Petition To Voluntarily Relinquish Parental Rights-Important Notice-Birth Parent

IN THE COURT OF COMMON PLEAS OF CHESTER COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION IN RE: {use initials only} Case Number: ___________________________ PETITION TO VOLUNTARILY RELINQUISH PARENTAL RIGHTS [TO AGENCY OR TO ADULTS INTENDING TO ADOPT CHILD] IMPORTANT NOTICE ­ BIRTH PARENT TO: [NAME] [ADDRESS] A petition has been filed asking the court to put an end to all rights you have to your child ____________________________. The court has set a hearing to consider ending your rights to your child. That hearing will be held in the Chester County Justice Center, West Chester, Pennsylvania on ______________________, 20_____, at _____:_____ am/pm in Courtroom No._______, before the Honorable ____________________________. Your presence is required at the hearing. You have a right to be represented at the hearing by a lawyer. You should take this paper to your lawyer at once. If you do not have a lawyer or cannot afford one, go to or telephone the office set forth below to find out where you can get legal help. LAWYER REFERRAL SERVICE CHESTER COUNTY BAR ASSOCIATION 15 WEST GAY STREET SECOND FLOOR WEST CHESTER, PENNSYLVANIA 19380 610-429-1500 American LegalNet, Inc. www.FormsWorkFlow.com