation not later than 72 hours after the birth of the
child.
That I understand such child will be placed for adoption
and that, except as hereinabove provided, I cannot under any
circumstances, after signing this document, change my mind and
revoke or cancel this consent or obtain or recover custody or
any other rights over such child.
That I have read and understand the above and I am signing

SB1999 - 44 - LRB103 30669 KTG 57130 b
it as my free and voluntary act.
Dated (insert date).
........................
B-5. (1) The parent of a child may execute a consent to
standby adoption by a specified person or persons. A consent
under this subsection B-5 shall be acknowledged by a parent
pursuant to subsection H and subsection K of this Section. The
form of consent required for the standby adoption of a born
child effective at a future date when the consenting parent of
the child dies or requests that a final judgment of adoption be
entered shall be substantially as follows:
FINAL AND IRREVOCABLE CONSENT
TO STANDBY ADOPTION
I, ..., (relationship, e.g. mother or father) of ...., a
male or female (circle one) child, state:
That the child was born on .... at .....
That I reside at ...., County of ...., and State of .....
That I am of the age of .... years.
That I hereby enter my appearance in this proceeding and
waive service of summons on me in this action only.
That I do hereby consent and agree to the standby adoption
of the child, and that I have not previously executed a consent
or surrender with respect to the child.

SB1999 - 45 - LRB103 30669 KTG 57130 b
That I wish to and understand that by signing this consent
I do irrevocably and permanently give up all custody and other
parental rights I have to the child, effective upon (my death)
(the child's other parent's death) or upon (my) (the other
parent's) request for the entry of a final judgment for
adoption if ..... (specified person or persons) adopt my
child.
That I understand that until (I die) (the child's other
parent dies), I retain all legal rights and obligations
concerning the child, but at that time, I irrevocably give all
custody and other parental rights to .... (specified person or
persons).
I understand my child will be adopted by .......
(specified person or persons) only and that I cannot, under
any circumstances, after signing this document, change my mind
and revoke or cancel this consent or obtain or recover custody
or any other rights over my child if ..... (specified person or
persons) adopt my child.
I understand that this consent to standby adoption is
valid only if the petition for standby adoption is filed and
that if ....... (specified person or persons), for any reason,
cannot or will not file a petition for standby adoption or if
his, her, or their petition for standby adoption is denied,
then this consent is void. I have the right to notice of any
other proceeding that could affect my parental rights.
That I have read and understand the above and I am signing

SB1999 - 46 - LRB103 30669 KTG 57130 b
it as my free and voluntary act.
Dated (insert date).
....................
If under Section 8 the consent of more than one person is
required, then each such person shall execute a separate
consent. A separate consent shall be executed for each child.
(2) If the parent consents to a standby adoption by 2
specified persons, then the form shall contain 2 additional
paragraphs in substantially the following form:
If .... (specified persons) obtain a judgment of
dissolution of marriage before the judgment for adoption is
entered, then ..... (specified person) shall adopt my child. I
understand that I cannot change my mind and revoke this
consent or obtain or recover custody of my child if .....
(specified persons) obtain a judgment of dissolution of
marriage and ..... (specified person) adopts my child. I
understand that I cannot change my mind and revoke this
consent if ...... (specified persons) obtain a judgment of
dissolution of marriage before the adoption is final. I
understand that this consent to adoption has no effect on who
will get custody of my child if ..... (specified persons)
obtain a judgment of dissolution of marriage after the
adoption is final. I understand that if either .....
(specified persons) dies before the petition to adopt my child
is granted, then the surviving person may adopt my child. I

SB1999 - 47 - LRB103 30669 KTG 57130 b
understand that I cannot change my mind and revoke this
consent or obtain or recover custody of my child if the
surviving person adopts my child.
A consent to standby adoption by specified persons on this
form shall have no effect on a court's determination of
custody or visitation under the Illinois Marriage and
Dissolution of Marriage Act if the marriage of the specified
persons is dissolved before the adoption is final.
(3) The form of the certificate of acknowledgement for a
Final and Irrevocable Consent for Standby Adoption shall be
substantially as follows:
STATE OF .....)
) SS.
COUNTY OF ....)
I, ....... (name of Judge or other person) ..... (official
title, name, and address), certify that ......., personally
known to me to be the same person whose name is subscribed to
the foregoing Final and Irrevocable Consent to Standby
Adoption, appeared before me this day in person and
acknowledged that (she) (he) signed and delivered the consent
as (her) (his) free and voluntary act, for the specified
purpose.
I have fully explained that this consent to adoption is
valid only if the petition to adopt is filed, and that if the

