This policy guide outlines how to complete and accept a relinquishment document and a Statement of Understanding for parents who read English and for parents who cannot read English or any other language. It details how to provide services to parents who are considering relinquishing a child for adoption and how to notify all required parties of a relinquishment.

This policy guide was updated from the 07/01/14 version to provide guidance to staff about Emergency Response investigations where a parent or parents indicate that they intend to voluntarily relinquish rights to their child. Voluntary relinquishment of parental rights takes place when a parent(s) decide(s) to voluntarily place their child for adoption through an agency. This can include placement through a public adoption agency (DCFS), or a private adoption attorney. This revised version also replaces gender binary language with gender-neutral language. 

Relinquishment of a Child

Voluntary relinquishment of parental rights takes place when (a) parent(s) decide(s) to voluntarily place their child for adoption through an agency. This can include placement through a public adoption agency (DCFS), a private adoption agency, or a private adoption attorney. In some circumstances, all parents of a child would have to sign a relinquishment or consent to an adoption. In other circumstances, the signature of one parent might suffice. When in doubt, consult with County Counsel.

Relinquishments during Emergency Response (ER) Investigations

During the course of an ER investigation, ER staff may come across instances where a parent indicates that they would like to relinquish rights to their child. A parent may have already begun the process of initiating an adoption through a private adoption agency or a private adoption attorney, or the parent may indicate that they would like to seek an independent adoption through a public adoption agency and are in need of guidance about the process. In such situations, ER staff should honor the parent(s)’ right to make a plan for their child, if the child is not in immediate danger, while the relinquishment plan is in process. It is often helpful to request copies of the relinquishment forms, including but not limited to the Relinquishment (AD 501), the Statement of Understanding (AD 885), and the AD22 – Health Facility Minor Release Report. It may also be helpful to request business cards from any private agency employees, attorneys and other professional staff who indicate that they are involved in the relinquishment process. These individuals often meet with the birth parents prior to the birth of the child, on site at the hospital, or in the community, including during nights and weekends. Therefore, it is important to try to determine who is involved with the family and what relinquishment related activities are taking place during the same time that the ER investigation is proceeding.

Information to know about relinquishments during the ER stage:

• For a relinquishment to be valid, a parent must sign a formal written document called a relinquishment, which relieves a parent of all legal responsibilities toward the child and makes an adoption agency the child’s legal custodian until the court grants the adoption. An informal affidavit is insufficient.
• A relinquishment is final 10 business days after the receipt of the filing with the California Department of Social Services (CDSS), unless the parent signs a waiver of the right to revoke the relinquishment.
• Before it becomes final, a parent may revoke (cancel) a relinquishment with or without the adoption agency’s consent.
• Once it becomes final, a relinquishment can only be set aside (rescinded) by mutual agreement between the agency and the parent who signed the relinquishment.
• A rescission (cancellation) is rarely granted, and the agency is prohibited from agreeing to a rescission once the court has granted an adoption.
• Unlike dependency adoptions, which often take place at the end of a long court case (but can also occur at any time during the Court dependency process), adoptions following relinquishments, where no dependency case is ever filed, proceed more quickly.
• A determination must be made as to the identity of all the child's legal parents before a relinquishment is taken. For example, a child may have multiple possible fathers. There may be a presumed father whose name appears on the birth certificate, a different presumed father who was legally married to the mother before the child's birth, a person who was identified as the biological father by DNA test or the Department of Child Support Services, and a person who verbally claims to be the father with no other apparent proof or legal presumption of paternity.

Relinquishments on Open Cases

Relinquishment is also a permanency option that is offered as part of the full disclosure process throughout a child's case. It is a permanent decision and must be made by the child's parent(s) voluntarily and without coercion from any entity.

A relinquishment is completed by an Adoptions Division Birth Parent CSW. When a parent indicates an interest in relinquishing their child for adoption, the parent is referred to an Adoptions Division Birth Parent CSW at 213-272-2834 or 213-545-4179. A parent or any DCFS staff member or community member can also send an email to Relinquishment@dcfs.lacounty.gov to request services.

On a case-by-case basis, a designated relinquishment [which identifies a specific prospective adoptive parent (PAP) desired by the birth parent(s)] can be accepted before the designated person(s) is approved to adopt as long as the birth parent understands the child can be placed only if the designated person's application to adopt has been approved. In such a case, the birth parent is notified if placement can't be made with the named/designated PAP and the birth parent has the opportunity to either rescind the relinquishment and request the child be returned to them or name a different PAP.

Upon assignment of a relinquishment case, the Adoptions Division Birth Parent CSW must have a minimum of two (2) face-to-face interviews with the parent(s) over a period of two (2) or more days (Per CDSS regulations).

• If the child to be relinquished has not yet been born, at least one (1) interview must occur after the child is born.
• A sample copy of the Statement of Understanding and the relinquishment documents are provided to the birth parent(s) during the first interview for their review.
• If appropriate, the Adoptions Division Birth Parent CSW accepts the relinquishment upon completing the second interview with the parent(s).

Competency of the Parent(s)

The parent must have the ability to understand the content, nature, and effect of signing the relinquishment. If the agency representative's observation or knowledge of the parent's history or current condition indicates that the parent may not have the ability to understand the content, nature, and effect of signing the relinquishment; the agency representative shall refer the parent to a licensed physician or to a licensed clinical psychologist for an evaluation of the parent's ability to understand, prior to accepting the parent's signature on the relinquishment.

An evaluation shall be required in at least the following circumstances:

1. The parent is receiving SSI/SSP for mental illness or developmental disability.
2. The parent has received psychiatric treatment and/or medication for mental illness or disease within the past two years.

The agency shall obtain a written authorization from the parent for release of the evaluation.

Other Requirements Before Taking a Relinquishment

• Before taking a relinquishment from one parent, verify that all other parents are no longer receiving, or eligible to receive, reunification services.
• ICWA must be cleared either by a court order or by completed ICWA 020 and ICWA 010 forms indicating no American Indian heritage.
• If the parents have sustained allegations of drug involvement or if DCFS suspects drug involvement, a clean drug test must be submitted before DCFS can take the parent’s relinquishment.  If a parent appears to be under the influence at the time they want to sign the relinquishment papers, then the parent will not be allowed to sign while under the influence.
• A competency evaluation may be used in lieu of a drug test if necessary. (i.e., if the parent cannot get clean to drug test due to addiction, or if marijuana is the drug of choice and it may be months before the marijuana is not detected in a drug test, etc.)
• DCFS must have the child’s original birth certificate on file.
• The adoptive family must be RFA approved.
• Paternity findings as to alleged/and/or legal fathers must be on file. If the child has (a) presumed father(s) who does not want to sign a relinquishment for adoption, usually a relinquishment should not be taken from the mother.

Parents with Children Voluntarily Placed

Parents whose child has not been involuntarily placed include:

• Parents of children who are voluntarily placed in out-of-home care with agencies such as DCFS or the Regional Center. In these cases, if a parent relinquishes to DCFS, DCFS will then file a non-dependency court action to dispense with notice to the other parent and/or terminate the other parent's parental rights. If both parents relinquish, it will be the attorney for the PAPs who files the Adoption Request aka Adoption Petition.
• Parents who are receiving Family Maintenance (FM) services for children who are court dependents but remain in the parent's care. (In these cases, once one or both parents relinquish to DCFS, the matter should be walked on to dependency court asking that the dependency matter be dismissed. If only one parent relinquishes, DCFS would ask that the court move forward with steps toward TPR for any other parent).

