S.I. No. 216/1976 - Adoption Rules, 1976.


S.I. No. 216 of 1976.

ADOPTION RULES, 1976.

An Bord Uchtála with the consent of the Minister for Justice and in exercise of the powers conferred on it by section 5 of the Adoption Act, 1952 (No. 25 of 1952), hereby makes the following rules:—

1. These rules may be cited as the Adoption Rules, 1976.

2. The adoption Rules, 1965 ( S.I. No. 19 of 1965 ), are hereby revoked.

3. In these rules—

"the Acts" means the Adoption Acts, 1952 to 1976;

"the Board" means An Bord Uchtála;

"the Registrar" means the Registrar of the Board.

4. Each of the forms set out in the Schedule shall be used in the case and manner indicated by the form.

5. Notwithstanding the revocation of the Adoption Rules, 1965, the forms prescribed in those Rules may continue to be used to the extent permitted by the Board.

6. The Board may require an applicant for an adoption order to submit medical evidence of the state of his health.

7. The Board may require the person or body that placed a child for adoption to submit medical evidence of the state of the child's health.

8. The Board may require any statement in a prescribed form to be verified by oral or other evidence.

9. The Registrar shall give to every applicant for an adoption order at least ten days' notice in writing or such shorter notice as may be accepted by the applicant of the date, hour and place of hearing of the application.

10. The Registrar shall give to every person whose consent to the making of an adoption order is required (other than such person as has indicated that he does not wish to be informed of the date on which the Board would hear him or his counsel or solicitor on the application for the adoption order) at least ten days' notice in writing of the date, hour and place at which the Board will hear him or his counsel or solicitor on the application for the order.

SCHEDULE.

Form 1

APPLICATION FOR ADOPTION ORDER.

Part I—Section A.

(To be completed only where the application is being made by a married couple).

We, the undersigned, being a married couple living together, desire to adopt the child named or described in this application form. We understand that if an adoption order is granted to us in respect of the child, we shall be fully responsible for the child's upbringing as if the child were born to us in lawful wedlock and we voluntarily undertake to discharge that responsibility as far as we are able. We have not received or made, or agreed to receive or make, any payment whatsoever in consideration of the adoption of this child.*

Husband's signature ............................................................ ......

Wife's signature ............................................................ .............

Date ............................................................ .....................

*Payments made or received in respect of the child's maintenance or solicitors' remuneration for professional services are not referred to here.

Part I—Section B.

(To be completed where the application is being made by one person only).

I, the undersigned person, being the mother of the child/the natural father of the child/a relative* of the child/a widow/widower

/images/si216y76p0003.gif

Strike out the parts that do not apply.

deside to adopt the child named or described in this application form. I understand that if an adoption order is granted to me in respect of the child, I shall be fully responsible for the child's upbringing as if the child were born to me in lawful wedlock and I voluntarily undertake to discharge that responsibility as far as I am able. I have not received or made, or agreed to receive or make, any payment whatsoever in consideration of the adoption of this child.**

Applicant's signature ............................................................ ..................

Date ............................................................ .........................

*"relative" here means grandparent, brother, sister, uncle or aunt, whether of the whole blood, of the half blood, or by affinity, relationship to an illegitimate child being traced through the mother only.

**Payments made or received in respect of the child's maintenance or solicitors' remuneration for professional services are not referred to here.

Part II—Section A.

(To be completed in every application. If the application is being made by a married couple, the particulars given should be those relating to the husband only).

1. Husband's/Applicant's name. (Strike out "husband's" or "applicant's",

whichever does not apply) ............................................................ .......................................................

(Block letters)

2. Address ............................................................ ............................................................ .............................

(Block letters)

............................................................ ............................................................ ..................................

............................................................ ............................................................ ..................................

3. Occupation ............................................................ ............................................................ ...........................

4. Relationship (if any) to child ............................................................ ............................................................ .......

