Tennessee Code 36-1-111 – Presurrender request for home study or preliminary home study – Surrender of child – Consent for adoption by parent – Effect of Surrender – Form of surrender – Waiver of interest – Interpreter for non – English speaking parents
Terms Used In Tennessee Code 36-1-111
- Adoption: means the social and legal process of establishing by court order, other than by paternity or legitimation proceedings or by voluntary acknowledgment of paternity, the legal relationship of parent and child. See Tennessee Code 36-1-102
- Adoptive parent or parents: means the person or persons who have been made the legal parents of a child by the entry of an order of adoption under this part or under of the laws of any state, territory or foreign country. See Tennessee Code 36-1-102
- Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
- Chambers: A judge's office.
- Child-caring agency: means any agency authorized by law to care for children outside their own homes for twenty-four (24) hours per day. See Tennessee Code 36-1-102
- children: means any person or persons under eighteen (18) years of age. See Tennessee Code 36-1-102
- Clerk of court: An officer appointed by the court to work with the chief judge in overseeing the court's administration, especially to assist in managing the flow of cases through the court and to maintain court records.
- Code: includes the Tennessee Code and all amendments and revisions to the code and all additions and supplements to the code. See Tennessee Code 1-3-105
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Consent: means :
(A) The written authorization to relinquish a child for adoption, which is given by an agency such as the department or a public child care agency of another state or country or licensed child-placing agency of this or another state, which agency has the authority, by court order or by surrender or by operation of law or by any combination of these, to place a child for adoption and to give permission for the adoption of that child by other persons. See Tennessee Code 36-1-102 - Continuance: Putting off of a hearing ot trial until a later time.
- court: includes the juvenile court for purposes of the authority to accept the surrender or revocation of surrenders of a child and to issue any orders of reference, orders of guardianship, or other orders resulting from a surrender or revocation that it accepts and for purposes of authorizing the termination of parental rights pursuant to §. See Tennessee Code 36-1-102
- Court report: means the report to the adoption or surrender court in response to an order of reference that describes to the court the status of the child and the prospective adoptive parents or the persons to whom the child is surrendered. See Tennessee Code 36-1-102
- Department: means the department of children's services or any of its divisions or units. See Tennessee Code 36-1-102
- Docket: A log containing brief entries of court proceedings.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
- Guardian: means a person or entity appointed by a court to provide care, custody, control, supervision, and protection for a child, and authorized by the court to adopt or consent to the adoption of the child as a result of a surrender, parental consent, or termination of parental rights. See Tennessee Code 36-1-102
- Guardianship: means the status created by a court order appointing a person or entity guardian of the child. See Tennessee Code 36-1-102
- Home study: means the product of a preparation process in which individuals or families are assessed by themselves and the department or licensed child-placing agency, or a licensed clinical social worker as to their suitability for adoption and their desires with regard to the child they wish to adopt. See Tennessee Code 36-1-102
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Legal parent: means :
(i) The biological mother of a child. See Tennessee Code 36-1-102 - Licensed child-placing agency: means any agency operating under a license to place children for adoption issued by the department, or operating under a license from any governmental authority from any other state or territory or the District of Columbia, or any agency that operates under the authority of another country with the right to make placement of children for adoption and that has, in the department's sole determination, been authorized to place children for adoption in this state. See Tennessee Code 36-1-102
- Licensed clinical social worker: means an individual who holds a license as an independent practitioner from the board of social worker certification and licensure pursuant to title 63, chapter 23, and, in addition, is licensed by the department to provide adoption placement services. See Tennessee Code 36-1-102
- Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
- Oath: A promise to tell the truth.
- Oath: includes affirmation. See Tennessee Code 1-3-105
- Order of reference: means the order from the court where the surrender is executed or filed or where the adoption petition is filed that directs the department or a licensed child-placing agency or licensed clinical social worker to conduct a home study or preliminary home study or to complete a report of the status of the child who is or may be the subject of an adoption proceeding, and that seeks information as to the suitability of the prospective adoptive parents to adopt a child. See Tennessee Code 36-1-102
- Parental consent: means the consent described in subdivision (16)(C). See Tennessee Code 36-1-102
- Parental rights: means the legally recognized rights and responsibilities to act as a parent, to care for, to name, and to claim custodial rights with respect to a child. See Tennessee Code 36-1-102
- parents: means any biological, legal, adoptive parent or parents or, for purposes of §. See Tennessee Code 36-1-102
- Person: includes a corporation, firm, company or association. See Tennessee Code 1-3-105
- Physical custody: means physical possession and care of a child. See Tennessee Code 36-1-102
- Preliminary hearing: A hearing where the judge decides whether there is enough evidence to make the defendant have a trial.