If a petition has been filed to terminate the parental rights of an alleged father and the adoptive placement has been approved by the ARA, the placement can proceed. The adoptive placement can also proceed if an identified father signs one (1) of the following forms:

• AD 588, Denial of Paternity by Alleged Father (In or Out of California)
• AD 590, Waiver of Right to Further Notice of Adoption Planning (Alleged Father In- or Out-if California)

The court may dispense with a hearing and issue an Ex Parte Application and Order to terminate parental rights if any of the following apply:

• The identity or whereabouts of the alleged father are unknown.
• The alleged father has been served with a written notice of his alleged paternity and the potential adoption, and he has failed to respond.
• The alleged father has signed a waiver of his right to notice or a denial of paternity.

Out-of-State Relinquishment

• By law, if a relinquishing parent and a court dependent/non-court dependent child reside outside of California, and if the child is to be cared for and placed for adoption by DCFS, the parent may relinquish the child to DCFS after the following requirements are met:
• Before signing the relinquishment, the parent received counseling and advising services from an agency that is licensed or approved to provide adoption services in the state of the parent's residence.
  • The relinquishment form is signed by DCFS before being signed by the parent.
    • This signifies DCFS's willingness to accept the relinquishment.
• The relinquishment form is then signed by the parent in the presence of a Licensed Adoptions worker from that state. Alternatively, the parent can get the form notarized per FC 8700 (c).

Advisement

Parents who want to relinquish their child must be advised on the relinquishment process.  This ensures that the relinquishment document is signed voluntarily and that the parents understand the availability of child welfare and legal services and the significance and the finality of relinquishing a child.

A parent who relinquishes a child must clearly understand that the court decides whether family reunification (FR) services are to be ordered. If a parent is uncertain of their eligibility for FR services and if these services affect their decision to relinquish a child, the parent should seek this information from the Adoptions Division Birth Parent CSW or the parent's attorney prior to signing the relinquishment document.

Relinquishment Document

The relinquishment document cannot be altered or corrected unless the correction or alteration is initiated by the following individuals:

• Parent who signed the document
• Reader or translator, if applicable
  • A DCFS employee who translates and/or reads the relinquishment document is not responsible for providing adoption services to the relinquishing or consenting parent(s) or to the prospective adoptive parent(s).
  • The translator and reader may be required to testify in court.
• Authorized agency representative
• Witnesses to the relinquishment

Notice of a Dependent Child's Relinquishment

If a parent has relinquished to DCFS for the purpose of adoption and the child has been found to be a dependent of the juvenile court, DCFS must provide written notice of the relinquishment within five (5) court days to all of the following:

• Juvenile court having jurisdiction of the child.
• All parties and their counsel.
• Child's attorney, if any.
• Relinquishing parent's attorney, if any.

If a parent relinquishes a child who has been found to be a dependent of the juvenile court to a licensed adoption agency, the adoption agency must provide written notice of the relinquishment within five (5) court days to the same entities mentioned above.

Relinquishments During Emergency Response Investigations

ER CSW Responsibilities

1. If the parent(s) inquire(s) about the SafelySurrendered Baby Law (SSB), provide information to parent(s).  
2. Find out if the parent(s) has/have already begun the process of initiating an adoption through a private adoption agency or private adoption attorney.
3. Inquire if the parent(s) would like to seek an independent adoption and are in need of guidance about the process. If they need guidance, CSW may refer them to the Independent Adoptions Unit at (213) 434-4090, (213) 763-9367 or (213) 763-9368 for Spanish speaking clients or email them at LACOISP@dcfs.lacounty.gov.
4. Honor the parent(s)’ right to make a plan for their child if the child is not in immediate danger while the relinquishment plan is in process.
5. Request copies of the relinquishment or adoption consent forms, including but not limited to

• • Relinquishment (AD 501)
  • Statement of Understanding (AD 885)
  • AD22 – Health Facility Minor Release Report.

6. Request business cards from any private agency employees, attorneys and other professional staff who indicate that they are involved in the relinquishment process.
7. Determine who is involved with the family and what relinquishment related or independent adoption related activities are taking place during the same time that the ER investigation is proceeding.
8. Contact DCFS's Adoptions Division (which provides relinquishment and voluntary adoption services to persons in the community, even if there is no open DCFS case) and provide a copy of the signed Relinquishment form from the private agency or private adoption attorney.

• • Inquiries and referrals related to relinquishment services can be sent to Relinquishment@dcfs.lacounty.gov

9. Know that an affidavit or notarized letter signed by a birth parent, informing that they wish to relinquish rights, is not a valid relinquishment.
10. ER staff cannot have the parent sign the CDSS Relinquishment form, as this must be completed by an Adoption Agency representative.
11. Know that there are many requirements prior to an Adoption Agency accepting a relinquishment and it is still the responsibility of the investigating ER Children’s Social Worker (CSW) to ensure the safety of the child by making sure that a viable relinquishment plan is in place prior to concluding the investigation. Additionally, note that in rare cases when a child is born with indicators of medical problems or other challenges, PAPs previously identified by birth parents may sometimes decide not to proceed with the adoption plan.
12. Attorneys involved in the relinquishment process, including an attorney for the birth mother, an attorney for the adopting parent(s), and/or an attorney for the agency, may be referred to County Counsel who advises DCFS on adoption matters. Inquire as to who that is with the Adoptions Division.
13. Be aware that a parent has the right to relinquish their child even in situations where the investigating CSW has found that the child’s safety is of immediate concern and is considering seeking a removal order from the court. In such instances:
    • The CSWs should consult with the relinquishment services CSW as well as the ER Supervisor, Assistant Regional Administrator, and County Counsel prior to filing a petition with the court (This higher level of consultation is meant to act as a safeguard to ensure that the Department does not prematurely file petitions with the Dependency court but instead teams up with parents when a plan has already been initiated by the family).