5. Date of birth ............................................................ ............................................................ ........................

6. Are you ordinarily resident in the State and, if so, since when? ...........................................................

............................................................ ............................................................ ..............................................

7. Religious denomination ............................................................ ............................................................ ...............

Part II—Section B.

(This section is to be completed only where the application is being made by a married couple. The questions relate to the wife).

8.

Wife's name ............................................................ ............................................................ ...

(Block letters)

9. Relationship (if any) to child ............................................................ ............................................................ .......

10. Date of birth ............................................................ ............................................................ ...................................

11. Are you ordinarily resident in the State and, if so, since when? ............................................................ ........

............................................................ ............................................................ ...........................................................

12. Date and place of marriage............................................................ ............................................................ ...........

13. Religious denomination ............................................................ ............................................................ ..............

Part II—Section C.

(To be completed in every application).

14. Have you previously applied for an adoption order in respect of this or any other child and, if so, with what result? ............................................................ ............................................................ ............................

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

15. (a) Have you any children of your own; if so, please give names, dates of birth and present addresses?

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

(b) Have you any other children in your care; if so, please give names and dates of birth?

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

16.

Christian name or first name of child to whom this application refers

............................................................ ............................................................ ......................................

(Block letters)

17. Sex ............................................................ ............................................................ .................................

18. Date of birth ............................................................ ............................................................ .......................

19. Name and address of person or body from whom you got the child ....................................................

............................................................ ............................................................ ....................................................

20. Date on which you took the child under your care ............................................................ ..........................

21.

Please give the names and addresses of two or more persons (either men or women) to whom reference may be made by the Board ............................................................ .............................................

............................................................ ............................................................ .....................................................

(Block letters)

Note:—The Board may require you to submit medical evidence of your state of health before coming to a decision on your application.

Form 2

PARTICULARS CONCERNING CHILD.

Note to applicant:—If you got the child from his parent or guardian you should fill this Form yourself. If you got the child from any other source you may fill this Form yourself or you may send it to the person or body that gave you the child and ask him to fill it and return it direct to the Registrar, An Bord Uchtála.

1.

Christian Name or first name of Child............................................................ ....................................

         (Block letters)

2. Sex ............................................................ ......................

3. Date of birth ............................................................ ............................................................ ........................

4. Is the child an orphan (both parents dead)? ............................................................ ..........................

5. Is the child illegitimate? ............................................................ ............................................................ ...........

6. Did the child's natural parents marry each other after the child's birth?

............................................................ ............................................................ .....................................................

(Note: If the answer is " yes ", the Board will require further information later but, at this stage, no details need be given).

7. If the child is an orphan, state

(a) Father's name ............................................................ ............................................................ .............

(b) Approximate date of father's death............................................................ .......................................

(c) Father's religion at death............................................................ ......................................................

(d) Mother's name ............................................................ ............................................................ .............

(e) Approximate date of mother's death............................................................ .....................................

(f) Mother's religion at death............................................................ .....................................................

8. If the child is illegitiate state

(a) Mother's name............................................................ ............................................................ ..............

(b) Is the mother alive or dead?............................................................ .................................................

(c) If alive, state her

(i) address ............................................................ ......................................................

(ii) occupation ............................................................ ............................................................ ....

(iii) date of birth, or if date is unknown, her approximate age ............................................................ ............................................................ ......................

............................................................ ............................................................ ........................

(iv) religion ............................................................ ............................................................ ............

(d) If the mother is dead, state her

(i) approximate date of death............................................................ ........................................

(ii) ordinary place of residence before her death.........................................................

............................................................ ............................................................ ...............

............................................................ ............................................................ ...............

(Block letters)

(iii) place of death ............................................................ .....................................................

............................................................ ............................................................ ................

(Block letters)

(iv) religion at death ............................................................ .........................................................

9. Name of person or persons, if any, who has or have been appointed by will or deed or by Court Order to be the guardian(s) of the child............................................................ .......................................

