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r1r STANDING COMMITTEE ON RULES OF PRACTICE - Maryland ...

r1r STANDING COMMITTEE ON RULES OF PRACTICE - Maryland ...

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[ ] I already have spoken with a lawyer whose name and<br />

OR<br />

telephone number are _________________________________<br />

______________________________________________________.<br />

I have read the instructions at the front of this form,<br />

and I am ready to consent to the adoption.<br />

[ ] I am at least 18 years old and am able to understand<br />

this document. I have read the instructions at the<br />

front of this form, and I do not want to speak with a<br />

lawyer before I consent to the adoption.<br />

C. Right to Counseling and Guidance<br />

I WANT TO COMPLETE THIS C<strong>ON</strong>SENT FORM BECAUSE:<br />

Check one of the following:<br />

[ ] I have already spoken with a counselor. I have read<br />

OR<br />

the instructions at the front of this form, and I am<br />

ready to consent to the adoption.<br />

[ ] I do not want to speak with a counselor. I have read<br />

D. Consent<br />

the instructions at the front of this form, and I am<br />

ready to consent to the adoption.<br />

I voluntarily and of my own free will consent to the ending<br />

(termination) of my rights as parent to and to the adoption of my<br />

child, ______________________________, by a person(s) known to me<br />

as _____________________________________________________________.<br />

E. Notice<br />

-368-

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