Adoptions Division Birth Parent CSW Responsibilities

1. Obtain the appropriate Relinquishment forms from the ER worker.
   1. AD501 Relinquishment form dependent upon the status of the mother/father as detailed below:
      • AD 501 Relinquishment – In or Out-of-County (Birth Mother/Biological Father/Presumed father in California)
      • AD 501A Relinquishment for birth mother, biological/presumed father who is not in California and not signing before a military officer.
      • AD504 Relinquishment for an out of state in armed forces birth mother, biological/presumed father
      • AD583 Relinquishment for a presumed father who denies he is the birth father in California and being signed in the presence of an agency different from the one accepting the relinquishment
      • AD584 Relinquishment out of state presumed father denies he is the birth father
      • AD586 Relinquishment in or out of county alleged natural father in California who is not denying paternity
      • AD 588 Relinquishment of an alleged father denying paternity
      • AD 590 Relinquishment for an alleged father waiving right to further notice
      • AD591 Relinquishment out of state alleged natural father who is not denying paternity and not signing before a military officer
      • AD593 Relinquishment out of state in armed forces alleged natural parent who is not denying paternity and signing before a military officer

1. •  
2. The appropriate Statement of Understanding form as detailed below:
   • AD885 Mother or a biological/presumed father of a child who is not detained
   • AD885A SOU Parent or a Presumed Parent of a child who is detained, a juvenile court dependent in out of home care, or the ward of a legal guardian.
   • AD885C SOU Alleged Natural father of a child who is not detained, a juvenile court dependent in out of home care or the ward of a legal guardian.
   • AD885D SOU Alleged parent of a child who is detained, a juvenile court dependent in out of home care or the ward of a legal guardian
   • AD899 SOU mother or presumed father of Indian Child who is not detained, a juvenile court dependent in out of home care or the ward of a legal guardian
   • AD899A SOU mother or presumed father of an Indian child who is detained, a juvenile court dependent in out of home care or the ward of a legal guardian
   • AD899C SOU alleged father of Indian Child who is not detained, a juvenile court dependent in out of home care or the ward of a legal guardian
   • AD899D SOU alleged parent of an Indian child who is detained, a juvenile court dependent in out of home care or the ward of a legal guardian
3. AD22 Health Facility Minor Release Report

2. If the ER worker does not have the forms, obtain the information from the Adoption agency and contact them to get a copy of the relinquishment forms.
3. Review relinquishment forms signed by private adoption agency.
4. Ensure that the forms are valid CDSS forms (do they match the forms listed on the CDSS website).
5. Check with Adoptions County Counsel to make sure the correct forms were submitted. Get AD22 –Hospital release form signed by birth mother, which authorizes the child to go home with adoptive parents instead of birth mother. 

Intake and Detention Control (IDC) CSW Responsibilities

1. Review the detention report for any language and/or statements indicating that the parent/s has made a choice or expressed an interest in relinquishing the child prior to the filing of a petition.
2. If statements are identified, advise the case-carrying CSW to email the Department’s Relinquishment Services at Reinquishment@dcfs.lacounty.gov and report the parent’s interest for further assessment. In addition, the case-carrying CSW should forward any relinquishment forms, if available, to the Department’s Relinquishment Services Unit.
3. Advise the case-carrying CSW to consult with their SCSW, Assistant Regional Administrator, and County Counsel to ensure that the Department does not prematurely file a petition.

Intake and Detention Control (IDC) SCSW Responsibilities

1. Document in CWS/CMS information regarding any communication/decisions with the Relinquishment unit.

Ensuring Relinquishment Requirements are Met

Adoptions Division Birth Parent CSW Responsibilities

1. Determine if the following conditions are met and documented in Case Notes:
   • That the relinquishing parent resides in Los Angeles County if the child is not a dependent of the court, or that the child is a dependent of the court in this county
   • That the parent(s) has(ve) chosen the plan of adoption for the child and freely chosen to relinquish the child
   • Make an attempt to determine who all the legal, biological and alleged parents of the child are. If in doubt, consult with County Counsel. If needed, ask the parent who wants to relinquish to assist in obtaining documents supporting parentage.
   • Whether the child is subject to the provisions of the Indian Child Welfare Act (ICWA)
   • That DCFS is able to place the child for adoption and that the parent is willing to sign the SOC 155, Voluntary Placement Agreement--Placement Request, for DCFS to provide temporary out-of-home care of the child, if the child is not a dependent of the Los Angeles County court.
   • That the parent has received needed services and advisement, as appropriate
   • That the parent has the ability to understand the content, nature, and effect of signing the relinquishment document.
2. Based on the determination, take the appropriate action:

   Determination	Required Action
   The child is a dependent of the Los Angeles County court.	Accept the referral and to take the relinquishment document. The Adoptions Division Birth Parent duty worker: Contacts the Regional Worker Requests to be added to CWS/CMS as a secondary worker
   The parent resides in another county. and The child is not a dependent of the Los Angeles County court.	Refer the parent to the appropriate agency in the county where they resides.
   At least one parent resides in Los Angeles County. and The child is not a dependent of the Los Angeles County court.	Accept the relinquishment, as appropriate. The Adoptions Division Birth Parent duty worker requests that the Adoptions Division Birth Parent SCSW open a child and parent case and assign them the case.

3. Contact the Matching Coordination Unit (MCU) to determine if there is an available home.
   1. If there is not an available home:
      1. Do not accept the relinquishment document.
      2. Inform the parent that voluntary placement is not possible unless they have identified a family who is RFA approved.
   2. If the parent has designated whom they want to adopt the child:
      1. Advise the parent that the child cannot be placed with the designated family until it is determined that a designee will be approved for adoptive placement and/or meets the requirements for an approved Resource Family Assessment completed by DCFS or a private adoption agency.
      2. Discuss voluntary placement with the parent until a foster or adoptive placement can be made.
   3. If appropriate, obtain the parent's signature on the SOC 155 for DCFS to provide temporary out-of-home care for the child.
4. If there is reason to suspect that the parent does not understand the content, nature, and effect of signing the relinquishment document:
   1. Refer them to a licensed physician or licensed clinical psychologist for an evaluation prior to accepting the parent's signature.
      • An evaluation is always required if either the parent is receiving SSI/SSP for a mental illness or a developmental disability or if the parent has received psychiatric treatment and/or medication for mental illness or disease within the past two (2) years.
   2. Complete the AD 100A, Authorization for Use and/or Disclosure of Health Information Agency Adoption Program.
   3. Obtain the parent's signature to authorize the release of the evaluation to DCFS.
5. If the parent needs a translator, refer to Assisting a Parent who Cannot Read Relinquishment Documents.
6. Explain the purpose of DCFS in the relinquishment process and the relevant services that it provides.
7. During the first interview with the parent, provide them with copies of the appropriate Statement of Understanding and the relinquishment document.

Providing Services to Parents Considering Relinquishment

Adoptions Division Birth Parent CSW Responsibilities

During the required face-to-face interviews:

1. If the parent(s) inquires about the SafelySurrendered Baby Law (SSB), provide information to parent(s).
2. Interview the parent, complete the Parent's Request for Service and ask the parent to sign.
3. Explain the purpose of DCFS in the relinquishment process and the relevant services that are provided.
4. Provide the parent with counseling to, at a minimum, assist them in:
   • Understanding the long-range implications of relinquishing their child to DCFS for adoption
   • Discerning their feelings regarding the relinquishment
   • Freely making their choice to relinquish the child for adoption
   • If the parent decides to relinquish the child, provide them inforamtion regarding:
     • Whether to complete a standard or a designated relinquishment
     • Post Adoption Contact Agreement. If the parent(s) wish to create a Post Adoption Contact Agreement, notify them that the prospective adoptive parents must agree to said contract, and that the contract would have to be approved by the court at the adoption finalization hearing.
       • Refer them to the Consortium for Children to establish/mediate a contract or,
       • Inform the birth parents that they and the adoptive parents may also create their own contract and provide them the Post Adoption Contact Agreement (PACA) forms.
5. Inform the parent that, prior to accepting the relinquishment document; DCFS must determine that it is able to place the child for adoption.
   1. Inform the parent that if DCFS believes it may be difficult to do so, the Matching Coordination Unit (MCU) is contacted to decide if there is an available home.
      • If there is a not an adoptive home available, DCFS will not accept the relinquishment document until one is found.
   2. Inform the parent that they must be willing to sign a voluntary placement agreement with DCFS if both:
      • DCFS determines it not difficult to place the child for adoption.
      • The parent wishes to place the child in foster care either while considering relinquishment or before signing the relinquishment document.
6. If a parent is ready to place the child, provide the parent with the SOC 155, Voluntary Placement Agreement -Placement Request, and assist them, as needed, in completing it.
   1. Ensure that the reason for request on the SOC 155 is “adoption planning”.
   2. If the placement is being requested on behalf of an Indian child, have the parent complete the SOC 155C, Voluntary Placement Agreement Parent/Agency (Indian Child). Although Tribal permission is not needed before opening a voluntary case, DCFS must follow ICWA regulations and provisions when dealing with the relinquishment/adoption of an Indian child.
      • Regulation 35363 says: When it is determined by the BIA or the tribe that the child meets the definition of an Indian child, the agency shall follow the provisions of Sections 35369 through 35383.
   3. Obtain the parent's signature on the original SOC 155 or SOC 155C and on one (1) copy. Sign and date the form.
   4. Provide the parent with a copy and file the original in the case record.
   5. If parent(s) are voluntarily placing their child with adoptive family identified by MCU (community cases only), create a case for child in CWS-CMS.
      • Adoptions Division Birth Parent SCSW shall create case in CWS/CMS with relinquishment services being the service component. The Adoptions Division Birth Parent CSW shall be assigned temporarily as the primary for the child until an Adoptive Placement (AP) CSW is assigned as primary.
   6. Request a state number for child via a SAAMs request submitted to TA Staff.
   7. Once state number for child has been obtained, prepare the 280 Request and submit to TA for foster care placement packet for the child.
      • Please note that if the child is under 3 years of age, per DCFS Policy, Assistant Regional Administrator (ARA) approval is required on the 280 Request. Once ARA approval is obtained on the 280 Request, submit the request to the TA so that the placement packet may be generated for the child. 
   8. Once the placement packet is prepared, coordinate with the prospective adoptive parents, the date the child is to be placed in their care and sign the foster care placement packet (ensuring that the adoptive parents have copies of the Agency/Foster Care Agreement, Medical Authorization for child and the DCFS 709). Ensure that all foster placement forms for the child are on file in the Green Placement Folder.
   9. Upon completion of the placement of the child with the prospective adoptive parents, ask the Adoptions Division Birth Parent Supervisor to request from the Adoption Assignment Desk that an A/P CSW be assigned as primary to the child. The Adoptions Division Birth Parent CSW shall remain on the case as secondary in order to complete relinquishment services to parent(s).
   10. Except in rare circumstances, the role of the Adoptions Division Birth Parent CSW will end after DCFS receives the acknowledgement for both the parents’ relinquishments and/or TPR. 
7. Review the terms of the voluntary placement agreement (SOC 155 or SOC 155C) with the parent.
   • If the birth mother has not signed the relinquishment within thirty (30) days of the child being placed, develop a Case Plan and follow the procedures outlined in Voluntary Placement.
   • Before the mother’s relinquishment can be accepted, a copy of the child's birth certificate must be obtained from Vital Records to ensure that the child’s name on the birth certificate matches the relinquishment document. (Alternatively, a relinquishment can be accepted with confirmation from the birth clerk regarding the child’s name. However, the relinquishment should not be filed with CDSS until the birth certificate is received.
8. Explain that a WIC 300 petition will be filed after five (5) months of voluntary placement in the following circumstances:
   • The parent has not requested the return of the child.
   • One (1) or both birth parents have not followed through with voluntarily relinquishing the child.
   • The child has been voluntarily relinquished but not adoptively placed.
   • The child has been freed for adoption by one (1) or both parents for twelve (12) months through:
     • Relinquishment
     • The termination of parental rights
9. If after five (5) months of voluntary placement, the child has not been adoptively placed, file a WIC 300 petition within six (6) months of the SOC 155 or the SOC 155C being signed by the parent(s). This does not apply when all of the following are met:
   • A birth mother has signed the relinquishment.
   • An acknowledgement of the relinquishment was issued.
   • The child was adoptively placed prior to the end of the six (6) month period.
   •  There is a legal action pending for the alleged father.
10. If the child is in a health care facility:
    1. Obtain the completed AD 22, Health Facility Minor Release Report, signed by the parent from the health care facility before accepting the child for placement.
    2. Complete Section III of the AD 22, and sign and date the form.
       • The identified resource parent(s) or DCFS representative receiving the child shall be the same as the person or agency designated by the parent or guardian in Section II, or the person authorized by DCFS to care for/receive the child or CSW on behalf of DCFS.
    3. Return the signed form to the facility, and keep one (1) copy for the case record.
11. If the parent has designated whom they want to adopt the child, do not accept the relinquishment document or voluntary placement agreement until it is determined that the designated family will be approved for the adoptive placement.
12. Provide the relinquishing parent(s) a sample copy of the relinquishment document and a Statement of Understanding for their review.
13. Have the birth parent(s) complete the AD 67, Information about the Birth Mother, and the AD 67A, Information about the Birth Father, to obtain medical and social background information from the birth parent(s). If needed:
    1. Assist the parents in completing the forms.
    2. If one parent is not interviewed, assist the present parent in completing the other parent's form.
    3. If needed, suggest that parent(s) consult family members when completing the form(s), and assist them in contacting the family members.
14. Obtain the parent's authorization on the AD 100A, Authorization for Use and/or Disclosure of Heath Information Agency Adoption Program, or the AD100, Authorization For Release, Use and/or Disclosure of Health and Other Information – Agency and Independent Adoptions Program to acquire the following information, as appropriate:
    • Verification of the birth mother's marital history.
    • Reports pertaining to the birth parent's medical background, including illness, disease, or defects of a hereditary or genetic nature.
      1. Obtain the medical history of the birth parent's extended family.
    • Reports regarding the birth mother from the prenatal physician and from the physician who delivered the child or the hospital in which the child was born, including any medications taken or any complications.
    • Reports or evaluations regarding the birth parent from medical or mental health professions, hospitals, or institutions in which the birth parent has received in-patient or out-patient services.
    • Any documentation or oral reports that indicate the birth parent may be of American Indian ancestry.
      1. Inform the parent of an Indian child that there must be an order of placement preference for the child in either voluntary or dependency relinquishment cases.
      2. Refer to Adopting and Serving Children Under the Indian Child Welfare Act (ICWA).
15. Obtain a signed release of information for the designated adoptive parent.
    • If the birth parent wants to designate the adoptive parent in the relinquishment documents, they must sign a release of information that allows the Adoptions CSW to speak to the Adoptive Parent.
16. Obtain a signed release of information from the Adoptive Parent giving authorization for DCFS to release their full legal name to the birth parent in the relinquishment documents designating them as the adoptive parent.
17. Obtain documentation from the relinquishing parent(s) that verifies the identity of the child's mother, any presumed fathers, and any alleged natural fathers.
    