............................................................ ............................................................ ........................................

(Block letters)

10. Address(es) of guardian(s) named in answer to question 9

............................................................ ............................................................ ...........................................

............................................................ ............................................................ ...........................................

............................................................ ............................................................ ...........................................

(Block letters)

11. If the child is or has been under the control of a Health Board or Registered Adoption Society state name and address of Health Board or Registered Adoption Society and date on which such body acquired control over the child.

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

............................................................ ............................................................ ........................................

12. Child's religion ............................................................ ............................................................ ..........................

............................................................ ............................................................ ..............................................

Signature ............................................................ ................................

Address ............................................................ .................................

............................................................ ............................................

Date ............................................................ ................................

FORM 3A

CONSENT TO ADOPTION.

(For use by mother where the identity of the applicant is known to her).

In the matter of an application for the adoption of ............................................................ .........................

I, ............................................................ ..................................

(name and marital status of

............................................................ ........................................... aged twenty-one years and

upwards (or, if under twenty-one, aged .............................................. years) make oath and say as follows:—

1. I am aware that an application is about to be made or has been made by ................................ of ........................... for an adoption order in respect of the child .......................

2. I am the mother of the child.

3. I did/did not marry the father of the child. (a)

4. The child is not less than six weeks old, having been born on the ............................................ day of ............................., 19.......

5. I know that the religion of themale applicant is ........................... and that the religion of the female applicant is...............................

6. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the child and that these rights and duties shall be transferred to the adopter or adopters.

7. I have been informed and I understand that An Bord Uchtála (Adoption Board) may make an adoption order in respect of the child referred to in paragraph 1 at any time after the signing of the consent.

8. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above.

9. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adopton order, by informing An Bord Uchtála, 65 Merrion Square, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.

10. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing.

11. My wishes in respect of the matters referred to in paragraph 10 above are as follows:—

(i) I do/I do not wish to be informed of the date on which the Board will, if I wish, hear me or my counsel or solicitor on the application for the adoption order. (a)

(ii) I do/I do not wish to be heard in person or to be represented by counsel or solicitor on the application for the adoption order. (a)

(iii) I do/I do not wish to be consulted again in relation to the application for the adoption order. (a)

12. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.

Signature ............................................................ .................

Sworn at ...........................................................in the county of ................................................on

this .................................... day of .........................................., 19.........., before me, ..............

............................................................ ........................(name) and I know the deponent

(or and I know ............................................................ ................ who certifies

to me that he knows the deponent).

Signature ............................................................ .................

Description (b) ........................................ ............................

(a) Delete words which do not apply.

(b) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths.

FORM 3B

CONSENT TO ADOPTION.

(For use by persons other than mother where the identity of the applicant is known to the consenting party).

In the matter of an application for the adoption of ............................................................ ...............................

I, ............................................................ ....... (name and marital status) of ............................................................ .......

aged twenty-one years and upwards (or, if under twenty-one, aged ....................................... years), make oath and say as follows:—

1. I am aware that an application is about to be made or has been made by ...................................................

.................................................. of ............................................................ ............... for an adoption order in respect of the child ...................................

2. I am/the father of the child/the guardian of the child/the person having charge of or control over the child (a).

3. I am the father of the child and I married the mother of the child. (a)

4. The child is not less than six weeks old, having been born on the .........................................

day of ........................................, 19....................

5. I know that the religion of the male applicant is............................................................ .....................................

and that the religion of the female applicant is ............................................................ ...........................

6. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the child and that these rights and duties shall be transferred to the adopter or adopters.

7. I have been informed and I understand that An Bord Uchtála (Adoption Board) may make an adoption order in respect of the child referred to in paragraph 1 at any time after the signing of the consent.

8. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above.

9. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtála, 65 Merrion Square, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.

10. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing.

