S.I. No. 170/1990 - Adoption Rules, 1990

Type Statutory Instrument
Publication 1990-07-06
Last updated 2010-07-14
State Repealed superseded text
Text As published
articles 13

This is the act as published. Later amendments are not folded into the text below: each one is a separate act in this repository and an entry in this law's history.

2 amending acts · 2010-07-14, Adoption Act 2010

Reform history JSON API

S.I. No. 170 of 1990.

ADOPTION RULES, 1990.

An Bord Uchtala, with the consent of the Minister for Health and in exercise of the powers conferred on it by section 5 of the Adoption Act, 1952 (No. 25 of 1952), hereby makes the following rules:—

1.

1.

These rules may be cited as the Adoption Rules, 1990.

2.

2.

The Adoption Rules, 1976 ( S.I. No. 216 of 1976 ), and the Adoption Rules, 1984 ( S.I. No. 134 of 1984 ), are hereby revoked.

3.

3.

The Adoption Rules 1988 ( S.I. No. 304 of 1988 ), the Adoption (No. 2) Rules, 1988 ( S.I. No. 329 of 1988 ) and these rules shall be construed as one and may be cited together as the Adoption Rules, 1988 to 1990.

4.

4.

In these rules—

"the Acts" means the Adoption Acts, 1952 to 1988:

"the Board" means An Bord Uchtala;

"the Registrar" means the Registrar of the Board.

"adoption agency" means a registered adoption society or a health board.

5.

5.

Each of the forms set out in the Schedule shall be used in the case and manner indicated by the form.

6.

6.

Notwithstanding the revocation of the Adoption Rules, 1976, and the Adoption Rules, 1984, the forms prescribed in those Rules may continue to be used to the extent permitted by the Board.

7.

7.

The Board may require an applicant for an adoption order to submit medical evidence of the state of his health.

8.

8.

The Board may require the person or body that placed a child for adoption to submit medical evidence of the state of the child's health.

9.

9.

The Board may require any statement in a prescribed form to be verified by oral or other evidence.

10.

10.

The Registrar shall give to every applicant for an adoption order at least ten days' notice in writing or such shorter notice as may be accepted by the applicant of the date, hour and place of hearing of the application.

11.

11.

The Registrar shall give to every person whose consent to the making of an adoption order is required (other than such person as has indicated that he does not wish to be informed of the date on which the Board would hear him or his counsel or solicitor on the application for the adoption order) at least ten days notice in writing of the date, hour and place at which the Board will hear him or his counsel or solicitor on the application for the order.

12.

12.

The Registrar shall give to every person summoned to attend before the Board as a witness at least ten days notice in writing of the date, hour and place at which he is to attend before the Board.

13.

13.

These rules shall come into operation three months after their signing.

GIVEN under the Official Seal of the Board this 6th day of July, 1990.

VIRGINIA ROCHFORD,

Chairman.

The Minister for Health hereby consents to the foregoing rules.

GIVEN under the Official Seal of the Minister for Health this 6th day of July 1990.

RORY O'HANLON,

Minister for Health.

SCHEDULE.

Form 1.

APPLICATION FOR ADOPTION ORDER.

PART 1 —SECTION A.

(To be completed in all cases where the application is being made by a married couple)

We, the undersigned, being a married couple living together, desire to adopt the child named or described in this application form. We understand that if an adoption order is granted to us in respect of the child, we shall be fully responsible for the child's upbringing, as if the child were born to us in lawful wedlock and we voluntarily undertake to discharge that responsibility as far as we are able. We have not received or made, or agreed to receive or make, any payment whatsoever in consideration of the adoption of this child.*

Husband's Signature ............................................................ ...
Wife's Signature............................................................ ............
Date............................................................ .................................

*Payments made or received in respect of the child's maintenance or solicitors' remuneration for professional services are not referred to here.

PART 1 — SECTION B.

(To be completed only where the application is being made by one person)

I, the undersigned person, being the mother of the child/the natural father of the child/a relative* of the child/a widow/widower (Delete inapplicable words).

desire to adopt the child named or described in this application form. I understand that if an adoption order is granted to me in respect of the child, I shall be fully responsible for the child's upbringing as if the child were born to me in lawful wedlock and I voluntarily undertake to discharge that responsibility as far as I am able. I have not received or made, or agreed to receive or make, any payment whatsoever in consideration of the adoption of this child.**

Applicant's Signature .................................................
Date ............................................................ ...................

