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ADOPT-225

Parent of Indian Child Agrees 
to End Parental Rights

Clerk stamps below when form is filed.

I want my child to be adopted by (name(s)):
a.
b.
Their relationship to Indian child: (Check all that apply)

Related to child (specify):

Members of child’s tribe   
None of the above

Indian parents

meet  
The parent(s) in  
preference requirements of the Indian Child Welfare Act.

do not meet    the placement

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Court name and street address:

Superior Court of California, County of

Indian child (name):
Date of birth: 
Child’s tribe(s):
Enrollment #:

Age:

Check here if you do not know the enrollment #.

Case Number:

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Your name:
Mother

City:

Phone #:

Father (Check only one. Each parent fills out a separate form.)

Your address (skip this if you have a lawyer):

Your tribe(s):

State:

Zip:
Enrollment #:

Check here if you do not know the enrollment #.

Your lawyer (if you have one): (Name, address, phone #, and State Bar #):

and I understand and say:

I agree to the adoption of my child by the parent(s) listed in

I am the parent in
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a.   I agree to give up my parental rights.
b.  
c.   I understand what will happen when I sign this form.
d.   No one has threatened me or made promises to me to get me to sign this form.
e.   I understand that until the judge signs an Adoption Order (ADOPT-215) or an order to end my parental

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.

f.

rights, I can change my mind and my child will be returned to me.    
I want the court to let me know if the adoption is canceled so I can ask the court to give custody of my child
back to me. The court will give the custody of my child back to me if the judge decides it is in my child’s best
interest.

g.   I do not give up any of my rights under the Indian Child Welfare Act by signing this form. 

h.   My child was at least 10 days old when I signed this form.
i.   I understand that notice of the adoption request will be sent to any Indian tribe of which my child may be a 
      member or eligible for membership.

Judicial Council of California, www.courtinfo.ca.gov
Rev. January 1, 2005, Mandatory Form
25 U.S.C. § 1913

Parent of Indian Child Agrees
to End Parental Rights

ADOPT-225, Page 1 of 2

Case Number:

Your name:

Date:

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At the time of signing this form, I do not live and am not domiciled on an Indian reservation.

Type or print your name

Signature of Indian parent

Judge’s Certification

I, Judge
Superior Court of California, County of

,

, certify:

This form was completed in writing and recorded before me.
I fully explained the terms and consequences to (name of parent):

The parent fully understood the terms and consequences.                
The parent speaks English or used an interpreter at the hearing.

Certified:

Date:

Judge (or Judicial Officer)

Rev. January 1, 2005

Parent of Indian Child Agrees 
to End Parental Rights

ADOPT-225, Page 2 of 2