11. My wishes in respect of the matters referred to in paragraph 10 above are as follows:—

(i) I do/I do not wish to be informed of the date on which the Board will, if I wish, hear me or my counsel or solicitor on the application for the adoption order. (a)

(ii) I do/I do not wish to be heard in person or to be represented by counsel or solicitor on the application for the adoption order. (a)

(iii) I do/I do not wish to be consulted again in relation to the application for the adoption order. (a)

12. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.

Signature ............................................................ .....................

Sworn at ........................................................... in the county of ..................................................

on this ............................................. day of ......................................................, 19...............,

before me, ............................................................ .......... (name) and I know the deponent

deponent (or and I know .......................................... who certifies

to me that he knows the deponent).

Signature ............................................................ ......................

Description (b) ............................................................ ..............

(a) Delete words which do not apply.

(b) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths.

FORM 4A

CONSENT TO ADOPTION.

(For use by mother where the identity of the applicant is not known to her).

In the matter of an application for the adoption of ............................................................ .....................

I, ............................................................ ............................................................ ........ (name and marital status) of ............................................................ ...................................................... aged twenty-one years and upwards (or, if under twenty-one, aged ............................. years), make oath and say as follows:—

1. I am informed and believe that an application has been made under serial number ...................................... (a) for an adoption order in respect of the

child ............................................................ ............

2. I am the mother of the child.

3. I did/did not marry the father of the child. (b)

4. The child is not less than six weeks old, having been born on the ...................................... day of ......................................, 19....................

5. I know that the religion of the male applicant is ............................................................ ....................................

and that the religion of the female applicant is ............................................................ ................................

6. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the child and that these rights and duties shall be transferred to the adopter or adopters.

7. I have been informed and I understand that An Bord Uchtála (Adoption Board) may make an adoption order in respect of the child referred to in paragraph 1 at any time after the signing of the consent.

8. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above.

9. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtála, 65 Merrion Square, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.

10. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing.

11. My wishes in respect of the matters referred to in paragraph 10 above are as follows:—

(i) I do/I do not wish to be informed of the date on which the Board will, if I wish, hear me or my counsel or solicitor on the application for the adoption order. (b)

(ii) I do/I do not wish to be heard in person or to be represented by counsel or solicitor on the application for the adoption order. (b)

(iii) I do/I do not wish to be consulted again in relation to the application for the adoption order. (b)

12. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.

Signature ............................................................ ................

Sworn at ........................................................... in the county of ................................................

on this ............................................. day of ........................................................., 19...............,

before me, ............................................................ ............. (name) and I know the deponent

(or and I know ............................................................ ............................................................ ........

who certifies to me that he knows the deponent)

Signature ............................................................ ...........................

Description (c) ............................................................ ..................

(a) Where the identity of the applicant is not known to the consenting party the applicant should request the Board to assign a serial number to the application and this number should be inserted here.

(b) Delete words which do not apply.

(c) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should sworn before a Notary Public or other person duly authorised to administer oaths.

FORM 4B

CONSENT TO ADOPTION.

(For use by persons other than mother where the identity of the

applicant is not known to the consenting party).

In the matter of an application for the adoption of ............................................................ ..........................

I, ............................................................ ............................................................ ...... (name and marital status) of ............................................................ ............................ aged twenty-one years and upwards (or, if under twenty-one, aged .................................. years) make oath and say as follows:—

1. I am informed and believe that an application has been made under serial number .................................. (a) for an adoption order in respect of the

child ............................................................ ......................................................

2. I am/the father of the child/the guardian of the child/the person having charge of or control over the child (b).

3. I am the father of the child and I married the mother of the child (b).

4. The child is not less than six weeks old, having been born on the ............................................................ ... day of .................................., 19.......................

5. I know that the religion of the male applicant is ............................................................ ....................................

and that the religion of the female applicant is ............................................................ ....................................

6. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the child and that these rights and duties shall be transferred to the adopter or adopters.