*"relative" here means grandparent, brother, sister, uncle or aunt, whether of the whole blood, of the half blood, or by affinity, relationship to a child born outside marriage being traced through the mother only.

**Payments made or received in respect of the child's maintenance or solicitors' remuneration for professional services are not referred to here.

PART 2 —SECTION A.

(To be completed in every application.)

(If the application is being made by a married couple, the particulars given in this section should be those relating to the Husband only).

1. Husband's/Applicant's name. (Delete "husband's" or "applicant's", whichever does not apply)
(Block letters)............................................................ ............................................................ ......................................
2. Address (Block letters)............................................................ ............................................................ .........
............................................................ ............................................................ ...................................................
3. Occupation............................................................ ............................................................ .............................
4. Relationship (if any) to the child ............................................................ .....................................................
5. Date of birth ............................................................ ............................................................ .........................
6. Are you ordinarily resident in the State and, if so, since when?
............................................................ ............................................................ ....................................................
7. Religious denomination ............................................................ ............................................................ ........

PART 2 — SECTION B.

(This section to be completed ONLY where the application is being made by a married couple.)

(The particulars given in this section should be those relating to the wife only)

8. Wife' name (Block letters) ............................................................ .........................................................
9. Occupation............................................................ ............................................................ .......................
10. Relationship (if any) to child ............................................................ .....................................................
11. Date of birth............................................................ ............................................................ ......................................
12. Are you ordinarily resident in the State and, if so, since when? ............................................................ ............................................................ ...............................................
13. Religious denomination ............................................................ ............................................................ ...

PART 2— SECTION C.

(This section to be completed only where the application is being made by a married couple)

14. Date and place of marriage............................................................ ...........................................................
15. Did either of you have a previous marriage; if so, please give the date and place, and the date of death of spouse or the date and place of dissolution?
............................................................ ............................................................ ..............................................
............................................................ ............................................................ ...............................................
............................................................ ............................................................ ................................................

PART 2 — SECTION D.

(To be completed in every application)

16. Have you previously applied for an adoption order in respect of this or any other child and, if so, with what result?
............................................................ ............................................................ ................................................
............................................................ ............................................................ .................................................
17. (a) Have you any children of your own; if so, please give names, dates of birth and present addresses?
............................................................ ............................................................ .................................................
............................................................ ............................................................ .................................................
............................................................ ............................................................ .................................................
(b) Have you any other children in your care; if so, please give names and dates of birth?
............................................................ ............................................................ .................................................
............................................................ ............................................................ ..................................................
............................................................ ............................................................ ..................................................
18. Christian name or first name of child to whom this application refers (Block letters)
............................................................ ............................................................ ..................................................
19. Sex ............................................................ ............................................................ .............................................
20. Date of birth............................................................ ............................................................ ..........................
21. Name and address of person or body from whom you got the child .................................................
............................................................ ............................................................ ................................................
............................................................ ............................................................ ..................................................
22. Date on which you took the child under your care............................................................ ......................
............................................................ ............................................................ ...................................................
23. Please give the names and addresses of two or more persons not related to you to whom reference may be made by the Board (Block letters)
............................................................ ............................................................ ...................................................
............................................................ ............................................................ ...................................................
............................................................ ............................................................ ....................................................

Note: The Board may require you to submit medical evidence of your state of health before coming to a decision on your application.

Form 2A.

BACKGROUND REPORT ON CHILD AND NATURAL PARENTS.

(To be completed by adoption agency for each application)

PART I.

THE CHILD

1. Name ............................................................ .................. Sex............................................................ .............
2. Date of Birth............................................................ ............................................................ ............................
3. Was the child born
(a) Outside Marriage?............................................................ ............................................................ ..........
(b) Within marriage? ............................................................ ............................................................ .............
(c) Of an extra-marital relationship? ............................................................ .................................................
4. Did the child's natural parents marry each other after the birth?
............................................................ ............................................................ ....................................................
5. Pre-placement history of child ............................................................ ..........................................................
............................................................ ............................................................ ....................................................
............................................................ ............................................................ .....................................................
6. If child was more than four months old at date of placement, please state reason(s) for delay ............
............................................................ ............................................................ .......................................................
............................................................ ............................................................ ......................................................
............................................................ ............................................................ ......................................................

