STATE OF HAWAI‘I
CONSENT BY CHILD
(AGE 10 OR OVER) TO ADOPTION
Child’s Legal Name
Child’s Birth Place
Name of Proposed Adoptive Parent(s)
Relationship to Child
I, the above-named child, being years old, do consent to my adoption by the
above-named person(s) who I believe will be a good parent(s) and able and willing to give me a
proper home and education.
I understand that once I am adopted I shall no longer be the legal child of my present legal
[ ]mother [ ]father [ ]parents, but will become the child of the above-named person(s) as if I had
been born to him, her or them.
(In Stepparent Adoptions) However, I understand that even after the adoption is granted,
I shall still be the child of my [ ]father [ ]mother, who is now married to the person wanting to adopt
Because I believe the proposed adoption is in my best interest, I request that the Court grant
this adoption and change my name to .
SIGNATURE OF CHILD
SOCIAL SECURITY NUMBER
SIGNATURE OF WITNESS
PRINT NAME OF WITNESS
CONSENT OF CHILD (AGE 10 OR OVER) TO ADOPTION