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Statement Of Parent Or Guardian Authorizing Temporary Placement Of Child For Adoption PCA 329 - Michigan
| Statement Of Parent Or Guardian Authorizing Temporary Placement Of Child For Adoption Form. This is a Michigan form and can be used in Adoption Statewide . |
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Approved, SCAO STATE OF MICHIGAN STATEMENT OF PARENT/GUARDIAN FILE NO. JUDICIAL CIRCUIT - FAMILY DIVISION AUTHORIZING TEMPORARY PLACEMENT OF COUNTY CHILD FOR ADOPTION In the matter of the child DOB: Full name of child 1. I have legal and physical custody of the child asmother. father. guardian pursuant to an order issued by the court. (copy of order attached) Name of court 2. I authorize , a child placing agency, to make a temporary placement of the child with prospective adoptive parents in accordance with the Michigan Adoption Code and a. I have read a preplacement assessment of the prospective adoptive parent(s) that was completed or updated less than a year ago and which states that the prospective adoptive parent(s) are suitable to be parent(s) of an adoptee. OR b. I have been informed that the child placing agency must give me an opportunity to review the preplacement assessment of the prospective adoptive parent(s) before any temporary placement. 3. I have been informed that I retain full parental rights to the child and that the agency must file a petition on my behalf if I wish to regain custody of my child during the temporary placement in the adoptive home. I declare under penalty of perjury that this statement has been examined by me and that its contents are true to the best of myinformation, knowledge, and belief. Date Signature of parent/guardian Signature of witness Name of parent/guardian (print) Name of witness (print) Signature of parent/guardian Signature of witness Name of parent/guardian (print) Name of witness (print) CERTIFICATION BY PARENT/GUARDIAN OF UNEMANCIPATED MINOR PARENT I certify that I am the parent legal guardian of who is an unemancipated minor parent of the child. I join with the parent in authorizing the child placing agency to make a temporary placement of the child with the prospective adoptive parents. Date Signature of parent/guardian Signature of witness Name of parent/guardian (print) Name of witness (print) Address City State Zip Do not write below this line - For court use only PCA 329 (9/98) STATEMENT OF PARENT/GUARDIAN AUTHORIZING TEMPORARY PLACEMENT OF CHILD FOR ADOPTION MCL 710.23b; MSA 27.3178(555.23b), MCL 710.23d; MSA 27.3178(555.23d)
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