PART 2.

THE NATURAL MOTHER

7. Name and Address............................................................ ............................................................ .............
............................................................ ............................................................ ...............................................
8. Date of birth, or if unknown, approximate age ............................................................ ...........................
9. Religion (if any) ............................................................ ............................................................ ....................
10. Marital Status ............................................................ ............................................................ ........................
11. Date and place of marriage (if applicable) ............................................................ ....................................
............................................................ ............................................................ ................................................
12. Level of Education: Primary/Secondary/Third Level? ............................................................ ..............
............................................................ ............................................................ ..............................................
13. Occupation............................................................ ............................................................ ............................
14. Is she currently in employment? ............................................................ ....................................................
15. Community Care Area of mother at time of initial contact with agency
............................................................ ............................................................ ..............................................
16. Date of initial contact with agency ............................................................ .............................................
17. By whom was the mother counselled? ............................................................ ...........................................
............................................................ ............................................................ ..................................................
............................................................ ............................................................ ..................................................
............................................................ ............................................................ ..................................................
18. Reason(s) for placing child for adoption ............................................................ ....................................
............................................................ ............................................................ ..................................................
............................................................ ............................................................ ...................................................
19. Did she meet the prospective adopters? ............................................................ ......................................
20. Has the mother other children? If so, please state number and whether they are with her, adopted or elsewhere............................................................ ............................................................ .............................
............................................................ ............................................................ ...................................................
............................................................ ............................................................ ...................................................
21. Please give particulars of any known history of psychiatric or hereditary illness in the natural mother or any member of her family ............................................................ ...............................................
............................................................ ............................................................ ...................................................
............................................................ ............................................................ ...................................................

PART 3. (To be completed only where the natural mother is under eighteen years of age)

22. How was the mother referred to the agency? ............................................................ ............................
............................................................ ............................................................ ................................................
23. Were her parents aware of the pregnancy? If so, what was their attitude? ........................................
............................................................ ............................................................ ..................................................
............................................................ ............................................................ ..................................................
............................................................ ............................................................ ...................................................
24. (a) Were her parents interviewed by the agency?
............................................................ ............................................................ .................................................
(b) If so, was the natural mother interviewed separately?
............................................................ ............................................................ ...................................................

PART 4.

THE NATURAL FATHER

25. Is his name known?............................................................ ............................................................ ............
26. Is he registered as the father on the child's birth certificate?
............................................................ ............................................................ .................................................
27. Is he married? ............................................................ ............................................................ ......................
28. Was he interviewed by the agency? ............................................................ .............................................
29. Is his relationship with the natural mother continuing or has it terminated? .....................................
30. What is his attitude to the proposed adoption?............................................................ .......................
............................................................ ............................................................ ................................................
............................................................ ............................................................ ................................................
31. Has he been appointed a guardian of the child pursuant to a court order or otherwise? ..................
32. Has the agency or the mother been given any indication that he intends applying to court for legal rights in relation to the child? If so, please give particulars ............................................................ .....
............................................................ ............................................................ ...............................................
33. Has the father other children? If so, please state number and whether they are with him, adopted or elsewhere ............................................................ ............................................................ ............................
............................................................ ............................................................ ..............................................
............................................................ ............................................................ ...............................................
34. Please give particulars of any known history of psychiatric or hereditary illness in the natural father or any member of his family
............................................................ ............................................................ ...............................................
............................................................ ............................................................ ...............................................

PART 5.

35. Please set out below any other information on the child's natural background which might have a bearing on the application. Please set out below any other information on the child's natural background which might have a bearing on the application.
............................................................ ............................................................ ................................................... ............................................................ ............................................................ ...................................................
............................................................ ............................................................ .................................................... ............................................................ ............................................................ ....................................................
............................................................ ............................................................ ..................................................... ............................................................ ............................................................ .....................................................
............................................................ ............................................................ ...................................................... ............................................................ ............................................................ ......................................................
............................................................ ............................................................ ...................................................... ............................................................ ............................................................ ......................................................
Signed............................................................ .....................................
Description ............................................................ .............................
Adoption Agency ............................................................ .................
Date ............................................................ .......................................

Form 2B.

BACKGROUND REPORT ON CHILD AND NATURAL PARENTS.

(To be completed by applicant(s) where the adoption was arranged otherwise than by a registered adoption society or health board)

PART 1.