SB1999 - 48 - LRB103 30669 KTG 57130 b
specified person or persons, for any reason, cannot or will
not adopt the child or if the adoption petition is denied, then
this consent will be void. I have fully explained that if the
specified person or persons adopt the child, by signing this
consent (she) (he) is irrevocably and permanently
relinquishing all parental rights to the child, and (she) (he)
has stated that such is (her) (his) intention and desire.
Dated (insert date).
Signature ..............................
(4) If a consent to standby adoption is executed in this
form, the consent shall be valid only if the specified person
or persons adopt the child. The consent shall be void if:
(a) the specified person or persons do not file a
petition for standby adoption of the child; or
(b) a court denies the standby adoption petition.
The parent shall not need to take further action to revoke
the consent if the standby adoption by the specified person or
persons does not occur, notwithstanding the provisions of
Section 11 of this Act.
C. The form of surrender to any agency given by a parent of
a born child who is to be subsequently placed for adoption
shall be substantially as follows and shall contain such other
facts and statements as the particular agency shall require.
FINAL AND IRREVOCABLE SURRENDER

SB1999 - 49 - LRB103 30669 KTG 57130 b
FOR PURPOSES OF ADOPTION
I, .... (relationship, e.g., mother, father, relative,
guardian) of ...., a male or female (circle one) child, state:
That such child was born on ...., at .....
That I reside at ...., County of ...., and State of .....
That I am of the age of .... years.
That I do hereby surrender and entrust the entire custody
and control of such child to the .... (the "Agency"), a
(public) (licensed) child welfare agency with its principal
office in the City of ...., County of .... and State of ....,
for the purpose of enabling it to care for and supervise the
care of such child, to place such child for adoption and to
consent to the legal adoption of such child.
That I hereby grant to the Agency full power and authority
to place such child with any person or persons it may in its
sole discretion select to become the adopting parent or
parents and to consent to the legal adoption of such child by
such person or persons; and to take any and all measures which,
in the judgment of the Agency, may be for the best interests of
such child, including authorizing medical, surgical and dental
care and treatment including inoculation and anaesthesia for
such child.
That I wish to and understand that by signing this
surrender I do irrevocably and permanently give up all custody
and other parental rights I have to such child.

SB1999 - 50 - LRB103 30669 KTG 57130 b
That I understand I cannot under any circumstances, after
signing this surrender, change my mind and revoke or cancel
this surrender or obtain or recover custody or any other
rights over such child.
That I have read and understand the above and I am signing
it as my free and voluntary act.
Dated (insert date).
........................
C-5. The form of a Final and Irrevocable Designated
Surrender for Purposes of Adoption to any agency given by a
parent of a born child who is to be subsequently placed for
adoption is to be used by legal parents only. The form shall be
substantially as follows and shall contain such other facts
and statements as the particular agency shall require:
FINAL AND IRREVOCABLE DESIGNATED SURRENDER
FOR PURPOSES OF ADOPTION
I, .... (relationship, e.g., mother, father, relative,
guardian) of ...., a male or female (circle one) child, state:
1. That such child was born on ...., at .....
2. That I reside at ...., County of ...., and State of
....., my email address (if I have one) is .... my cell phone
number where I can receive text messages (if I have one) is
.... and my land line phone number (if I have one) is ...., and

