Judicial Council of California, courts.ca.gov

02dbbc453bf1370269cc06d048f08d02f54ecb38

California Superior Local Rules

Case Number: Instructions This request must be completed for agency, independent, intercountry, and tribal customary adoptions. For a stepparent adoption or a stepparent adoption to confirm parentage, use Stepparent Adoption Request (form ADOPT-203). Fill out one adoption request for each child to be adopted. You may also need to provide additional forms, certified documents, or other paperwork to inform the judge of the status of a parent or possible parent who may have parental rights in these proceedings and how that parent will or will not participate in these proceedings.

For more information on the different types of adoptions and how to determine the status of a parent and the documentation that may be required, see form ADOPT-050-INFO, selfhelp.courts.ca.gov/adoptions, or visit your local county court self-help center before filling out this form. 1 Adopting parent or parents a. Name: b. Name: c. Street address: City: State: Zip: Telephone number: d. Relationship to child: e. Lawyer (if any) (name, address, telephone numbers, email address, and State Bar number): Check this box if there are more adopting parents.

Use a separate piece of paper and write “ADOPT-200, Other Adoptive Parents” at the top and complete a–e. Turn it in with this form. 2 Hearing is set for: (To be completed by the clerk of the superior court if a hearing date is available.) Date: Time: a.m. p.m. Dept.: Room: Name and address of court if different from above: To the person served with this request: If you do not come to this hearing, the judge can order the adoption without your input. 3 Each adopting parent: a. Is at least 10 years older than the child or meets the criteria in Family Code

section 8601(b); b. Will treat the child as their own; c. Will support and care for the child; d. Has a suitable home for the child; and e. Agrees to adopt the child.

Rev. July 1, 2025 Adoption Request Adopting parent or parents: Case Number: 4 County of filing This Adoption Request is filed in this court because (check all that apply): a. An adopting parent lives in this county; b. The child was born in or the child now lives in this county; c. An office of the agency that placed the child or is filing the request for adoption is located in this county; d. An office of the department or public adoption agency that is investigating the request is located in this county; e.

A placing birth parent lived in this county when the adoptive placement agreement, consent, or relinquishment was signed; f. A placing birth parent lived in this county when the request was filed; g. The child was freed for adoption in this county. (Note: If the child is a dependent of the court (in foster care), this Adoption Request must be filed in the county where the child was freed for adoption or the county where the adopting parent or parents reside. See Family Code sections 8714 and 8714.5). For more information on dependent children, . 5 Type of adoption Check one of the following: a.

Agency (name): Relative Nonrelative Tribal customary adoption (attach tribal customary adoption order) b. Independent: Relative Nonrelative Additional Parent (more than two) c. Intercountry(name of agency): 6 Information about the child a. Child’s name before adoption (only for independent, intercountry, tribal customary adoption, or dependent child's adoption by a relative (Family Code, § 8714.5): b. Gender: Female Male Nonbinary c. Date of birth: d. Child’s address (if different from address of adopting parent or parents): Street: City: State: Zip: e. Place of birth (if known): City: State: Country: f.

If the child is 12 or older, does the child agree to the adoption? Yes No g. Date child was placed in the physical care of the adopting parent or parents: h. The child was conceived by assisted reproduction in compliance with Family Code

section 7613. Yes No i. The child is a dependent of the court. Yes No (If yes, add Juvenile Case No. and County) Juvenile Case No. County: j. The child's new name will be: ADOPT-200, Page 2 of 5

Rev. July 1, 2025 Adoption Request Case Number: Adopting parent or parents: 7 Legal guardian Does the child have a legal guardian? Yes No (If yes, attach Letters of Guardianship or fill out below.) a. Date guardianship ordered: b. County: c. Case number: 8 Inquiry and notice under the Indian Child Welfare Act (ICWA) a. The inquiry required under law to determine whether the child may be an Indian child has been made, and a completed Indian Child Inquiry Attachment (form ICWA-010(A)) is attached.

Note: In agency adoptions, it is the responsibility of the agency to ensure that this inquiry is conducted and the form is made part of the file. In independent adoptions, the adoption service provider, CDSS Regional Office, or delegated county adoption agency is responsible. For adoptions of a dependent child under the Welfare and Institutions Code, other evidence, including court orders regarding ICWA, may be necessary. b.

A completed version of Parental Notification of Indian Status (form ICWA-020) is attached OR a good faith attempt has been made to provide the form to the parents, Indian custodian, or guardian of the child and inform them that they are required to complete and submit the form to the court. Note: In agency adoptions, it is the responsibility of the agency to ensure that these forms are made part of the file. In independent adoptions, the adoption service provider, CDSS Regional Office, or delegated county adoption agency is responsible. c. There is reason to know that this child is an Indian child.