THE CHILD

1. Name ............................................................ ......................... Sex ............................................................ ......
2. Date of Birth ............................................................ ............................................................ ..........................
3. Was the child born
(a) Outside marriage? ............................................................ ............................................................ ...........
(b) Within marriage? ............................................................ ............................................................ .............
(c) Of an extra-marital relationship? ............................................................ ................................................
4. Did the child's natural parents marry each other after the birth? ..........................................................
5. Pre-placement history of child ............................................................ ..........................................................
............................................................ ............................................................ .....................................................
............................................................ ............................................................ ....................................................
6. Has the mother other children? If so, please state number and whether they are with her, adopted or elsewhere.
............................................................ ............................................................ .....................................................
............................................................ ............................................................ ..................................................

PART 2.

THE NATURAL MOTHER

7. Name and Address............................................................ ............................................................ .................
............................................................ ............................................................ ..................................................
............................................................ ............................................................ ...................................................
8. Date of birth, or if unknown, approximate age ............................................................ ...........................
9. Religion ............................................................ ............................................................ ...................................
10. Marital Status ............................................................ ............................................................ ......................
11. Date and place of marriage (if applicable)............................................................ ....................................
............................................................ ............................................................ ................................................
12. Level of Education: Primary/Secondary/Third Level?............................................................ ................
............................................................ ............................................................ ................................................
13. Occupation ............................................................ ............................................................ ..........................
14. Is she currently in employment? ............................................................ ...................................................
15. Reason(s) for placing child for adoption ............................................................ ....................................
............................................................ ............................................................ .................................................
............................................................ ............................................................ ..................................................
16. How did she meet the prospective adopters?............................................................ ................................
............................................................ ............................................................ ...................................................
............................................................ ............................................................ ...................................................
............................................................ ............................................................ ..................................................

PART 3.

THE NATURAL FATHER

17. Is his name known? ............................................................ ............................................................ ..............
18. Is he registered as the father on the child's birth certificate?............................................................ ......
............................................................ ............................................................ ...................................................
19. Is he married? ............................................................ ............................................................ ..........................
20. Is his relationship with the natural mother continuing or has it terminated?........................................
21. What is his attitude to the proposed adoption?............................................................ ............................
............................................................ ............................................................ ...................................................
22. Has he been appointed a guardian of the child pursuant to a court order or otherwise? ...................
23. Has he given any indication that he intends applying to court for legal rights in relation to the child? If so, please give particulars.
............................................................ ............................................................ ...................................................

PART 4.

24. Please set out below any other information on the child's natural background which might have a bearing on the application. Please set out below any other information on the child's natural background which might have a bearing on the application.
............................................................ ............................................................ .................................................... ............................................................ ............................................................ ....................................................
............................................................ ............................................................ .................................................... ............................................................ ............................................................ ....................................................
............................................................ ............................................................ ................................................... ............................................................ ............................................................ ...................................................
............................................................ ............................................................ ................................................... ............................................................ ............................................................ ...................................................
............................................................ ............................................................ .................................................. ............................................................ ............................................................ ..................................................
............................................................ ............................................................ .................................................. ............................................................ ............................................................ ..................................................
............................................................ ............................................................ ................................................. ............................................................ ............................................................ .................................................
Signature of female applicant ............................................................ .
Signature of male applicant ............................................................ .....
Date ............................................................ ..............................................

Form 3A.

CONSENT TO ADOPTION.

(For use by mother where the identity of the applicant(s) is known to her)