SB1999 - 51 - LRB103 30669 KTG 57130 b
any other contact information is ....
3. That I am of the age of .... years.
4. That I do hereby surrender and entrust the entire
custody and control of such child to the .... (the "Agency"), a
(public) (licensed) child welfare agency with its principal
office in the City of ...., County of .... and State of ....,
for the purpose of enabling it to care for and supervise the
care of such child, to place such child for adoption with
............................. (specified person or persons)
and to consent to the legal adoption of such child and to take
any and all measures which, in the judgment of the Agency, may
be for the best interests of such child, including authorizing
medical, surgical and dental care and treatment including
inoculation and anesthesia for such child. If only first names
are used for the specified person or persons, I voluntarily
sign this designated surrender without disclosure to me of the
last name of the specified person or persons. However, I
understand that if I wish to know the last name of the
specified person or persons, I may request it before signing
the form. If I do not receive the last name, I may choose not
to sign the designated surrender form.
5. That I wish to and understand that by signing this
surrender I do irrevocably and permanently give up all custody
and other parental rights I have to such child.
6. That if the petition for adoption is not filed by the
specified person or persons designated herein or, if the

SB1999 - 52 - LRB103 30669 KTG 57130 b
petition for adoption is filed but the adoption petition is
dismissed with prejudice or the adoption proceeding is
otherwise concluded without an order declaring the child to be
the adopted child of each specified person, then I understand
that the Agency will send notice to me at the mailing address,
at the email address, through a text message to my cell phone
number provided in paragraph 2, and to any other contact
information I have provided in paragraph 2 within 5 business
days of this occurrence. The person sending the notice shall
prepare an affidavit of notice. I understand that I will have
15 business days from the date that the written notice was sent
to respond, within which time I may choose to designate other
adoptive parent(s). However, I acknowledge that the Agency has
full power and authority to place the child for adoption with
any person or persons it may in its sole discretion select to
become the adopting parent or parents and to consent to the
legal adoption of the child by such person or persons.
7. That I acknowledge that this surrender is valid even if
the specified persons separate or divorce or one of the
specified persons dies prior to the entry of the final
judgment for adoption.
8. That I expressly acknowledge that the above paragraphs
6 and 7 do not impair the validity and absolute finality of
this surrender under any circumstance.
9. That I understand that I have a remaining obligation to
keep the Agency informed of my current contact information

SB1999 - 53 - LRB103 30669 KTG 57130 b
until the adoption of the child has been finalized if I wish to
be notified in the event the adoption by the specified
person(s) cannot proceed.
10. That I understand I cannot under any circumstances,
after signing this surrender, change my mind and revoke or
cancel this surrender or obtain or recover custody or any
other rights over such child.
11. That I have read and understand the above and I am
signing it as my free and voluntary act.
Dated (insert date).
..............................
D. The form of surrender to an agency given by a parent of
an unborn child who is to be subsequently placed for adoption
shall be substantially as follows and shall contain such other
facts and statements as the particular agency shall require.
SURRENDER OF UNBORN CHILD FOR
PURPOSES OF ADOPTION
I, .... (father), state:
That I am the father of a child expected to be born on or
about .... to .... (name of mother).
That I reside at ...., County of ...., and State of .....
That I am of the age of .... years.
That I do hereby surrender and entrust the entire custody

SB1999 - 54 - LRB103 30669 KTG 57130 b
and control of such child to the .... (the "Agency"), a
(public) (licensed) child welfare agency with its principal
office in the City of ...., County of .... and State of ....,
for the purpose of enabling it to care for and supervise the
care of such child, to place such child for adoption and to
consent to the legal adoption of such child, and that I have
not previously executed a consent or surrender with respect to
such child.
That I hereby grant to the Agency full power and authority
to place such child with any person or persons it may in its
sole discretion select to become the adopting parent or
parents and to consent to the legal adoption of such child by
such person or persons; and to take any and all measures which,
in the judgment of the Agency, may be for the best interests of
such child, including authorizing medical, surgical and dental
care and treatment, including inoculation and anaesthesia for
such child.
That I wish to and understand that by signing this
surrender I do irrevocably and permanently give up all custody
and other parental rights I have to such child.
That I understand I cannot under any circumstances, after
signing this surrender, change my mind and revoke or cancel
this surrender or obtain or recover custody or any other
rights over such child, except that I have the right to revoke
this surrender by giving written notice of my revocation not
later than 72 hours after the birth of such child.