- Preliminary home study: means an initial home study conducted prior to or, in limited situations, immediately after, the placement of a child with prospective adoptive parents who have not previously been subject to a home study that was conducted or updated not less than six (6) months prior to the date a surrender is sought to be executed to the prospective adoptive parents or prior to the date of the filing of the adoption petition. See Tennessee Code 36-1-102
- Probable cause: A reasonable ground for belief that the offender violated a specific law.
- Property: includes both personal and real property. See Tennessee Code 1-3-105
- Prospective adoptive parents: means a nonagency person or persons who are seeking to adopt a child and who have made application with a licensed child-placing agency or licensed clinical social worker or the department for approval, or who have been previously approved, to receive a child for adoption, or who have received or who expect to receive a surrender of a child, or who have filed a petition for termination or for adoption. See Tennessee Code 36-1-102
- Record: means information that is inscribed on a tangible medium or that is stored in an electronic or other medium and is retrievable in a perceivable form. See Tennessee Code 1-3-105
- Related: means grandparents or any degree of great-grandparents, aunts or uncles, or any degree of great-aunts or great-uncles, or stepparent, or cousins of the first degree, or first cousins once removed, or any siblings of the whole or half degree or any spouse of the above listed relatives. See Tennessee Code 36-1-102
- Representative: when applied to those who represent a decedent, includes executors and administrators, unless the context implies heirs and distributees. See Tennessee Code 1-3-105
- sex: means a person's immutable biological sex as determined by anatomy and genetics existing at the time of birth and evidence of a person's biological sex. See Tennessee Code 1-3-105
- signed: includes a mark, the name being written near the mark and witnessed, or any other symbol or methodology executed or adopted by a party with intention to authenticate a writing or record, regardless of being witnessed. See Tennessee Code 1-3-105
- State: when applied to the different parts of the United States, includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
- Surrender: means a document executed under §. See Tennessee Code 36-1-102
- United States: includes the District of Columbia and the several territories of the United States. See Tennessee Code 1-3-105
- Venue: The geographical location in which a case is tried.
- written: includes printing, typewriting, engraving, lithography, and any other mode of representing words and letters. See Tennessee Code 1-3-105
TENNESSEE SURRENDER FORM
I, (full name of surrendering party) ______________, born (surrendering party’s date of birth) ______________, sign this surrender to end my parental rights and responsibilities to (full name of child) ____________________, born (child’s date of birth) ______________ in (location of child’s birth) ____________________. I am this child’s (circle one) mother / father / possible father / guardian.
I surrender my parental rights to and request that this Court give guardianship to (a person/family with a current, approved home study, or a licensed child-placing agency) ______________.
I know I only have three (3) days to change my mind and revoke this decision after I sign this form. This decision may not be changed if I do not revoke this surrender on or before ______________ (three days after today, calculated under Tennessee Rule of Civil Procedure 6.01). To revoke, I must sign a revocation form before the Judge or officiant with me now or his or her successor.
I have completed the Surrendering Party Pre-Surrender Information Form. I have provided true and complete answers to all the questions on that form to the best of my knowledge.
I know that I should only sign this form if I want my parental rights terminated. If I want to talk to my own lawyer before I sign this form, I should tell the Judge or other officiant now and this surrender process will stop. I can talk to my lawyer and then decide if I still want to end my parental rights. If I do not have my own lawyer, I understand that I am free to go obtain my own lawyer and this surrender process will stop until I have done so, or I may continue without my own lawyer at this time. The judge or other officiant has also advised me that once my child is born, I am still free to obtain my own lawyer, who I can consult with prior to and during any reaffirmation of this surrender which I may choose to make.
If anyone is putting pressure on me to sign this surrender, or trying to make me sign against my will, or has promised me something I value in order to make me want to sign this surrender, I understand that I should tell the Judge or officiant about that before I sign this form. The Judge or officiant will not allow me to be forced to sign this surrender.
