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Free Legal Forms Starter Template form67_12_a

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					Form 67.12-A Form of declaration by parent or guardian under section 18(6) or 19(4) of the Adoption (Scotland) Act 1978 IN THE COURT OF SESSION in the PETITION of [A.B.] (designation and address) for An order freeing the child [E.F.] for adoption under section 18 of the Adoption (Scotland) Act 1978

I, , of (address) being a parent [or guardian] of the child [E.F.], hereby state (1) That I declare that I prefer not to be involved in future questions concerning the adoption of [E.F.]. (2) [Where the declaration is made under section 18(6): That this declaration and its effect has been explained to me by the reporting officer appointed by the court] [or where the declaration is made under section 19(4): That this declaration and its effect has been explained to me by the adoption agency (insert name)]. (Signed by parent or guardian) This declaration was signed by (Signed) (Designation) (Address) before me at on the day of


				
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