SB1999 - 55 - LRB103 30669 KTG 57130 b
That I have read and understand the above and I am signing
it as my free and voluntary act.
Dated (insert date).
........................
E. The form of consent required from the parents for the
adoption of an adult, when such adult elects to obtain such
consent, shall be substantially as follows:
CONSENT
I, ...., (father) (mother) of ...., an adult, state:
That I reside at ...., County of .... and State of .....
That I do hereby consent and agree to the adoption of such
adult by .... and .....
Dated (insert date).
.........................
F. The form of consent required for the adoption of a child
of the age of 14 years or over, or of an adult, to be given by
such person, shall be substantially as follows:
CONSENT
I, ...., state:
That I reside at ...., County of .... and State of .....

SB1999 - 56 - LRB103 30669 KTG 57130 b
That I am of the age of .... years. That I hereby enter my
appearance in this proceeding and waive service of summons on
me. That I consent and agree to my adoption by .... and .....
Dated (insert date).
........................
G. The form of consent given by an agency to the adoption
by specified persons of a child previously surrendered to it
shall set forth that the agency has the authority to execute
such consent. The form of consent given by a guardian of the
person of a child sought to be adopted, appointed by a court of
competent jurisdiction, shall set forth the facts of such
appointment and the authority of the guardian to execute such
consent.
H. A consent (other than that given by an agency, or
guardian of the person of the child sought to be adopted who
was appointed by a court of competent jurisdiction) shall be
acknowledged by a parent before a judge of a court of competent
jurisdiction or, except as otherwise provided in this Act,
before a representative of an agency, or before a person,
other than the attorney for the prospective adoptive parent or
parents, designated by a court of competent jurisdiction.
I. A surrender, or any other document equivalent to a
surrender, by which a child is surrendered to an agency shall
be acknowledged by the person signing such surrender, or other
document, before a judge of a court of competent jurisdiction,

SB1999 - 57 - LRB103 30669 KTG 57130 b
or, except as otherwise provided in this Act, before a
representative of an agency, or before a person designated by
a court of competent jurisdiction.
J. The form of the certificate of acknowledgment for a
consent, a surrender, or any other document equivalent to a
surrender, shall be substantially as follows:
STATE OF ....)
) SS.
COUNTY OF ...)
I, .... (Name of judge or other person), .... (official
title, name and location of court or status or position of
other person), certify that ...., personally known to me to be
the same person whose name is subscribed to the foregoing
(consent) (surrender), appeared before me this day in person
and acknowledged that (she) (he) signed and delivered such
(consent) (surrender) as (her) (his) free and voluntary act,
for the specified purpose.
I have fully explained that by signing such (consent)
(surrender) (she) (he) is irrevocably relinquishing all
parental rights to such child or adult and (she) (he) has
stated that such is (her) (his) intention and desire. (Add if
Consent only) I am further satisfied that, before signing this
Consent, ........ has read, or has had read to him or her, the
Birth Parent Rights and Responsibilities-Private Form.
Dated (insert date).

SB1999 - 58 - LRB103 30669 KTG 57130 b
Signature ...............
K. When the execution of a consent or a surrender is
acknowledged before someone other than a judge, such other
person shall have his or her signature on the certificate
acknowledged before a notary public, in form substantially as
follows:
STATE OF ....)
) SS.
COUNTY OF ...)
I, a Notary Public, in and for the County of ......, in the
State of ......, certify that ...., personally known to me to
be the same person whose name is subscribed to the foregoing
certificate of acknowledgment, appeared before me in person
and acknowledged that (she) (he) signed such certificate as
(her) (his) free and voluntary act and that the statements
made in the certificate are true.
Dated (insert date).
Signature ...................... Notary Public
(official seal)
There shall be attached a certificate of magistracy, or
other comparable proof of office of the notary public
satisfactory to the court, to a consent signed and
acknowledged in another state.

