DOB: 
 

  Judge: 

 , adoptee

Bar no.

 

 2. A release of the child has been executed according to law by
 
 

Name(s)

 .

 

 3. The consent to the adoption is genuine and is given by the person(s) having legal authority to sign the consent and the best 
 

interests of the adoptee will be served by the adoption.

	4.	The	adoptee	is	an	Indian	child	as	defined	in	MCR	3.002(12)	and	the	court	has	considered	the	application	of	the	Indian	Child
	 Welfare	Act	and	the	Michigan	Indian	Family	Preservation	Act	in	this	matter.

In the matter of 

Full name of child

1. Date of hearing: 
 

THE COURT FINDS:

 
 

 

	

IT IS ORDERED:

5. The rights of the parent(s) or the person in loco parentis 

Name(s)

 are terminated.

Date

 

Judge

Approved, SCAOJIS CODE: OTADo not write below this line - For court use onlySTATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYORDER TERMINATING PARENTAL RIGHTS/RIGHTS OF PERSON IN LOCO PARENTISAFTER RELEASE OR CONSENTFILE NO.PCA 318 (6/18) ORDER TERMINATING PARENTAL RIGHTS/RIGHTS OF PERSON IN LOCO PARENTIS       AFTER RELEASE OR CONSENTMCL 710.29(7), MCL 710.51(1), 25 USC 1901 et seq., MCL 712B.1 et seq.

PCA 318, Order Terminating Parental Rights/Rights of Person In Loco Parentis After Release or Consent

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About This Form:

• Sourced from www.courts.michigan.gov/adoptions-court-forms (2023-03)
• Page(s): 1
• Fields(s): 15
• Average fields per page: 15
• Reading Level: Grade 8
• LIST Grouping(s): FA-00-00-00-00.

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