FORM SUMMARY Name of Form: Consent to Termination of Parental Rights (Judicial) Form Number: JC-1637 Statutory Reference: §§48.41(2)(b), Wisconsin Statute Benchbook Reference: JV 13 Purpose of Form: Consent form signed by a parent before a judicial officer consenting to the termination of his or her parental rights to a child. Who Completes It: Party seeking the termination will usually make the arrangements to have this consent completed and filed with the court; it may be brought to court to be completed and signed at the termination hearing. Distribution of Form: Original filed with the court. Accompanying Forms: May accompany the Petition for termination of parental rights (voluntary) or may be received subsequent to the filing of the petition. New Form/Modification: Modification, last update 7/96. Modifications: Added a file/date stamp area to upper left corner. Added a statement on the bottom indicating that the form shall not be modified. Comments: None About this form: This form is the product of the Wisconsin Records Management Committee, a committee of the Director of State Court's Office and a mandate of the Wisconsin Judicial Conference. If you have additional information that does not change the meaning of the form, attach it on a separate page. The form itself shall not be altered. Date: 04/24/2008 Page 1 American LegalNet, Inc. www.FormsWorkflow.com COUNTY STATE OF WISCONSIN, CIRCUIT COURT, IN THE INTEREST OF For Official Use Consent to Termination of Parental Rights (Judicial) a person under the age of 18. Case No. Date of Birth UNDER OATH, I STATE: 1. My name is My address is My date of birth is 2. My child is not a member of or eligible for membership in an Indian tribe. (For an Indian child, use the Indian Child Welfare Act version (IW-1637) of this consent.) 3. I am the (check one): mother. alleged father. presumed father. adjudicated father. biological (non-adjudicated) father. 4. I have been informed and understand that a court order terminating parental rights will permanently end ALL legal rights and duties that exist between myself and this child, such as: • Duty to support • Right to custody and visitation • Right to inherit 5. I wish to give up any parental rights that I may have to this child and consent to the court entering an order terminating my parental rights. 6. I give up the right to know of any future hearing or proceedings in this matter. 7. I am making this decision on my own free will. No promises or threats have been made to get me to sign this document. Subscribed and sworn to before me on ____________________________________________ Signature Notary Public, State of Wisconsin Name Printed or Typed My commission expires: Date APPROVAL OF GUARDIAN AD LITEM (Needed for minor or incompetent parent) I am the guardian ad litem for the above named parent who is a incompetent. I am familiar with the facts. I join in minor the consent to the termination of this person’s parental rights. CERTIFICATE OF JUDGE I certify that I am the judge of the County, State of court of , a court of record. The above named parent appeared before me on this date. I questioned this parent and found this consent to be informed and voluntary before I accepted it. ____________________________________________ Signature of Guardian ad Litem Signature of Circuit Court Judge Name Printed or Typed Name Printed or Typed Date Date JC-1637, 04/08 Consent to Termination of Parental Rights (Judicial) §48.41(2)(b), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. American LegalNet, Inc. www.FormsWorkflow.com