SB1999 - 59 - LRB103 30669 KTG 57130 b
L. A surrender or consent executed and acknowledged
outside of this State, either in accordance with the law of
this State or in accordance with the law of the place where
executed, is valid.
M. Where a consent or a surrender is signed in a foreign
country, the execution of such consent shall be acknowledged
or affirmed in a manner conformable to the law and procedure of
such country.
N. If the person signing a consent or surrender is in the
military service of the United States, the execution of such
consent or surrender may be acknowledged before a commissioned
officer and the signature of such officer on such certificate
shall be verified or acknowledged before a notary public or by
such other procedure as is then in effect for such division or
branch of the armed forces.
O. (1) The parent or parents of a child in whose interests
a petition under Section 2-13 of the Juvenile Court Act of 1987
is pending may, with the approval of the designated
representative of the Department of Children and Family
Services ("Department" or "DCFS"), execute a consent to
adoption by a specified person or persons:
(a) in whose physical custody the child has resided
for at least 6 months; or
(b) in whose physical custody at least one sibling of
the child who is the subject of this consent has resided
for at least 6 months, and the child who is the subject of

SB1999 - 60 - LRB103 30669 KTG 57130 b
this consent is currently residing in this foster home; or
(c) in whose physical custody a child under one year
of age has resided for at least 3 months.
The court may waive the time frames in subdivisions (a),
(b), and (c) for good cause shown if the court finds it to be
in the child's best interests.
A consent under this subsection O shall be acknowledged by
a parent pursuant to subsection H and subsection K of this
Section.
(2) The final and irrevocable consent to adoption by a
specified person or persons in a Department of Children and
Family Services (DCFS) case shall be substantially as follows:
FINAL AND IRREVOCABLE CONSENT TO ADOPTION BY
A SPECIFIED PERSON OR PERSONS: DCFS CASE
I, ......................................, the
.................. mother or father (circle one) of a male or
female (circle one) child, state:
1. My child ............................ (name of
child) was born on ..... (insert date) at
.................... Hospital in the City/Town of
........., in ................ County, State of
...............
2. I reside at ......................, County of
............. and State of ..............

SB1999 - 61 - LRB103 30669 KTG 57130 b
Mail may also be sent to me at this address
............................, in care of
.................
My home telephone number is......................
My cell telephone number is......................
My e-mail address is.................................
3. I, ..........................., am .... years old.
4. I enter my appearance in this action for my child to
be adopted by the person or persons specified herein by me
and waive service of summons on me in this action only.
5. I hereby acknowledge that I have been provided a
copy of the Birth Parent Rights and Responsibilities in
Illinois for Final and Irrevocable Consents to Adoption by
a Specified Person or Persons for DCFS Cases before
signing this Consent and that I have had time to read this
form or have it read to me and that I understand the rights
and responsibilities described in this form. I understand
that if I do not receive any of my rights as described in
the form, it shall not constitute a basis to revoke this
Final and Irrevocable Consent to Adoption by a Specified
Person or Persons.
6. I do hereby consent and agree to the adoption of
such child by .......... (names of current foster
parent(s) or caregiver(s), hereinafter referred to as the
"specified person or persons") only.
7. I wish to sign this consent and I understand that by

SB1999 - 62 - LRB103 30669 KTG 57130 b
signing this consent I irrevocably and permanently give up
all my parental rights I have to my child.
8. I understand that this consent allows my child to
be adopted by the specified person or persons only and
that I cannot under any circumstances after signing this
document change my mind and revoke or cancel this consent.
9. I understand that this consent will be void if:
(a) the Department places my child with someone
other than the specified person or persons; or
(b) a court denies the adoption petition for the
specified person or persons to adopt my child; or
(c) the DCFS Guardianship Administrator refuses to
consent to my child's adoption by the specified person
or persons on the basis that the adoption is not in my
child's best interests.
I understand that if this consent is void I have
parental rights to my child, subject to any applicable
court orders including those entered under Article II of
the Juvenile Court Act of 1987, unless and until I sign a
new consent or surrender or my parental rights are
involuntarily terminated. I understand that if this
consent is void, my child may be adopted by someone other
than the specified person or persons only if I sign a new
consent or surrender, or my parental rights are
involuntarily terminated. I understand that if this
consent is void, the Department will notify me within 30