    1. Photocopy all available documents for the case record.
    2. Explain the important, possible repercussions of not accurately identifying other possible parents.
    3. The purpose of verifying the identity of the parties involved is to have authentic, verifiable identification that the person relinquishing is actually the parent who has the ability to relinquish. Regulation 35129(a)(5)(A) requires DCFS to obtain and verify all information necessary to identify the child's mother, any presumed father(s), and any alleged natural father(s).
       • If the relinquishing parent has an unofficial ID, can it be crosschecked through any other means? If the parent is unable to obtain an ID, identify the reasons. Consider whether there are other issues, such as substance abuse or mental health that require further assessment before accepting a relinquishment.
18. Provide the AD 880, Declaration of Mother, to the birth mother and ensure that they answer all of the questions and provide all known information about the father(s). Below are a few sample questions found on the AD 880:
    • Does a judgment of paternity already exist?
    • Was the mother married at the time of the child's conception or at any time thereafter?
    • Was the mother cohabitating with a man at the time of the child's conception or the birth of the child?
    • Has the mother received support payments or promises of support pertaining to the child or in connection with her pregnancy?
    • Has any man formally or informally acknowledged or declared his possible paternity of the child?
    • If paternity tests have been administered, what are the results?
19. Have the birth mother sign and date the form once it is complete.
    • If mother is not available, obtain the information from an appropriate person.
20. Report the results of the AD 880 questions to the court in the final adoption report and in any other report that concerns the termination of parental rights for the alleged father.
21. If the relinquishing parent does not reside in California, provide the above services by telephone and/or with the assistance of an adoption agency in the state or country where the parent is to the extent possible. If the local adoption agency is not willing to help, the birth parent may also have the documents notarized.

Advising Birth Mother and Presumed Father Whose Child is not Detained

Adoptions Division Birth Parent CSW Responsibilities

Take the following actions when advising a mother or a presumed father who is considering relinquishing a child who has been voluntarily removed:

1. If the child is not a dependent of the court, inform the birth parent(s) of their right to seek legal counsel to assist in the relinquishment process.
   • Upon a parent's request, refer them to legal resources, such as attorney referral services, legal aid offices, or other known public legal assistance services.
2. After a parent agrees to a Voluntary Placement Agreement, and subsequently the child becomes a court dependent, inform the parents of their right to seek legal counsel from the attorney representing them in the dependency case.
3. If interviewing a presumed father, explain the reason that DCFS believes him to be the child's presumed father and, if necessary, the definition of a "presumed father".
4. Explain the following information to the parent(s), as applicable:

Advising an Alleged Natural Father of a Child who is not Detained or a Court Dependent

Adoptions Division Birth Parent CSW Responsibilities

1. Explain the following to the alleged natural father of a non-detained or non-court dependent child:
   • The reasons DCFS considers themselves to be the alleged natural father of the child
   • The alleged natural father's right to:
     • File a petition with the court to establish paternity, if they wishes to take paternal responsibility for the child
     • Deny paternity
     • Waive their right to further notice of the adoption proceeding
     • Sign a relinquishment
     • Take no action
     • Seek legal counsel regarding their choice or decision, for assistance in contesting an adoption, or to appeal DCFS's petition to terminate their parental rights
   • DCFS' plan for the child
   • The extent that DCFS will allow the alleged natural father to participate in the selection of the adoptive family, if they decide to sign a relinquishment and the various rights associated with signing a designated relinquishment versus a standard relinquishment.
   • The alternatives to adoptive placement
   • The alleged natural father may talk about the plan to relinquish the child with other professionals and with family and friends.
   • Relinquishment means the parent who relinquishes will no longer be the child's legal parent, and he would be giving up care, custody, and control of the child to the adoption agency. It terminates their rights to custody, services, and earnings of the child, as well as their responsibility to care for the child.
   • The possibility of a post-adoption contact agreement, if appropriate.
   • Adoption terminates any inheritance from the parents or blood relatives of the child unless they make specific provision for the child by will or by trust; the child legally inherits from their adoptive family.
   • The timelines of when a relinquishment becomes final, when it can be revoked, whether he would like to sign a waiver of the right to revoke the relinquishment.
2. Determine what actions the alleged natural father wishes to take.
3. Upon their request and as appropriate, refer them to attorney referral services, legal aid offices, or other, known public legal assistance services.
4. Provide him with the appropriate Statement of Understanding and Relinquishment document.
   • These forms must be completed in the presence of the Adoptions CSW and subsequently signed in front of witnesses.
5. Review the Statement of Understanding with the birth parent to ensure that they understand the meaning of each item and to answer any questions.

Advising a Parent whose Child has been Removed

Adoptions Division Birth Parent CSW Responsibilities

When advising a mother, a presumed father or and alleged father who is considering relinquishing a child who is detained, a juvenile court dependent in out-of-home care, or a ward of a legal guardian, take the following actions.

1. Inform the parent of their right to seek legal counsel from the attorney representing them in the dependency case.
2. Encourage each parent to discuss the decision to relinquish the child with their attorney. Explain what relinquishment means, the options surrounding a relinquishment, and the legal consequences of a relinquishment.
3. Inform the parent that DCFS must follow the legal noticing requirements, which require DCFS to provide written notice of the relinquishment within five (5) court days to the following parties:
   • Juvenile court having jurisdiction of the child
   • All parties and their attorneys
   • Child's attorney
   • Relinquishing parent's attorney, if applicable
4. If the child is the subject of a legal guardianship established by the Probate Court, refer the parent to attorney referral services, legal aid offices, or other known public legal assistance services.
5. Explain the following to the mother or the presumed father:
   • DCFS' reason for believing the father is the child's presumed father
   • That if a presumed father does not believe themselves to be the child's father but agrees to adoption, the presumed father may either:
     • Sign a relinquishment document, stating that though they are relinquishing their parental rights, they do not believe that they are the child's father.
     • File a petition with the court asking it to determine that they are not the child's father.
     • Explain that even if the presumed father states orally or in writing that they are not the parent of the child. They are a presumed father under the law and they have legal rights and responsibilities with respect to the child.
   • DCFS' adoption plan for the child
   • The parent may talk about the plan to relinquish the child with other professionals and with friends and family.
   • The extent that DCFS will allow the alleged natural father to participate in the selection of the adoptive family, if they decide to sign a relinquishment
   • The services available, as determined by the child's juvenile court status, to assist them in obtaining resources and skills needed to parent the child
   • Alternative forms of adoption
   • That the juvenile court can terminate parental rights if it determines reunification is not possible
   • That they have the right to seek legal counsel from their attorney in a dependency case to contest and appeal the court's action
6. Refer the parent to the case-carrying CSW if they want more information regarding available services either before deciding whether to relinquish the child or if they do not want to relinquish the child.
7. If the child is the subject of a legal guardianship established by the Juvenile Court or the Probate Court, refer to Change of Permanent Plan from Legal Guardianship to Adoption.
8. Provide each parent with the appropriate Statement of Understanding and the Relinquishment document to complete.
9. Review the Statement of Understanding and the Relinquishment document with the birth parent to ensure that they understand the meaning of each item and answer any questions.
10. Follow all additional steps outlined in Advising an Alleged Natural Father of a Child who is not Detained or a Court Dependent.