Notice of the adoption request will be provided to the child’s tribe or tribes, parents, Indian custodian, and the Bureau of Indian Affairs, using Notice of Child Custody Proceeding for Indian Child (form ICWA-030). For more information on these requirements and for

definitions, see form . 9 Adoption of an Indian child a. This is an adoption of an Indian child. The adopting parent or parents have filled out and attached Adoption of Indian Child (form ADOPT-220) and will bring Parent of Indian Child Agrees to End Parental Rights (form ADOPT-225) to the hearing. b. This is a tribal customary adoption under Welfare and Institutions Code

section 366.24. Parental rights have been modified under and in accordance with the attached tribal customary adoption order, and the child has been ordered placed for adoption. 10 Agency adoption information a. The adopting parent or parents have received information about the Adoption Assistance Program, the Regional Center, mental health services available through Medi-Cal or other programs, and federal and state tax credits that may be available. b. Joinder is being filed at same time as this Adoption Request. c. Joinder will be filed. ADOPT-200, Page 3 of 5

Rev. July 1, 2025 Adoption Request Case Number: Adopting parent or parents: 11 Independent adoption information a. The adopting parent or parents will file promptly with the department or delegated county adoption agency the information required by the department in the investigation of the proposed adoption. b. A copy of the Independent Adoption Placement Agreement from the California Department of Social Services is attached. (This is required in most independent adoptions; see Family Code

section 8802.) c. All persons with parental rights agree to the adoption and have signed the Independent Adoptive Placement Agreement or consent on the appropriate California Department of Social Services form. (List the name and relationship to child of each person who has not signed the agreement form): d. The child will have more than two parents. The following persons with existing parental rights agree to this adoption and will maintain their existing parental rights:

(1) Name: Relationship to child: Name: Relationship to child:

(2) An agreement waiving termination of parental rights, signed by both the existing parents and the adopting parent or parents, was filed with the court. Note: If a person who may have parental rights has not signed a consent or relinquishment, the adopting parent or parents must obtain other signed documents or file for termination of parental rights or other action. 12 Intercountry and California re-adoption questions a. This adoption may be subject to the Hague Adoption Convention (form may be required to be filed with this request. See Calif. Rules of Court 5.490-5.493). b.

This is an adoption conducted under the requirements of the Hague Adoption Convention and the child has already moved with the adopting parent or parents to another Hague Convention member country or will be moving at the conclusion of this adoption. Child will be moving or has moved to (name of country): Adopting parent or parents: seek(

s) a California adoption will be petitioning for a Hague Adoption Certificate will be seeking a Hague Custody Declaration. c. This is an intercountry re-adoption. The adoption was finalized in another country before the child entered the United States with the adopting parent or parents. Date the child entered the United States: See form for a list of documents to attach to this Adoption Request. 13 Contact after adoption (optional) Contact After Adoption Agreement (form ) (Family Code, § 8616.5) a. is attached. b. is attached as required in Family Code

section 8714.50 (dependent child agency adoption). c. will be completed as required in Welfare and Institutions Code

section 16002 between siblings and filed before the adoption hearing. d. will be filed before the adoption hearing. e. This is a tribal customary adoption. Postadoption contact is governed by the attached tribal customary adoption order. For more information, see form . ADOPT-200, Page 4 of 5

For your protection and privacy, please press the Clear This Form button after you have printed the form. Rev. July 1, 2025 Adoption Request ADOPT-200, Page 5 of 5 Case Number: Adopting parent or parents: Additional Information Needed If there are any other persons who are or may be the child's parent, you will be required to obtain additional forms, submit specified paperwork, and possibly participate in additional court proceedings. Other paperwork or additional court proceedings may be necessary.

During the adoption process, you must provide additional documents to the court or the department or agency handling your home study. These documents can include: Consent or relinquishment for adoption–properly signed and accepted by court. Death certificates, prior court orders, or pending court orders. Waiver or denial of parentage–properly signed and accepted by court. Additional court proceedings can include: Filing a petition and order freeing the child from parental custody and control. This is a separate action. Filing a petition and order terminating parental rights of an alleged father.

This action can be filed within the adoption process. Important: Seek the advice of an attorney. Refer to form https://selfhelp.courts.ca.gov/adoptions, or visit your local county court self-help center for more information. , see also 14 Requests to court a. The adopting parent or parents ask the court to approve the adoption and to declare that the adopting parent or parents and the child have the legal relationship of parent and child, with all the rights and duties of this relationship, including the right of inheritance. b.

The adopting parent or parents ask the court to date its order approving the adoption as of an earlier (date): for the following reason (Family Code, § 8601.5): (Enter a date no earlier than the date parental rights were ended.) c. This is a tribal customary adoption. The adopting parent or parents ask the court to approve the adoption and to declare that the adopting parent or parents and the child have the legal relationship of parent and child, with all of the rights and duties stated in the attached tribal customary adoption order and in accordance with Welfare and Institutions Code

section 366.24. 15 If a lawyer is representing you in this case, the lawyer must sign here: Date: Type or print lawyer’s name Signature of lawyer for adopting parent or parents 16 I declare under penalty of perjury under the laws of the State of California that the information in this form and all its attachments is true and correct to my knowledge. This means that if I lie on this form, I am guilty of a crime.

Date: Type or print your name Signature of adopting parent Date: Type or print your name Signature of adopting parent Date: Type or print your name Signature of adopting parent NOTICE—ACCESS TO AFFORDABLE HEALTH INSURANCE: Do you or someone in your household need affordable health insurance? If so, you should apply for Covered California. Covered California can help reduce the cost you pay toward high-quality affordable health care. For more information, visit www.coveredca.com, or call Covered California at 1-800-300-1506 (English) or 1-800-300-0213 (Spanish).

Document details

Collection	California Superior Local Rules
Citation	02dbbc453bf1370269cc06d048f08d02f54ecb38
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	02dbbc453bf1370269cc06d048f08d02f54ecb38

Source file is stored in the law ingest library (pdf).