In the Juvenile Court of Utah 

__________ Judicial District ________________ County 

Court Address ______________________________________________________ 

____________________________________, 
(Child’s name) 

In the matter of 

a minor child 

Findings of Fact, Conclusions of 
Law and Order 

_______________________________ 
Case Number 

_______________________________ 
Judge 

This matter came before the court on petitioner’s Petition to Terminate Parental Rights 
upon Voluntary Relinquishment. 

A hearing was held on _______________________ (date), before  

[  ]  ______________________________ (name), a judge.  

[  ]  ______________________________ (name), a person appointed by the judge for 

the purpose of taking the relinquishment. 

Petitioner was placed under oath before questions were asked of the petitioner. 
Petitioner then signed the Voluntary Relinquishment of Parental Rights freely and 
voluntarily. 

Having received petitioner’s voluntary consent, 

The Court Finds: 

1. 

Petitioner ___________________________________________________ (name)  
is the natural   [  ] father   [  ] mother of the child named below. 

Findings of Fact, Conclusions of Law and Order 

Approved Board of Juvenile Court Judges February 13, 2009 
Revised August 27, 2021 

Page 1 of 4 

2. 

Petitioner’s residence is: 

ity, State, Zip 

ddress 

  A

  C

 

 

       

3. 

The petitioner’s child is: 

Name 

Current Residence 

Date of Birth 

Sex 

Place of Birth 

4. 

The person who has custody of the child is: 

5. 

Petitioner is asking the court to terminate parental rights because: 

This child is not a member of or eligible for membership in an Indian tribe. 

Petitioner understands that by signing the Voluntary Relinquishment of Parental 
Rights her/his parental rights over this child will be terminated and that s/he will 
no longer have any rights or obligations of a parent to this child from the date the 
order terminating petitioner’s parental rights is entered and forward. 

Petitioner understands that the parental rights s/he is voluntarily relinquishing 
include, but are not limited to, the rights of custody, visitation, and any other 
contact with this child, whether in person, by mail, or any electronic means, and 
any input regarding decisions made about this child. 

Findings of Fact, Conclusions of Law and Order 

Approved Board of Juvenile Court Judges February 13, 2009 
Revised August 27, 2021 

Page 2 of 4 

6. 

7. 

8. 

 

ame 

ddress 

hone 

mail 

ity, State, Zip 

elation to child 

  N

  A

  C

  P

  E

  R

       

       

9. 

Petitioner understands that the parental obligations s/he is voluntarily 
relinquishing include, but are not limited to, obligations to provide for the care, 
support, education, and moral training of this child. 

10.  Petitioner understands that s/he must pay any obligation for support of this child 

incurred before the date s/he signs the Voluntary Relinquishment of Parental 
Rights. 

11.  Petitioner understands that termination of her/his parental rights does not 

extinguish this child’s right to inherit from petitioner’s estate upon petitioner’s 
death.  

12.  Petitioner understands that termination of parental rights does not remove from 

this child eligibility for benefits from any third person, including, but not limited to, 
any agency or state, the United States or Indian tribe. 

13.  Petitioner is not under the influence of alcohol, prescription or non-prescription 
drugs, or any substance that might affect her/his thinking or behavior. 

14.  Petitioner understands that once s/he signs the Voluntary Relinquishment of 

Parental Rights s/he cannnot change her/his mind, that the relinquishment 
cannot be changed, and that her/his parental rights and obligations will be 
terminated forever. 

The Court Concludes: 

Rights. 

15.  Petitioner freely and voluntarily signed the Voluntary Relinquishment of Parental 

The primary purpose for petitioner relinquishing petitioner’s parental rights is not 
to avoid support obligations for this child. 

It is in the best interest of the child that petitioner’s parental rights be permanently 
terminated.  

The Court Orders: 

18.  Pursuant to Utah Code Section 80-4-105, petitioner’s parental rights and 

obligations over the child are permanently terminated from this date forward.  

19. 

The parental rights which are terminated include, but are not limited to, the rights 
of custody, visitation, and any other physical contact with this child, whether in 
person, by mail, or any electronic means, and any input regarding decisions 
made about this child. 

Findings of Fact, Conclusions of Law and Order 

Approved Board of Juvenile Court Judges February 13, 2009 
Revised August 27, 2021 

Page 3 of 4 

16. 

17. 

 

       

20 

21 

22 

The parental obligations which are terminated include, but are not limited to, the 
obligations to provide for the care, support, education, and moral training of this 
child.  

This order does not terminate any support obligations incurred before the date 
the consent was entered.  

This order does not extinguish this child’s right to inherit from petitioner’s estate, 
nor does it remove eligibility from this child for entitlements from state or federal 
governments or Indian tribes that this child may be entitled to as a result of 
petitioner being this child’s parent. 

23 

[  ]  Other orders relating to this child’s care and welfare that are in the child’s 

best interests: 

udge’s signature may instead appear at the top of the first page of this document. 

 
Date 

Signature ► 

 

 

Judge 

       

  J

 

 

Findings of Fact, Conclusions of Law and Order 

Approved Board of Juvenile Court Judges February 13, 2009 
Revised August 27, 2021 

Page 4 of 4