In the matter of an application for the adoption of the child ............................................................ ....... In the matter of an application for the adoption of the child ............................................................ .......
............................................................ ............................................................ ............................................................ ............................................................ ............................................................ ............................................................
I, ............................................................ ........................ (name) of ............................................................ .............. I, ............................................................ ........................ (name) of ............................................................ ..............
............................................................ ............................................................ .......................................... (address) Spinster/Married/Divorced/Widow (a) aged eighteen years and upwards (or, if under eighteen, aged ................. years), make oath and say as follows: ............................................................ ............................................................ .......................................... (address) Spinster/Married/Divorced/Widow (a) aged eighteen years and upwards (or, if under eighteen, aged ................. years), make oath and say as follows:
1. I am aware that an application is about to be made or has been made by .................................. 1. I am aware that an application is about to be made or has been made by ..................................
............................................................ ............................................................ ......................................... ............................................................ ............................................................ .........................................
of ............................................................ ............................................................ .................................. for an adoption order in respect of the said child. of ............................................................ ............................................................ .................................. for an adoption order in respect of the said child.
2. I am the mother of the said child. 2. I am the mother of the said child.
3. I did/did not marry the father of the said child. (b) 3. I did/did not marry the father of the said child. (b)
4. I am/I am not the sole guardian of the said child. The father has/has not been appointed a guardian of the said child pursuant to a court order or otherwise. (c) 4. I am/I am not the sole guardian of the said child. The father has/has not been appointed a guardian of the said child pursuant to a court order or otherwise. (c)
5. To the best of my knowledge and belief the father has not instituted proceedings in relation to guardianship or custody of the said child. (d) 5. To the best of my knowledge and belief the father has not instituted proceedings in relation to guardianship or custody of the said child. (d)
6. The said child is not less than six weeks old, having been born on the ............day of ......... 19... 6. The said child is not less than six weeks old, having been born on the ............day of ......... 19...
7. I know that the religion of the male applicant is............................................................ ......... and that the religion of the female applicant is ............................................................ ........... 7. I know that the religion of the male applicant is............................................................ ......... and that the religion of the female applicant is ............................................................ ...........
8. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the said child and that these rights and duties shall be transferred to the adopter or adopters. 8. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the said child and that these rights and duties shall be transferred to the adopter or adopters.
9. I have been informed and I understand that an Bord Uchtala (Adoption Board) may make an adoption order in respect of the said child at any time after the signing of this consent. 9. I have been informed and I understand that an Bord Uchtala (Adoption Board) may make an adoption order in respect of the said child at any time after the signing of this consent.
10. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above. 10. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above.
11. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtala, Hawkins House, Dublin 2, and that on the making of an adoption order my consent becomes irrevocable. 11. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtala, Hawkins House, Dublin 2, and that on the making of an adoption order my consent becomes irrevocable.
12. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing. I also understand that if I wish to be heard I will be informed of the date on which the Board will hear me or my counsel or solicitor. 12. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing. I also understand that if I wish to be heard I will be informed of the date on which the Board will hear me or my counsel or solicitor.
13. I say that my wishes in respect of the matters referred to in paragraph 12 above are as follows:— 13. I say that my wishes in respect of the matters referred to in paragraph 12 above are as follows:—
(i) I do/I do not wish to be heard on the application for the adoption order. (e) (i) I do/I do not wish to be heard on the application for the adoption order. (e)
(ii) I do/I do not wish otherwise to be consulted again in relation to the application for the adoption order. (f) (ii) I do/I do not wish otherwise to be consulted again in relation to the application for the adoption order. (f)
14. I understand that this affidavit may be used as evidence that I consent to the adoption order being made. 14. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.
Signature ............................................................ ............................
Sworn at ............................................................ ............ in the county of ............................................................ . Sworn at ............................................................ ............ in the county of ............................................................ .
on this .................. day of............................................................ ............................................... 19......... on this .................. day of............................................................ ............................................... 19.........
before me, and I know the deponent (or and I know............................................................ ............................... before me, and I know the deponent (or and I know............................................................ ...............................
who certifies to me that he knows the deponent) who certifies to me that he knows the deponent)
Signature ............................................................ ..........................
Description (g) ............................................................ ................
(a), (b), (c), (d), (e) and (f) Delete words which do not apply. All deletions must be initialled by the deponent and by the person before whom the affidavit is sworn. (a), (b), (c), (d), (e) and (f) Delete words which do not apply. All deletions must be initialled by the deponent and by the person before whom the affidavit is sworn.
(g) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths. (g) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths.

Form 3B.

CONSENT TO ADOPTION.

