JC-1637, 04/08 Consent to Termination of Parental Rights (Judicial)
§48.41(2)(b), Wisconsin Statutes
This form shall not be modified. It may be supplemented with additional material.
STATE OF WISCONSIN, CIRCUIT COURT,
IN THE INTEREST OF
a person under the age of 18.
Consent to Termination of
Date of Birth
For Official Use
UNDER OATH, I STATE:
1. My name is
My address is
My date of birth is
2. My child is not a member of or eligible for membership in an Indian tribe. (For an Indian child, use the Indian Child
Welfare Act version (IW-1637) of this consent.)
3. I am the (check one):
biological (non-adjudicated) father.
4. I have been informed and understand that a court order terminating parental rights will permanently end
ALL legal rights and duties that exist between myself and this child, such as:
• Duty to support
• Right to custody and visitation
• Right to inherit
I wish to give up any parental rights that I may have to this child and consent to the court entering an order
terminating my parental rights.
I give up the right to know of any future hearing or proceedings in this matter.
I am making this decision on my own free will. No promises or threats have been made to get me to sign this
Subscribed and sworn to before me
Notary Public, State of Wisconsin
My commission expires:
Name Printed or Typed
APPROVAL OF GUARDIAN AD LITEM
(Needed for minor or incompetent parent)
I am the guardian ad litem for the above named parent who is a
incompetent. I am familiar with the facts. I join in
the consent to the termination of this person’s parental rights.
CERTIFICATE OF JUDGE
I certify that I am the judge of the