Probate Court 
 Case No.: 

   

tate of Alabama 

Unified Judicial System 

                           Page 1 of 3 
Form PR-2                    8/08     

CONSENT FOR ADULT TO BE 
ADOPTED 
(Section 26-10A-11(b), Ala.Code 1975) 

TATE OF ALABAMA  

___________________COUNTY 

n the Matter of the Adoption Petition of [Full Name(s) and Age(s) of Petitioner(s) and His/Her/Their Residence Address(es), 
Including City(ies) or Town(s), State(s), and Zip Code(s)]: 
_______________________________________________________________________________ 
_______________________________________________________________________________. 

o Adopt ____________________________________________________ (Name of Person), an Adult. 

 KNOW ALL MEN BY THESE PRESENTS that I, __________________________________ 
_________________________________________,  as (Check which boxes are applicable): [      the person 
being adopted; OR [    ] the spouse or  [    ] the guardian or [      the conservator of the person 
being adopted; OR [    ] the guardian ad litem appointed by this Court for the person being 
adopted (having filed a written report), after been first duly placed under oath, do hereby state, 
agree, and consent to [    ] my adoption  [   ] the adoption of _________________________ (Name 
of person being adopted) by _________________________________ 
[Name(s) of Petitioner(s), unless identity waived] in order that the person being adopted may have all the 
privileges which may be accorded to the person by the laws of Alabama upon his or her legal 
adoption.     

he Petitioner(s) further aver(s) as follows (Check which boxes are applicable): 

      1.  That the person being adopted is _____ years of age, having been born on 
____________________________ (state month, day, and year of birth). 

      2.  Any Other Name(s) by Which the Person Being Adopted Has Been Known: 
_________________________________________________________________________________.

      3.  That a copy of the Petition for Adoption of the person was received and that [Check which 
boxes are applicable]: [    ] the person being adopted has read the Petition and understands its 
content and purpose; OR the [       spouse, [    ] guardian, [      conservator, or [      guardian 
ad litem has read the Petition and understands its content and purpose; 

      4.  As the: [   ] person being adopted; OR the [   ] spouse, [   ] guardian, [   ] custodian, or  
[   ] guardian ad litem of the person being adopted, I am executing this document voluntarily 
and unequivocally thereby consenting to the adoption. 

      5.  I, as the [    ] person being adopted; OR the [    ] spouse, [    ] guardian, [    ] custodian, 
or [   ] guardian ad litem of the person being adopted, understand that by signing this 
document and the subsequent court order to ratify the consent, I will forfeit all rights and 
obligations and that I understand the consent to the adoption and execute it freely and 
voluntarily. 

       6.  I understand that the consent to the adoption may be irrevocable, and I should not 
execute it if I need or desire psychological or legal advice, guidance, or counseling.  
 

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     ]  7.  I, as the [    ] person being adopted; OR the [    ] spouse, [    ] guardian, [    ] custodian, 
or  [   ] guardian ad litem of the person being adopted, have received or have been offered a 
copy of this document.  

CONSENT FOR ADULT TO BE ADOPTED 
(Section 26-10A-11(b), Ala.Code 1975) 

 

 

Unified Judicial System 
                                     Page 2 of 3 
Form PR-2                             8/08 

tate of Alabama 

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     ]  8.  I, as the [   ] person being adopted; OR the [   ]  spouse, [   ] guardian, [   ] custodian, or 
[   ]   guardian ad litem, am voluntarily waiving the right to know the identity of each petitioner 
who petitions to adopt the person by executing this consent. 

       9.  I, as the [   ]  person being adopted; OR the [   ]  spouse, [   ]  guardian, [   ] custodian, or 
[   ]   guardian ad litem of the person being adopted, waive further notice of the adoption 
proceedings by the execution of this consent, unless there is a contest or appeal of the 
adoption proceedings. 

       10.  I understand that notice of withdrawal of this consent must be mailed to 
___________________ (county where the consent or petition is filed, if known) Probate Court at the following 
address; OR _________________________________________________________________ 
(name and address of agency with whom document is filed); OR  
_______________________________________________ (name of the petitioner(s) or his/her/their attorney, if the 
county where the petition was filed is unknown) and that such withdrawal must be mailed within five days of 
the execution of this document. 

     ] 11.  That the purpose of this adoption is as follows: ___________________________ 

________________________________________________________________________________ 

(Attach additional sheets, if necessary), and not for any fraudulent purpose. 

     ] 12.  That a hearing will be conducted by this Court regarding the Petition for Adoption at 
which hearing the person being adopted, and, if applicable, the spouse, guardian, conservator, 
or guardian ad litem, will be informed in writing.  

 do hereby request that Judge of Probate make all orders and decrees as may be necessary or   
proper to legally effect the adoption. 

iven under my hand at ____ o’clock [   ]  A.M.  [   ] P.M. (time) on _____________________ (date), 
at ___________________________________________________________________ (address of filing)  

____________________________________     

[Signature of Person Being Adopted, Spouse, 
Guardian, Conservator, or Guardian ad Litem] 

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I, ____________________________________________, sign my name to this instrument this the 
_____ day of _______________________, 20 ___, and being first duly sworn, do hereby declare 
to the undersigned authority that I execute it as my free and voluntary act for the purpose 
therein expressed, and I am _____ years of age or older, of sound mind, and under no 
constraint or undue influence. 

                                                                                         

_____________________________________ 
[Signature of Person Being Adopted, Spouse,                 
Guardian, Conservator, or Guardian ad Litem] 

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State of Alabama 
Unified Judicial System 
                                Page 3 of 3 
Form PR-2                        8/08 

 

CONSENT FOR ADULT TO BE ADOPTED 
(Section 26-10A-11(b), Ala.Code 1975) 

STATE OF ___________________________ 

 ______________________________ COUNTY 

ubscribed, sworn to and acknowledged before me by   

_____________________________   this 
 

  

_____ day of ___________________, 20 ____. 

                                                                __________________________________ 
                                        Notary Public 
                                           (My commission expires: ___________________) 

 
 

 
 

 
 

 
 

 acknowledge receipt of two copies of this document. _____________________________(Seal) 
                                                                                                                                                                                    
                                                                                             _________________________________ 
                                                                                                                         (Date) 
 

NOTICE OF WITHDRAWAL 

, ______________________________________________,  as [Check which boxes are applicable]:  
] the 
person being adopted; OR the [    ] spouse, or [    ] guardian, or [    ] conservator of the person 
being adopted; OR [    ] the guardian ad litem appointed by this Court for the person being 
adopted, on this ________   day of  ______________________, 20___, at _______ [   ] a.m. [   ] 
p.m.(time of day) in the presence of two (2) witnesses, whose signatures and addresses are 
subscribed below, hereby withdraw the Consent to Adoption previously signed by me. 

   

  

 

                                

                                          [Signature of Person Being Adopted, Spouse, 
                                                                                                           Guardian, Conservator, or Guardian ad Litem] 

                                                                                         
__________________________________       

________________________________________________ 
[Printed Name of Witness] 

_______________________________________________ 

[Signature of Witness] 

_____________________________________________________________________________ 

[Home Address of Witness, including City or Town, State, and Zip Code] 

_______________________________________________ 

[Printed Name of Witness] 

_______________________________________________ 

[Signature of Witness] 

_____________________________________________________________________________ 

[Home Address of Witness, including City or Town, State, and Zip Code] 

 

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