No one is pressuring, threatening, or paying me to get me to sign this form. I believe voluntary termination of my parental rights is in the best interest of my child.
By signing below I voluntarily terminate my parental rights and surrender my child to the person(s) or agency listed above.
This ______________ day of ______________, 20____________________.
______________
Surrendering Party’s Signature
Judge or Officiant Attestation
I interviewed the surrendering party and witnessed execution of the foregoing surrender as required by T.C.A. § 36-1-111. The surrendering party understands that he/she is surrendering parental rights to this child. There is no reason to believe that this is not a voluntary act.
The Surrendering Party’s Pre-Surrender Information Form, the surrendering party’s Social and Medical History Form, and if the surrender is to an individual, or individuals, as opposed to an agency, the individual’s, or individuals’, court report based upon a current and approved home study are attached to this form. The Pre-Surrender Information Form and Social and Medical History Form are properly verified by a notary or I reviewed the information with the surrendering party and he/she has attested before me to the correctness of those forms.
This ______________ day of ______________, 20____________________.
______________
Judge or Officiant’s Signature
Name and Title: ______________
Court or Employing Institution and Location: ______________
ACCEPTANCE BY AGENCY or PROSPECTIVE ADOPTIVE PARENT(S)
I/We ______________ and ______________ individually or I, ______________, on behalf of the licensed child-placing agency, ______________, hereby accept the surrender of ______________ (child) from ______________ (surrendering party) and plan to adopt the surrendered child or for an agency, expect and intend to place this child for adoption with an appropriate family. I/We or the undersigned agency have physical custody of this child or will have physical custody upon discharge of this child from a healthcare facility. I/We or the undersigned agency agree(s) to assume responsibility for obtaining guardianship of the surrendered child through a court order within thirty (30) days of the date of the surrender. I/We or the undersigned agency agree(s), to be responsible for the care, custody, financial support, medical care, education, moral, and spiritual training of this child, pending an adoption.
I/We have completed the Accepting Party’s Pre-Acceptance Information Form. The information provided in that form is true to the best of my/our knowledge.
This ______________ day of ______________, 20____________________.
______________
Signature of Prospective Adoptive Parent
______________
Signature of Prospective Adoptive Parent
______________
Signature of Agency Representative and Title
______________
Judge or Officiant Attestation
I interviewed the accepting parties and witnessed execution of the foregoing acceptance.
The Accepting Party’s Pre-Acceptance Information Form and any accepting individual’s/individuals’ court report based upon a current and approved home study are attached to this form. The Accepting Party’s Pre-Acceptance Information Form is properly verified by a notary or I reviewed the information with the accepting parties and they have attested before me to the correctness of the form.
This ______________ day of ______________, 20____________________.
______________
Judge or Officiant’s Signature
Name and Title: ______________
Court or Employing Institution and Location: ______________
SURRENDERING PARTY’S PRE-SURRENDER INFORMATION FORM
STATE OF ______________
COUNTY OF ______________
Being duly sworn according to law, affiant would state:
(Date of Birth)____________________ or
(Date of Birth)____________________ or
(Date of Birth)____________________ of
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
______________
If “yes,” please provide the name and address of the tribe, all available information regarding the tribal membership, including a membership number if there is one, or the basis for the belief that one may be a tribal member. If there is a tribal membership card or tribal enrollment document please provide a copy by attaching it to this form.
______________
______________
______________
Will this child be sent out of Tennessee to another state for adoption?
Yes [ ] No [ ]
Yes [ ] No [ ] If no, go to #9.
If yes, please list the amount paid, to whom the payment was made, who made the payment, when was the payment made, and for what purpose the payment was made: ______________ ______________ ______________
______________
______________
______________
For a custodian, other than the surrendering party, please list the custodians:
Custodian(s)
______________
Street
______________
City ______________, State ____________________, Zip ______________
Telephone Number: Home: ____________________Work: ____________________
Do you understand that all these things are available? Yes [ ] No [ ]
FURTHER, AFFIANT SAITH NOT.
This ______________ day of ______________, 20____________________.