SB1999 - 63 - LRB103 30669 KTG 57130 b
days using the addresses and telephone numbers I provided
in paragraph 2 of this form. I understand that if I receive
such a notice, it is very important that I contact the
Department immediately, and preferably within 30 days, to
have input into the plan for my child's future.
10. I understand that if a petition for adoption of my
child is filed by someone other than the specified person
or persons, the Department will notify me within 14 days
after the Department becomes aware of the petition. The
fact that someone other than the specified person or
persons files a petition to adopt my child does not make
this consent void.
11. If a person other than the specified person or
persons files a petition to adopt my child or if the
consent is void under paragraph 9, the Department will
send written notice to me using the mailing address and
email address provided by me in paragraph 2 of this form.
The Department will also contact me using the telephone
numbers I provided in paragraph 2 of this form. It is very
important that I let the Department know if any of my
contact information changes. If I do not let the
Department know if any of my contact information changes,
I understand that I may not receive notification from the
Department if this consent is void or if someone other
than the specified person or persons files a petition to
adopt my child. If any of my contact information changes,

SB1999 - 64 - LRB103 30669 KTG 57130 b
I should immediately notify:
Caseworker's name and telephone number:
............................................................;
Agency name, address, zip code, and telephone number:
............................................................;
Supervisor's name and telephone number:
............................................................;
DCFS Advocacy Office for Children and Families:
800-232-3798.
12. I expressly acknowledge that paragraph 9 (and
paragraphs 8a and 8b, if applicable) do not impair the
validity and finality of this consent under any
circumstances.
13. I have read and understand the above and I am
signing it as my free and voluntary act.
Dated (insert date).
.............................................
Signature of parent
(3) If the parent consents to an adoption by 2 specified
persons, then the form shall contain 2 additional paragraphs
in substantially the following form:
8a. I understand that I cannot change my mind or
revoke this consent or recover custody of my child on the
basis that the specified persons divorce or are granted a
dissolution of a civil union or that one of the specified

SB1999 - 65 - LRB103 30669 KTG 57130 b
persons has died.
8b. I understand that if the specified persons get a
divorce or are granted a dissolution of a civil union
before the petition to adopt my child is granted, this
consent remains valid only for ............... (name only
one specified person) to adopt my child.
8c. I understand that if either of the specified
persons dies before the petition to adopt my child is
granted, this consent remains valid for the surviving
person to adopt my child.
(4) The form of the certificate of acknowledgement for a
Final and Irrevocable Consent for Adoption by a Specified
Person or Persons: DCFS Case shall be substantially as
follows:
STATE OF ..............)
) SS.
COUNTY OF .............)
I, .................... (Name of Judge or other person),
..................... (official title, name, and address),
certify that ............., personally known to me to be the
same person whose name is subscribed to the foregoing Final
and Irrevocable Consent for Adoption by a Specified Person or
Persons: DCFS Case, appeared before me this day in person and
acknowledged that (she)(he) signed and delivered the consent

SB1999 - 66 - LRB103 30669 KTG 57130 b
as (her)(his) free and voluntary act, for the specified
purpose.
I have fully explained that by signing this consent this
parent is irrevocably and permanently relinquishing all
parental rights to the child so that the child may be adopted
by a specified person or persons, and this parent has stated
that such is (her)(his) intention and desire. I have fully
explained that this consent is void only if:
(a) the placement is disrupted and the child is moved
to a different placement; or
(b) a court denies the petition for adoption; or
(c) the Department of Children and Family Services
Guardianship Administrator refuses to consent to the
child's adoption by a specified person or persons on the
basis that the adoption is not in the child's best
interests.
Dated (insert date).
...............................
Signature
(5) If a consent to adoption by a specified person or
persons is executed in this form, the following provisions
shall apply. The consent shall be valid only for the specified
person or persons to adopt the child. The consent shall be void
if:
(a) the placement disrupts and the child is moved to

SB1999 - 67 - LRB103 30669 KTG 57130 b
another placement; or
(b) a court denies the petition for adoption; or
(c) the Department of Children and Family Services
Guardianship Administrator refuses to consent to the
child's adoption by the specified person or persons on the
basis that the adoption is not in the child's best
interests.
If the consent is void under this Section, the parent
shall not need to take further action to revoke the consent. No
proceeding for termination of parental rights shall be brought
unless the parent who executed the consent to adoption by a
specified person or persons has been notified of the
proceedings pursuant to Section 7 of this Act or subsection
(4) of Section 2-13 of the Juvenile Court Act of 1987.
(6) The Department of Children and Family Services is
authorized to promulgate rules necessary to implement this
subsection O.
(7) (Blank).
(8) The Department of Children and Family Services shall
promulgate a rule and procedures regarding Consents to
Adoption by a Specified Person or Persons in DCFS cases. The
rule and procedures shall provide for the development of the
Birth Parent Rights and Responsibilities Form for DCFS Cases.
(9) A consent to adoption by specified persons on this
consent form shall have no effect on a court's determination
of custody or visitation under the Illinois Marriage and