(For use by person other than mother where the identity of the applicant(s) is known to the consenting party)

In the matter of an application for the adoption of the child ............................................................ ...... In the matter of an application for the adoption of the child ............................................................ ......
I, ............................................................ ............................................ (name) of ...................................................... I, ............................................................ ............................................ (name) of ......................................................
............................................................ ............................................................ .................................................(address) ............................................................ ............................................................ .................................................(address)
Bachelor/Spinster/Married/Divorced/Widow/Widower (a) aged eighteen years and upwards (or, if under eighteen, aged ................................... years), make oath and say as follows:— Bachelor/Spinster/Married/Divorced/Widow/Widower (a) aged eighteen years and upwards (or, if under eighteen, aged ................................... years), make oath and say as follows:—
1. I am aware that an application is about to be made or has been made by ................................... ............................................................ ............................................................ .............................................. of............................................................ ............................................................ ....................... for an adoption order in respect of the said child. 1. I am aware that an application is about to be made or has been made by ................................... ............................................................ ............................................................ .............................................. of............................................................ ............................................................ ....................... for an adoption order in respect of the said child.
2. I am the father of the said child/a guardian of the said child/a person having charge of or control over the said child. (b) 2. I am the father of the said child/a guardian of the said child/a person having charge of or control over the said child. (b)
3. I am the father of the said child and I married the mother of the said child. (c) 3. I am the father of the said child and I married the mother of the said child. (c)
4. The said child is not less than six weeks old, having been born on the ...................... day of .............., 19........ 4. The said child is not less than six weeks old, having been born on the ...................... day of .............., 19........
5. I know that the religion of the male applicant is............................................................ ....and that the religion of the female applicant is............................................................ .......................................... 5. I know that the religion of the male applicant is............................................................ ....and that the religion of the female applicant is............................................................ ..........................................
6. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the said child and that these rights and duties shall be transferred to the adopter or adopters. 6. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the said child and that these rights and duties shall be transferred to the adopter or adopters.
7. I have been informed and I understand that An Bord Uchtala (Adoption Board) may make an adoption order in respect of the said child at any time after the signing of this consent. 7. I have been informed and I understand that An Bord Uchtala (Adoption Board) may make an adoption order in respect of the said child at any time after the signing of this consent.
8. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above. 8. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above.
9. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtala, Hawkins House, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable. 9. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtala, Hawkins House, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.
10. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or otherwise to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing. I also understand that if I wish to be heard I will be informed of the date on which the Board will hear me or my counsel or solicitor. 10. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or otherwise to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing. I also understand that if I wish to be heard I will be informed of the date on which the Board will hear me or my counsel or solicitor.
11. I say that my wishes in respect of the matters referred to in paragraph 10 above are as follows:— 11. I say that my wishes in respect of the matters referred to in paragraph 10 above are as follows:—
(i) I do/I do not wish to be heard on the application for the adoption order. (d) (i) I do/I do not wish to be heard on the application for the adoption order. (d)
(ii) I do/I do not wish otherwise to be consulted again in relation to the application for the adoption order. (e) (ii) I do/I do not wish otherwise to be consulted again in relation to the application for the adoption order. (e)
12. I understand that this affidavit may be used as evidence that I consent to the adoption order being made. 12. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.
Signature ............................................................ .................
Sworn at ...................................... in the county of ............................................ on this ......................... day of................................ 19 .................................................. before me, and I know the deponent (or and I know ............................................................ ................ who certifies to me that he knows the deponent). Sworn at ...................................... in the county of ............................................ on this ......................... day of................................ 19 .................................................. before me, and I know the deponent (or and I know ............................................................ ................ who certifies to me that he knows the deponent).
Signature............................................................ ....................................
Description (f)............................................................ ............................
(a), (b), (c), (d) and (e) Delete words which do not apply. All deletions must be initialled by the deponent and by the person before whom the affidavit is sworn. (a), (b), (c), (d) and (e) Delete words which do not apply. All deletions must be initialled by the deponent and by the person before whom the affidavit is sworn.
(f) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths. (f) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths.

Form 3C.

CONSENT TO ADOPTION.

(For use by mother where the identity of the applicant(s) is known to her)

