JDF 510 R 1 / 1 8 CONSENT TO A DOPTION NON - CUSTODIAL PARENT District Court Denver Juvenile Court County, Colorado Court Address: IN THE MATTER OF THE PETITION OF: (N ame of person (s) seeking to adopt) FOR THE ADOPTION OF A CHILD COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Phone Number: E - mail: FAX Number: Atty. Reg. #: Case Number: Division Courtroom CONSENT TO ADOPTION NON - CUSTODIAL PARENT 1. I (name) am the birth parent of ( name of child). 2. I have received a copy of the Petition for Adoption , Petition to Terminate Child - Legal Relationship and the Notice of Hearing. 3. I hereby voluntarily consent to the adoption of the above - named child by the P etitioner (s) named in this action . 4. I waive notice of any fu r ther proceedings based on my consent to the adoption . Waiver and Acceptance of Service I declare under oath that I am the Respondent in this case, that I have received and accept service of the Consent to Adoption Non - Custodial Parent and a copy of the Petition for Adoption Petition to Terminate Child - Legal Relationship, Notice of Hearing, and Other (Please identify): in this case. This waiver of service shall not be construed as an admission by me of the truth of the allegations in the Petition and I reserve the right to receive notices of se ttings and the right to respond and appear in person. Note: If you are in the active military service of the United States of America, you may be entitled to request a temporary suspension of these proceedings under the Servicemembers Civil Relief Act (5 0 U.S.C. App. 247 520, et seq .). Please consult with your base legal officer or the attorney of your choice. I have decided to waive the stay provisions of the Servicemembers Civil Relief Act (50 U.S.C. 247 520, et seq.) as well as my right to court - appointe d counsel under the Act and permit the action to proceed. This waiver of service shall not be construed as an admission by me of the truth of the allegations in the Petition. VERIFICATION I declare under penalty of perjury under the law of Colorado that the foregoing is true and correct. Executed on the day of , , at (date) (month) (year) (city or other location, and state OR country (printed name of Respondent) Signature American LegalNet, Inc. www.FormsWorkFlow.com