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In The Matter of The Adoption Of: and Concerning

This document is a consent form for contact between an adopted person and their biological family. It contains fields for the adopted person's name and relationship to the person they want to contact. They can choose to consent to contact through correspondence, phone calls, or meetings. Alternatively, they can refuse contact and choose to keep their records sealed. The form requires signatures from the adopted person and the confidential intermediary, and certification that the court received a copy.

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79 views1 page

In The Matter of The Adoption Of: and Concerning

This document is a consent form for contact between an adopted person and their biological family. It contains fields for the adopted person's name and relationship to the person they want to contact. They can choose to consent to contact through correspondence, phone calls, or meetings. Alternatively, they can refuse contact and choose to keep their records sealed. The form requires signatures from the adopted person and the confidential intermediary, and certification that the court received a copy.

Uploaded by

Steve
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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 District Court  Denver Juvenile Court

_________________________________________ County, Colorado


Court Address:

IN THE MATTER OF THE ADOPTION OF:

AND CONCERNING:

, Petitioner
COURT USE ONLY
Attorney or Party Without Attorney (Name and Address): Case Number:

Phone Number: E-mail:


FAX Number: Atty. Reg.#: Division Courtroom
CONSENT RELEASE OR REFUSAL TO CONTACT

I, __________________________________________________________________________, CONSENT TO CONTACT


with my _________________________________________________________________________________(relationship).
My legal name is: _____________________
My legal birth name was: Date of Birth: _______
I agree to the following form of contact:
 exchange of correspondence  telephone call
 personal meeting  other (specify) _________________________________________

I state that my consent is voluntary and informed, and I release the confidential intermediary, the training organization, the
Court and any agency from any liability resulting from this contact.

___________________________________________________ ___________________________________________
Signed Date Confidential Intermediary Date

_________________________________________________________________________________________________________________________________
Address of Signatory

I, _______________________________________________________________________________, REFUSE CONTACT


with my __________________________________________________________________________________(relationship).

My current legal name is: ____________________


My legal birth name was: Date of Birth:

I acknowledge receipt of information about the Colorado Voluntary Adoption Registry for my use in the event I should ever
desire to have contact with this individual. It is my present desire that the records remain sealed and my anonymity be
preserved.

_____________________________________________ ___________________________________________
Signed Date Confidential Intermediary Date

_________________________________________________________________________________________________________________________________
Address of Signatory

I certify that a signed copy of this Consent Release or Refusal to Contact was received in the __________________Court,
________________County, Colorado.
_____________________________________________ ___________________________________________
Date Signature of Clerk
JDF 346 R9/00 CONSENT RELEASE OR REFUSAL TO CONTACT

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