SB1999 - 68 - LRB103 30669 KTG 57130 b
Dissolution of Marriage Act or the Illinois Religious Freedom
Protection and Civil Union Act if the marriage or civil union
of the specified persons is dissolved after the adoption is
final.
P. If the person signing a consent is incarcerated or
detained in a correctional facility, prison, jail, detention
center, or other comparable institution, either in this State
or any other jurisdiction, the execution of such consent may
be acknowledged before social service personnel of such
institution, or before a person designated by a court of
competent jurisdiction.
Q. A consent may be acknowledged telephonically, via
audiovisual connection, or other electronic means, provided
that a court of competent jurisdiction has entered an order
approving the execution of the consent in such manner and has
designated an individual to be physically present with the
parent executing such consent in order to verify the identity
of the parent.
R. An agency whose representative is acknowledging a
consent pursuant to this Section shall be a public child
welfare agency, or a child welfare agency, or a child placing
agency that is authorized or licensed in the State or
jurisdiction in which the consent is signed.
S. The form of waiver by a putative or legal father of a
born or unborn child shall be substantially as follows:

SB1999 - 69 - LRB103 30669 KTG 57130 b
FINAL AND IRREVOCABLE
WAIVER OF PARENTAL RIGHTS OF PUTATIVE OR LEGAL FATHER
I, ...................., state under oath or affirm as
follows:
1. That the biological mother ............... has
named me as a possible biological or legal father of her
minor child who was born, or is expected to be born on
..........., ......, in the City/Town of........., State
of ...........
2. That I understand that the biological mother
............. intends to or has placed the child for
adoption.
3. That I reside at ................, in the City/Town
of..........., State of ................
4. That I am ................ years of age and my date
of birth is ..............., .............
5. That I (select one):
..... am married to the biological mother.
..... am not married to the biological mother and
have not been married to the biological mother within
300 days before the child's birth or expected date of
child's birth.
..... am not currently married to the biological
mother, but was married to the biological mother,
within 300 days before the child's birth or expected

SB1999 - 70 - LRB103 30669 KTG 57130 b
date of child's birth.
6. That I (select one):
..... neither admit nor deny that I am the
biological father of the child.
..... deny that I am the biological father of the
child.
7. That I hereby agree to the termination of my
parental rights, if any, without further notice to me of
any proceeding for the adoption of the minor child, even
if I have taken any action to establish parental rights or
take any such action in the future including registering
with any putative father registry.
8. That I understand that by signing this Waiver I do
irrevocably and permanently give up all custody and other
parental rights I may have to such child.
9. That I understand that this Waiver is FINAL AND
IRREVOCABLE and that I am permanently barred from
contesting any proceeding for the adoption of the child
after I sign this Waiver.
10. That I waive any further service of summons or
other pleadings in any proceeding to terminate parental
rights, if any to this child, or any proceeding for
adoption of this child.
11. That I understand that if a final judgment or
order of adoption for this child is not entered, then any
parental rights or responsibilities that I may have remain

SB1999 - 71 - LRB103 30669 KTG 57130 b
intact.
12. That I have read and understand the above and that
I am signing it as my free and voluntary act.
Dated: ..................., ..............
...........................................
Signature
OATH
I have been duly sworn and I state under oath that I have read
and understood this Final and Irrevocable Waiver of Parental
Rights of Putative or Legal Father. The facts contained in it
are true and correct to the best of my knowledge. I have signed
this document as my free and voluntary act in order to
facilitate the adoption of the child.
..............................
Signature
Signed and Sworn before me on
this ............ day
of ..........., 20....
...................
Notary Public
(Source: P.A. 99-833, eff. 1-1-17; 100-1060, eff. 1-1-19.)
SB1999 - 72 - LRB103 30669 KTG 57130 b
INDEX
Statutes amended in order of appearance