Consent by Parents to Adoption
We, (name of natural father) of (street address, city, state, zip code), and (name of
natural mother), of (street address, city, state, zip code), the parents of (name of child),
a (male or female) child who was born on (date of birth), consent to (his or her) adoption
by (name of husband) and (name of wife), husband and wife, who reside at (street
address, city, state, zip code).
Witness our signatures this the ____ day of _______________, 20____.
_______________________ _______________________
(Signature of Natural Father) (Signature of Natural Mother)
(Printed Name of