Signature: Biological [ ] Legal [ ] Mother ______________________________________________
Biological [ ] Legal [ ] Father ______________________________________________
Legal Guardian ______________ of
______________
Name of Child
Sworn to and subscribed before me this the ______________ day of ______________, 20____________________.
____________________
Notary Public
My commission expires: ______________
(A notary is necessary if information on this form is not reviewed by and acknowledged before a Judge or officiant.)
ACCEPTING PARTY’S PRE-ACCEPTANCE INFORMATION FORM
STATE OF ______________
COUNTY OF ______________
Being duly sworn affiants would state:
____________________
____________________
____________________
____________________
____________________
____________________ Or
______________
______________
FURTHER, AFFIANT SAITH NOT.
This ______________ day of ______________, 20____________________.
______________
Signature of Prospective Adoptive Parent
______________
Signature of Prospective Adoptive Parent
OR
______________
Signature of Representative of Agency
Name of Agency ______________
Sworn to and subscribed before me this the ____________________ day of ____________________, 20____________________.
____________________
Notary Public
My commission expires: ______________
(A notary is necessary if information on this form is not reviewed by and acknowledged before a Judge or officiant.)
REVOCATION OF SURRENDER BY A PARENT OR GUARDIAN
STATE OF ______________
COUNTY OF ______________
Being duly sworn affiants would state:
______________
______________
______________
______________
(Name of Judge or Officiant)
FURTHER, AFFIANT SAITH NOT.
This ______________ day of ______________, 20____________________.
Signature:
Biological______Legal______other:
______________
Biological______Legal______ather:
______________
Legal Guardian:
______________
Sworn to and subscribed before me this____________________ day of ____________________, 20____________________.
This Revocation of Surrender was received by me on the ______________ day of ______________, 20____________________.
Please Print: ______________
Signature: ______________
Judge or Officiant
DENIAL OF PATERNITY AND NOTICE BY A LEGAL FATHER
STATE OF ____________________
COUNTY OF ____________________
Pursuant to Tennessee Code Annotated § 36-1-111(t), and first being duly sworn according to law, affiant would state the following:
My name is ____________________. I am personally acquainted with ____________________, the biological mother of ____________________, a child [to be born], or a child [who was born] in ____________________ (City) ____________________ (State) on the ____________________day of ____________________, 20 ______________.
I am or I have been told that I am or may be the presumed and/or legal father of the above-named child.
I AM CERTAIN THAT I AM NOT THE BIOLOGICAL FATHER OF THIS CHILD.
I understand that the mother has placed or wishes to place this child for adoption, or that the child is the subject of legal proceedings leading to the child’s adoption, or leading to a determination of the child’s legal custody or guardianship. I do not want custody of this child. I either agree with an adoption plan or I do not wish to be involved in the decision.
I HEREBY WAIVE MY PARENTAL RIGHTS TO THIS CHILD, IF I HAVE ANY RIGHTS, AND I WANT MY PARENTAL RIGHTS, IF ANY, TO BE TERMINATED WITHOUT FURTHER ACTION BY, OR NOTICE TO, ME.
I formally waive my rights to notice of legal proceedings regarding the child including: adoption, custody, guardianship, and termination of other parents’ rights and any other similar actions.
I understand that by my execution of this Denial of Paternity and Notice, along with the finalization of the child’s adoption, I will lose any right I may have to act as parent, to visit with, or otherwise be involved in this child’s life. I also relinquish any right to petition to have my legal and biological relationship to this child determined by a court.
I FURTHER UNDERSTAND THAT I MAY NOT REVOKE THIS DENIAL AT ANY TIME AFTER I SIGN IT.
I also understand that while this denial is not revocable, it is not effective to terminate my parental rights or responsibilities unless or until an adoption of the child is finalized. If the adoption is not finalized, I understand that I retain any rights that I otherwise had to rebut a presumption that I am the father of the child.
FURTHER AFFIANT SAITH NOT this ______________ DAY OF ______________, 20____________________.
____________________
Legal Father (Please Print)
____________________
Signature of Legal Father
____________________
Address
____________________
City, State, Zip Code
Personally appeared before me the above-named ____________________, who is known to me and who acknowledged that he executed the above Denial of Paternity and Notice as his own free and voluntary act.
Notary Public ____________________ My commission expires: