Case Number:

ADOPT-206

Your name:

1

2

a.

b.

Declaration Confirming Parentage in Stepparent Adoption: Gestational Surrogacy

This form is attached to form ADOPT-200 (Adoption Request). 

This optional form may be attached to the form ADOPT-200 if the adopting parent was married to or in a state-registered 
domestic partnership or equivalent civil union with the parent who established parentage through a gestational surrogacy 
process. You may instead attach a declaration in another format containing substantially the same information. The legal 
parent through surrogacy and the adopting parent must complete separate declarations.

I                                                                                                                                         declare as follows:

(write your name)

Relationship between the legal parent and the adopting parent seeking to confirm parentage (check one):

I am the parent of a child born through a gestational surrogacy process. Only my parentage was established  
through the Uniform Parentage Act or another proceeding related to the surrogacy. Before the birth of the 
child, I married, or entered into a state-registered domestic partnership (including a domestic partnership or 
civil union from out-of-state that is legally equivalent to a marriage) with, the adopting parent who is seeking 
to confirm parentage, (name)

, and we remain in that union.

I am the adopting parent seeking to confirm parentage. Before the birth of the child, I married, or entered into 
a state-registered domestic partnership (including a domestic partnership or civil union from out-of-state that 
is legally equivalent to a marriage) with, the parent whose parentage has been established for a child born 
through a gestational surrogacy process, (name)
remain in that union.

, and we

3 We were married/registered as domestic partners                                                                                                           , 
before our child was born. A copy of our marriage certificate, registered domestic partner certificate, or certificate 
of out-of-state domestic partnership or civil union is attached.

on (date you entered into your earliest union)

4 Our child (name of child to be adopted)

was born on (date)

outside of the state of California. A copy of our child’s birth certificate is attached.

5

Our child was conceived through a gestational surrogacy process. (Describe how your child was conceived.)

Judicial Council of California,   
New January 1, 2021, Optional Form  
Family Code, § 9000.5

Declaration Confirming Parentage in 
Stepparent Adoption: Gestational Surrogacy

ADOPT-206, Page 1 of 2

Your name:

Case Number:

6

If there are any other persons who are or may be the child’s parents, describe these persons’ relationship to the 
child, including their names, the ways in which these persons act as parents to the child, and whether these 
persons consent to the adoption:

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Type or print your name

Sign your name

Date:

 Rev. January 1, 2021 

Declaration Confirming Parentage in 
Stepparent Adoption: Gestational Surrogacy

ADOPT-206, Page 2 of 2