Completing the Statement of Understanding

Adoptions Division Birth Parent CSW Responsibilities

1. For Indian children, adhere to the procedure outlined in Adopting and Serving Children Under the Indian Child Welfare Act (ICWA).
2. Provide each birth parent with the appropriate Statement of Understanding to complete. (Utilize the CDSS website to ensure you provide the most updated version of each of these forms):
   1. Choose one (1) of the following forms, as appropriate, for a child who does not fall under the ICWA:
      • AD 885, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian
      • AD 885A, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian
      • AD 885C, Statement of Understanding Agency Adoptions Program – Alleged Natural Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian
      • AD 885D, Statement of Understanding Agency Adoptions Program – Alleged Parent of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian
   2. Ensure that the appropriate Statement of Understanding is signed prior to the relinquishment document being accepted.
3. Review the Statement of Understanding with the parent to ensure that they understand the relinquishment process, is signing the form of their own free will, and understands the finality of the adoption.
   1. If the parent understands this and wishes to proceed:
      1. Indicate their understanding by initialing each explanatory statement.
      2. Indicate their preference regarding options for the filing of the relinquishment document by checking the box next to their choice.
   2. If the parent does not have a clear understanding of the information in the Statement of Understanding, do not proceed until the parent's questions are clarified.
   3. If it is determined that the parent who is signing the relinquishment does not read English and/or another language, adhere to the procedures outlined in #Assisting a Parent who Cannot Read Relinquishment Documents.
4. Obtain the parent's signature on the original and two (2) copies of the Statement of Understanding. The Statement of Understanding must have original signatures.
   • In cases where the parent-child relationship status is the same for all children being relinquished, the parent should sign three (3) original forms for the relinquishment per child.
   • The parent who signs the form translated in their native language is not required to sign the English version of it.
     1. If signed in California, ensure that the parent signs the Statement of Understanding in the presence of the Adoptions Division Birth Parent CSW and two (2) witnesses who are at least eighteen (18) years of age. The Adoptions Division Birth Parent CSW cannot be a witness.
     2. If signed out-of-state, ensure that:
        1. The parent signed it in the presence of an authorized child welfare services agency representative or a notary public.
        2. It is a California Department of Social Services (CDSS) authorized form.
        3. If a reader or translator is used by an out-of-state agency, they are verified by the out-of-state agency. If the parent resides out-of-state, they will be referred to an authorized or accredited adoption agency in that state, and the Statement of Understanding can be signed before a notary.
     3. If signed outside of the United States, ensure that the parent signs the Statement of Understanding in the presence of one (1) of the following:
        • A minister, commissioner, or charge d'affaires of the United States who resides and who is an accredited representative of the United States in the country where the proof of acknowledgement is made
        • A consul, vice consul, or consular agent of the United States who resides and is a representative of the United States in the country where the proof of acknowledgement is made
        • A judge of a court of record from the country where the proof of acknowledgement is made
        • A commissioner appointed by the Governor or Secretary of State for that purpose
        • A notary public. In such a case, the signature of the notary public must be proved or acknowledged before a judge of a court of record of the country where the proof of acknowledgement is made, by any American diplomatic officer, consul general, consul, vice consul, or consular agent, or by an apostille (certification) affixed to the instrument pursuant to the terms of the Hague Convention Abolishing the Requirement of Legalization for Foreign Public Documents.
5. Provide the parents with a copy of the signed Statement of Understanding.
6. Explain to the parent that they have the option of waiting a maximum of fourteen (14) calendar days before signing the relinquishment document.
   • Explain that if that time elapses, a new Statement of Understanding must be signed if they wish to relinquish.

Discussing Filing Options and Time Frames

Adoptions Division Birth Parent CSW Responsibilities

1. Inform the relinquishing parent(s) that:
   • They have the option of requesting the signed relinquishment document be filed without a holding period.
     • Explain that the relinquishment document is not sent to the state until the end of the next business day after signing.
   • They have the option of requesting that the signed relinquishment document be held by DCFS for a specified period of time for up to thirty (30) calendar days before it is submitted for filing.
   • They have the option of requesting that the signed relinquishment document be held for more than thirty (30) calendar days, if questions about the right of any other parent to legal custody of the child have not been resolved.
2. If a signed relinquishment document will be held for more than thirty (30) days due to unresolved questions regarding the child's custody:
   1. Explain to the relinquishing parent that the parent and the Adoptions Division Birth Parent CSW must mutually agree and sign a written statement, which indicates that it is necessary to hold the relinquishment document for an extended period of time.
   2. Ensure that the written statement specifies the time period the relinquishment document will be held and the reason for holding the document for more than thirty (30) calendar days.
      1. If the specific number of days cannot be stated in advance, the extended period ends when the Adoptions Division Birth Parent CSW becomes aware of the resolution regarding all other parent's right to legal custody of the child.
   3. Inform the relinquishing parent in writing within three (3) business days of becoming aware of the resolution of the custody issues that the extended period will end five (5) business days after the date the notice to the relinquishing parent is sent.
3. Explain to the relinquishing parent that they are permitted to revoke their relinquishment at any time prior to the expiration of any holding period and at any time before the relinquishment document is filed with the California Department of Social Services (CDSS). A relinquishment document becomes final ten (10) business days after CDSS receives the filing.
   1. Explain that if the last day of the holding period falls on a weekend or legal holiday, DCFS allows parents to revoke the relinquishment on the next business day following the weekend or holiday.
   2. Explain that DCFS will not place the child for adoption prior to the relinquishment document being filed with CDSS.
4. Explain to the relinquishing parent that they also have the option to sign a Waiver of Right to Revoke a Relinquishment if they want to have the relinquishment be effective immediately.

Accepting the Relinquishment Document

Adoptions Division Birth Parent CSW Responsibilities

1. Accept the relinquishment document, if all of the following criteria are met:
   • The parent is able to understand the content, nature, and effect of signing the relinquishment document.
     • If the parent underwent a psychiatric evaluation, the document was signed no later than thirty (30) days after their psychiatric evaluation was completed.
     • If the court has appointed a conservator for the parent, both the order of conservatorship specifically allows the parent to relinquish their child for adoption and the psychiatric evaluation establishes the parent's ability to understand the content, nature, and effect of the relinquishing the child for adoption.
   • For voluntary cases, the parent has signed the SOC 155, Voluntary Placement Agreement--Placement Request, and the AD 22, Health Facility Minor Release Report, if the child is in a health facility.
   • The Statement of Understanding has been signed and initialed by the parent.
2. If the child is a newborn, accept the relinquishment document if all of the following are met:
   • The mother has been medically discharged from the hospital.
     • The exception is when the mother's stay is delayed beyond five (5) days. In this case, obtain a written statement from the attending physician that the mother is not suffering from a known physical or mental impairment, which would preclude them from relinquishing the child for adoption.
     • For voluntary cases, the mother has signed the SOC 155 and the AD 22, if the child is in a health facility.
   • The mother has initialed and signed the Statement of Understanding.

