Consent to adoption. [Title of court] In the Matter of the Adoption of _________ by _________ We, _________ and _________, father and mother [or as the case may be] of _________, a minor child _________ years of age, hereby consent to the adoption of the child by _________, as sought in the attached petition of _________, and hereby waive all right to the custody and control of the child. Dated this _________ day of _________, _________[date]. [Signatures] [Acknowledgment if required by statute]