In the matter of an application for the adoption of the child ............................................................ ...... In the matter of an application for the adoption of the child ............................................................ ......
............................................................ ............................................................ ............................................................ . ............................................................ ............................................................ ............................................................ .
I, ............................................................ ................................... (name) of ............................................................ .... I, ............................................................ ................................... (name) of ............................................................ ....
............................................................ ............................................................ ............................................ (address) ............................................................ ............................................................ ............................................ (address)
Spinster/Married/Divorced/Widow/(a) aged eighteen years and upwards (or, if under Eighteen, aged ............................ years), do solemnly and sincerely declare that:— Spinster/Married/Divorced/Widow/(a) aged eighteen years and upwards (or, if under Eighteen, aged ............................ years), do solemnly and sincerely declare that:—
1. I am aware that an application is about to be made or has been made by ..................................... ............................................................ ............................................................ ............................................... of............................................................ ............................................................ ............................................ for an adoption order in respect of the said child. 1. I am aware that an application is about to be made or has been made by ..................................... ............................................................ ............................................................ ............................................... of............................................................ ............................................................ ............................................ for an adoption order in respect of the said child.
2. I am the mother of the said child. 2. I am the mother of the said child.
3. I did/did not marry the father of the said child. (b) 3. I did/did not marry the father of the said child. (b)
4 I am/I am not the sole guardian of the said child. The father has/has not been appointed a guardian of the said child pursuant to a court order or otherwise. (c) 4 I am/I am not the sole guardian of the said child. The father has/has not been appointed a guardian of the said child pursuant to a court order or otherwise. (c)
5. To the best of my knowledge and belief the father has not instituted proceedings in relation to guardianship or custody of the said child.(d) 5. To the best of my knowledge and belief the father has not instituted proceedings in relation to guardianship or custody of the said child.(d)
6. The said child is not less than six weeks old, having been born on the ..................................... 6. The said child is not less than six weeks old, having been born on the .....................................
day of ................................... 19........................ day of ................................... 19........................
7. I know that the religion of the male applicant is............................................................ .................. 7. I know that the religion of the male applicant is............................................................ ..................
and that the religion of the female applicant is............................................................ ..................... and that the religion of the female applicant is............................................................ .....................
8. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the said child and that these rights and duties shall be transferred to the adopter or adopters. 8. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the said child and that these rights and duties shall be transferred to the adopter or adopters.
9. I have been informed and I understand that An Board Uchtala (Adoption Board) may make an adoption order in respect of the said child at any time after the signing of this consent. 9. I have been informed and I understand that An Board Uchtala (Adoption Board) may make an adoption order in respect of the said child at any time after the signing of this consent.
10. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above. 10. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above.
11. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtala, Hawkins House, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable. 11. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtala, Hawkins House, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.
12. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or otherwise to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing. I also understand that if I wish to be heard I will be informed of the date on which the Board will hear me or my counsel or solicitor. 12. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or otherwise to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing. I also understand that if I wish to be heard I will be informed of the date on which the Board will hear me or my counsel or solicitor.
13. I say that my wishes in respect of the matters referred to in paragraph 12 above are as follows:—– 13. I say that my wishes in respect of the matters referred to in paragraph 12 above are as follows:—–
(i) I do/I do not wish to be heard on the application for the adoption order. (e) (i) I do/I do not wish to be heard on the application for the adoption order. (e)
(ii) I do/I do not wish otherwise to be consulted again in relation to the application for the adoption order. (f) (ii) I do/I do not wish otherwise to be consulted again in relation to the application for the adoption order. (f)
14. I understand that this declaration may be used as evidence that I consent to the adoption order being made, and I made this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act, 1938 . 14. I understand that this declaration may be used as evidence that I consent to the adoption order being made, and I made this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act, 1938 .
Signature ............................................................ ....................
Declared before me, by ............................................... (name of declarant) who is personally known to me (or who is identified to me by) Declared before me, by ............................................... (name of declarant) who is personally known to me (or who is identified to me by)
............................................................ ............................................................ ............................................ ............................................................ ............................................................ ............................................
who is personally known to me), at............................................................ ........................................... who is personally known to me), at............................................................ ...........................................
............................................................ ............................................................ ............................................. ............................................................ ............................................................ .............................................
on this ............................................. day of...........................................19............................................... on this ............................................. day of...........................................19...............................................
Signature............................................................ .............................................
Description (g) ............................................................ ..................................
(a), (b), (c), (d), (e) and (f) Delete words which do not apply. All deletions must be initialled by the declarant and by the person before whom the declaration is made. (a), (b), (c), (d), (e) and (f) Delete words which do not apply. All deletions must be initialled by the declarant and by the person before whom the declaration is made.
(g) This declaration may be made before a Notary Public, a Commissioner for Oaths, a Peace Commissioner or a person authorised by law to take and receive statutory declarations. (g) This declaration may be made before a Notary Public, a Commissioner for Oaths, a Peace Commissioner or a person authorised by law to take and receive statutory declarations.

Form 3D.

CONSENT TO ADOPTION.

(For use by persons other than mother where the identity of the applicant(s) is known to the consenting party)

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