Selecting the Appropriate Relinquishment Document

Adoptions Division Birth Parent CSW Responsibilities

1. Choose one (1) of the appropriate documents to complete from the list of Required Relinquishment Forms.
   • For Indian children, adhere to the procedures outline in Adopting and Serving Children Under the Indian Child Welfare Act (ICWA).
2. Enter the following information on the appropriate relinquishment form:
   • Child's name, sex, date of birth, and place of birth as stated on their birth certificate
     1. Ensure that a copy of the child's birth certificate has been obtained.
     2. If there is a discrepancy between the name of the child on the relinquishment document and the name on the birth certificate, complete an affidavit explaining the discrepancy.
     3. Attach a copy of the affidavit to the copy of the relinquishment document when it is sent to the California Department of Social Services (CDSS) to be filed and when the finalization packet is submitted for approval.
   • Name of the relinquishing parent as it appears on the child's birth certificate. If the parent is not named on the child's birth certificate, the parent must sign their legal name
     1. Include all of the parent's aliases that are used in legal transactions.
   • Name of the adoption agency (DCFS Adoptions & Permanency Resource Division) and the office address and telephone number of the Adoptions Division Birth Parent CSW who is signing the relinquishment
   • If the relinquishing parent chooses to designate a person to adopt the child, the designated person's name

Determining if the Relinquishment Document can be Signed

Adoptions Division Birth Parent CSW Responsibilities

1. If it is appropriate for a parent to sign a relinquishment document, give the appropriate original and two (2) copies of the relinquishment document to the parent to sign.
   • The relinquish document must have original signatures.
   • The relinquishment document cannot be altered or corrected unless it is initialed by the parent who signed the document, the reader or translator (if applicable) Adoptions Division Birth Parent CSW, and the witnesses to the relinquishment.
     1. If signed in Los Angeles County, ensure that these forms are signed in the presence of the Adoptions Division Birth Parent CSW and two (2) other witnesses.
        • The witnesses must be at least eighteen (18) years of age and cannot be the Adoptions Division Birth Parent CSW who is also signing the document.
     2. If signed out-of-state, ensure that these forms are signed in the presence of an authorized or accredited adoption agency or before a notary public.
        • Ensure that the use of a reader or translator by an out-of-state agency, if verified by the out-of-state agency.
     3. If signed outside of the United States, ensure that an appropriate person witnesses the parent's signature.
2. At the time the relinquishment document is signed:
   1. Request that the parent read the AD 908, Adoptions Information Act Statement, and sign two (2) copies of the form.
      • Parent also has the option of signing the AD902, Consent for Contact form if they so choose. 
   2. Advise the parent of the provisions of Family Code (FAM) Section 8701.
   3. Sign the "authorized official" portion of the three (3) relinquishment documents.
   4. Give the parent a copy of the completed relinquishment document and keep two (2) copies for the case record.
3. If the child has been temporarily placed with DCFS and the birth mother has not signed the relinquishment document within thirty (30) days of signing the SOC 155, Voluntary Placement Agreement-Placement Request, follow all procedures outlined in Voluntary Placement.
4. Within five (5) months from the date the SOC 155 or SOC 155C was signed, file a WIC 300 petition, if any of the following situations exist:
   • One (1) or both birth parents have not followed through with voluntarily relinquishing the child.
   • The child has been voluntarily relinquished but not adoptively placed. The exception is when the following one (1) situation has occurred:
     • The birth mother has signed a relinquishment document.
     • An acknowledgement of the relinquishment was issued.
     • The child was adoptively placed prior to the end of the six (6) month period.
     • There is a legal action under Family Code (FAM) Section 7662 pending on the alleged father.

Notifying the Court of a Dependent Parent's Relinquishment

For all pre-disposition cases, it is the responsibility of the Adoptions Division Birth Parent CSW who took the Relinquishment to provide notification of a parent's relinquishment to the court. In situations where the Adoptions Division Birth Parent CSW is not available, the Dependency Investigator must provide notification to the court. If a DI is not assigned to the case, it is the CS CSW’s responsibility.

Adoptions Division Birth Parent CSW or DI Responsibilities

1. If the child is a dependent of the court and once the birth parent has signed the relinquishment document:
   1. Immediately notify the case-carrying CSW.
   2. Review the online case record to ensure that all identifying information is recorded and current. Update the case record as necessary.
   3. As soon as information of the relinquishment by the parent is obtained, create the Ex Parte Application and Order by referring to the Sample Ex Parte Application and Order Report.
      1. When the report is created, a dialogue box appears titled, "Ex Parte Application and Order Document Options".
      2. Select "Other".
      3. Complete all appropriate fields on the report that are not populated by CWS/CMS.
      4. Manually enter any information not found in the application.
   4. Provide written notice to the following individuals within five (5) business days of the parent signing the relinquishment via the Ex Parte Application and Order:
      • Case-carrying CSW
      • Juvenile court having jurisdiction of the child
      • All parties and their attorneys
      • Relinquishing parent's attorney, if applicable
2. Request online approval for the Ex Parte Application and Order.
   1. Print the report.
   2. Sign and date the hard copy.
3. Submit the hard copy of the Ex Parte Application and Order, and, if applicable, all supporting documents to the SCSW for approval. 
   1. Do not attach the signed relinquishment documents to the court report.
   2. If the court ordered DCFS to submit the relinquishment documents, consult with the County Counsel.
   3. If advised to submit the documents to the court, place the original relinquishment documents in a sealed envelope and label it with the following information:
      • Court room and court case number
      • Child's name
      • The phrase, "For Court Eyes Only"
   4. Document that the relinquishment documents were submitted to the court in the Contact Notebook.
4. If the Ex Parte Application and Order was not approved, take necessary corrective action and resubmit the report for approval.
5. When the report is approved, send it and all attachments to DCFS support staff for final preparation and delivery to the court.
   • Ensure that it is delivered to the court by noon prior to the fifth (5th) day after obtaining information on the relinquishment.
6. Fax a copy of the report no later than five (5) judicial days after the parent(s) relinquish the child to the child's attorney and the relinquishing parent's attorney, if applicable.
   • File the fax transmission confirmation sheet in the Court Document folder of the case file.
7. Upon receipt of the minute order, ensure that the correct hearing date is entered in the Hearing Notebook.
   • Update the default date of "12/31/2001" with the date the case was heard.

Adoptions Division Birth Parent SCSW Responsibilities

1. Review the relinquishment packet that includes the Ex Parte Application and Order and any supporting documents.
2. If approved:
   1. Sign and date the Ex Parte Application and Order.
   2. Approve the Ex Parte Application and Order online.
   3. Return the packet to the Adoptions Division Birth Parent CSW.
3. If not approved, request corrective action online, and return the packet to the CSW.

Assisting a Parent who Cannot Read Relinquishment Documents

Adoptions Division Birth Parent CSW Responsibilities

Adhere to the following procedures if a parent who must sign a relinquishment, consent, or Statement of Understanding form cannot read English but does read their native language.

