IN THE INTEREST OF:, a child � Respondent � Address AOC-292 � Doc. Code: AWCA Rev. 6-17Page 1 of 2Commonwealth of KentuckyCourt of Justice www.courts.ky.govKRS 625.041(3); 199.011(16); and199.500APPEARANCE WAIVER ANDCONSENT TO ADOPTION lexet justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE Case No. Court District Family County � Division � WAIVER OF APPEARANCEI, , hereby state that I am the natural parent of the above-named child and I hereby voluntarily, and with full knowledge and agreement, waive my right to appear in the above-styled proceeding to terminate my parental rights.Parent's SignatureParent's Name (Please Print)Counsel for ParentGuardian ad litem for Minor ParentCabinet DesigneeSUBSCRIBED and SWORN to before me this day of , 2.My Commission expires: . � � Notary Public Please mail a copy of the FINAL JUDGMENT to: American LegalNet, Inc. www.FormsWorkFlow.com Preparer's Name & Address AOC-292Rev. 6-17Page 2 of 2I, , hereby state that I am the natural mother father of , the child to be adopted, who was born to me in wedlock out-of-wedlock on in .CONSENT TO ADOPTION(parent's name)(child's name)(child's date of birth)(city, state, country of child's birth)I also state, and acknowledge by my initials, that: � � � � � � � � � � � � � � � � � The proposed adoptive parent of my child is:. � I understand that if the adoption is not adjudged, that the disposition of my child will be made pursuant to KRS 199.550. � The total amount of my legal fees related to the execution of this consent are $ to be paid � by. � That I have reviewed this consent and the legal effect of this consent has been fully explained to me. � That I have not been coerced in any way to execute this consent, nor have I been given or promised anything of � value, except those expenses allowable under KRS 199. 590(6), to execute this consent. � That it is my intention to consent to the adoption of my child. I understand that this consent to the adoption of my child will become after the later of the placement approval (if required by the secretary for families and children) or the execution of this consent and that this sent to the proposed adoptive parent or the attorney � � � � � � � � � � � � � � � � � � � � � mail. If placement approval by the secretary is not required, the voluntary and informed consent � � Consenting Parent's Signature � � Consenting Parent's Signature SUBSCRIBED and SWORN to before me this day of , 2.My Commission expires: . � � Notary Public Reviewer's Name & Address SUBSCRIBED and SWORN to before me this day of , 2.My Commission expires: . � � Notary Public American LegalNet, Inc. www.FormsWorkFlow.com