1. Check the California Department of Social Services (CDSS) website for forms that have already been translated.
   • If additional information is needed, contact the CDSS Language Services Unit at (916) 651-8865 or LTS@dss.ca.gov to obtain a translated copy of the appropriate document.
2. If CDSS cannot provide the translated forms within a reasonable time frame, the Adoptions Division Birth Parent cannot accept the relinquishment.
3. If the parent signing the statement cannot read any language:
   1. Provide the forms that can be read to the parent in a language that they understand.
      1. Obtain translated forms from the CDSS Language Services Unit.
   2. If applicable, permit the parent their own reader.
   3. If a parent cannot locate a reader, provide a DCFS employed reader who is approved by DCFS to read in the language to be read. The reader can be someone deemed fit and qualified by the agency (no certification required).
      1. Consult with the chain of command if there is not a DCFS employee that speaks the language.
   4. Audio record or videotape the reading of the forms to the parent.
      1. Consult with the SCSW or the ARA for information on obtaining tapes and recording equipment.
      2. File the tape in the adoption folder.
      3. Include a signed DCFS/A 409, attesting that the forms were accurately read.
4. Determine if the parent has a clear understanding of the information contained in the relinquishment, consent, and Statement of Understanding.
   1. If they do, proceed with having them sign the forms.
      • They do not need to sign the English versions of these forms.
   2. If they do not, inform them that the forms cannot be signed until the information has been clarified.
5. Ensure that the parent signs the relinquishment, consent, and Statement of Understanding using their legal signature and that they include all aliases used in legal transactions.

SCSW Approval

• Ex Parte Application and Order

Attachments

Alternative Forms of Adoption

Required Relinquishment Forms

Sample Ex Parte Application and Order Report

Forms

CWS/CMS

AD 22, Health Facility Minor Release Report

AD100, Authorization For Release, Use and/or Disclosure of Health and Other Information – Agency and Independent Adoptions Program

AD 100A, Authorization for Use and/or Disclosure of Heath Information Agency Adoption Program

AD 501, Relinquishment In or Out-of-County (Birth Mother and/or Presumed Father in California)

AD 501A, Relinquishment Out-of-State (Birth Mother and/or Presumed Father)

AD 504, Relinquishment Out-of-State in the Armed Forces (Birth Mother and/or Presumed Father)

AD 583, Relinquishment In or Out-of-County (Presumed Father Denies He is the Birth Father)

AD 584, Relinquishment Out-of-State (Presumed Father Denies He is the Birth Father)

AD 586, Relinquishment In- or Out-of-County (Alleged Natural Father in California)

AD 588, Denial of Paternity by Alleged Natural Father (In or Out of California)

AD 590, Waiver of Right to Further Notice of Adoption Planning (Alleged Natural Father In- or Out-if California)

AD 590A, Waiver of Right to Further Notice of Adoption Planning (Presumed Father In- or Out-of-California)

AD 591, Relinquishment Out-of-State (Alleged Natural Father)

AD 593, Relinquishment Out-of-State in Armed Forces (Alleged Natural Father), if signing before a military officer

AD 885, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 885A, Statement of Understanding Agency Adoption Programs – A Mother or a Presumed Father of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 885C, Statement of Understanding Agency Adoptions Program – Alleged Natural Father of a Child Who is Not Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 885D, Statement of Understanding Agency Adoptions Program – Alleged Natural Father of a Child Who is Detained, a Juvenile Court Dependent in Out-of-Home Care, or the Ward of a Legal Guardian

AD 908, Adoptions Information Act Statement

AD 4339, Relinquishment Out-of-State (Birth Mother and/or Presumed Father)

LA Kids

AD 67, Information about the Birth Mother (Spanish)

AD 67A, Information about the Birth Father (Spanish)

DCFS/A 409, Adoptions & Permanency Resources Division Reader's/ Translator's Statement

SOC 155, Voluntary Placement Agreement--Placement Request

SOC 155C, Voluntary Placement Agreement Parent/Agency (Indian Child)

Hard Copy

AD 4333, Acknowledgement and Confirmation of Receipt of Relinquishment Documents

DCFS/A 14, Parent's Request for Service

Referenced Policy Guides

0080-502.25, Family Maintenance Services for Court and Voluntary Cases

0080-507.20, Concurrent Planning and the Concurrent Planning Assessment (CPA)

0100-510.21, Voluntary Placement

0200-507.10, Identifying a Prospective Adoptive Family for a Child through the Matching Coordination Unit (MCU)

0200-508.25, Filing, Revoking, and Rescinding a Relinquishment

0200-513.05, Postadoption Contact Agreements

0300-303.15, Writing the Detention Report

0300-503.99, Change of Permanent Plan from Legal Guardianship to Adoption

1200-500.05, Adopting and Serving Children Under the Indian Child Welfare Act (ICWA)

Statutes

California Department of Social Service (CDSS), Adoptions Manual, Title 22, Section 35003 – Summarizes the procedures used with regards to relinquishment and consent procedures for parents who cannot read English or any other language.

CDSS, Title 22, Div 2, Adoptions Manual Sections 35129.1 – 25129.2 – Explains the advisement that birth parents should receive regarding their rights when placing a child for adoption.

CDSS, Title 22, Div 2, Adoptions Manual, Sections 35130 – 35149 – Summarizes instructions on accepting a relinquishment.

CDSS, Title 22, Div 2, Adoptions Manual, Sections 35151 – 35152.1 – Summarizes instructions for the Statement of Understanding.

Family Code (FAM) Section 7611 – States the conditions for when a man is presumed to be the natural father of a child.

FAM Section 7660.5 – States, in part, how a presumed father may waive the right to notice of any adoption proceeding.

FAM Section 7662 – Summarizes when a petition should be filed to terminate the parental rights of a father when a birth mother relinquishes, consents to, or proposes to relinquish for the adoption of a child.

FAM Section 7662(b) – States, in part, that a birth father may validly execute a waiver or a denial of paternity before or after the birth of a child and that, once signed, no notice of, relinquishment for, or consent to adoption of the child is required from the birth father for the adoption to proceed.

FAM Section 8620(a)(1) – States, in part, that if a parent is seeking to relinquish a child or to execute an adoptive placement agreement, DCFS will ask the child and the child's parents/legal guardian whether the child is, or may be, a member of an Indian tribe.

FAM Section 8700(c) – States, in part, when a California adoption agency can accept a relinquishment from a parent not residing in California.

FAM Section 8700(i) – States, in part, DCFS must provide notice of the relinquishment of a child who is within WIC Section 300 or who is the subject of a petition for juvenile court jurisdiction under WIC 300 within five (5) court days to those indicated.

FAM Section 8701 – States, in part that before, or any time after, the relinquishment document is signed, the birth parent signing it may request from DCFS all known information about the status of the child's adoption, except for personal, specified, identifying information about the adoptive parent(s).

FAM Section 8702 – States, in part, when a relinquishment document is signed by the birth parents, a statement is to be presented that ensures the birth parents and prospective adoptive parents of the integrity of the adoption process.

FAM Section 8801 – States, in part, that the selection of a prospective adoptive parent is to be personally made by the child's birth parent(s) and not delegated to an agent.

Welfare and Institutions Code (WIC) Section 300 – Details the criteria that a child must meet to be adjudged by the juvenile court as a dependent of the court.

WIC Section 11400(o) – Outlines the provisions of a voluntary placement.

WIC Section 16507.2 – States that prior to entering a voluntary placement agreement with a parent or legal guardian, the social worker will make every attempt to keep the family together by offering the appropriate child welfare services except in the case of a voluntary placement that is pending relinquishment.