7. I have been informed and I understand that An Bord Uchtála (Adoption Board) may make an adoption order in respect of the child referred to in paragraph 1 at any time after the signing of the consent.

8. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above.

9. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtála, 65 Merrion Square, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.

10. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing.

11. My wishes in respect of the matters referred to in paragraph 10 above are as follows:—

(i) I do/I do not wish to be informed of the date on which the Board will, if I wish, hear me or my counsel or solicitor on the application for the adoption order (b).

(ii) I do/I do not wish to be heard in person or to be represented by counsel or solicitor on the application for the adoption order (b).

(iii) I do/I do not wish to be consulted again in relation to the application for the adoption order (b).

12. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.

Signature ............................................................ .........................

Sworn at ..................................................... in the county of .......................................................

on this ............................................. day of ......................................................... 19...............,

before me, ............................................................ ........................ (name) and I know the

deponent (or, and I know ............................................................ ..........................................

who certifies to me that he knows the deponent).

Signature ............................................................ ...........................

Description (c) ............................................................ ..................

(a) Where the identity of the applicant is not known to the consenting party the applicant should request the Board to assign a serial number to the application and this number should be inserted here.

(b) Delete words which do not apply.

(c) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths.

FORM 5A

CONSENT TO ADOPTION.

(For use where the applicant is a widower and is known to the consenting party).

In the matter of an application for the adoption of ............................................................ .......................... I, ............................................................ ....................... (name and marital status) of ........................................... aged twenty-one years and upwards (or, if under twenty-one, aged ........................................... years) make oath and say as follows:—

1. I am aware that an application is about to be made or has been made by ...................................................

of ................................................ for an adoption order in respect of the child ...............................................

2. I am/the mother/father/guardian of the child/person having charge of or control over the child (a).

3. (To be completed by the mother only) I did/did not marry the father of the child. (a)

4. I am the father of the child and I married the mother of the child. (a)

5. The child is not less than six weeks old, having been born on the......................................................... day of............................................ 19..................

6. I know that the religion of the applicant is ............................................................ ......................................

7. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the child and that these rights and duties shall be transferred to the adopter.

8. I have been informed and I understand that An Bord Uchtála (Adoption Board) may make an adoption order in respect of the child referred to in paragraph 1 at any time after the signing of the consent.

9. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above and I know that the applicant is a widower.

10. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtála, 65 Merrion Square, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.

11. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing.

12. My wishes in respect of the matters referred to in paragraph 11 above are as follows:—

(i) I do/I do not wish to be informed of the date on which the Board will, if I wish, hear me or my counsel or solicitor on the application for the adoption order (a).

(ii) I do/I do not wish to be heard in person or to be represented by counsel or solicitor on the application for the adoption order (a).

(iii) I do/I do not wish to be consulted again in relation to the application for the adoption order. (a)

13. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.

Signature ............................................................ .........................

Sworn at ...................................................... in the county of .......................................................

on this ............................................. day of ........................................................, 19...............,

before me, ............................................................ .................. (name) and I know the deponent

(or, and I know ........................................ who certifies to me that he knows the deponent).

Signature ............................................................ ...........................

Description (b) ............................................................ ..................

(a) Delete words which do not apply.

(b) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths.

FORM 5B

CONSENT TO ADOPTION.

(For use where the applicant is a widower and is not known to the consenting party).

In the matter of an application for the adoption of ............................................................ ......................

I, ............................................................ ............................................................ ........ (name and marital status) of ............................................................ ............ aged twenty-one years and upwards (or, if under twenty-one, aged .................................. years) make oath and say as follows:—

1. I am informed and believe than an application has been made under serial number .................................... (a) for an adoption order in respect of the

child ............................................................ ...............................................

2. I am/the mother of the child/father of the child/guardian of the child/ person having charge of or control over the child (b).

3. (To be completed by the mother only) I did/did not marry the father of the child. (b)

4. I am the father of the child and I married the mother of the child. (b)

5. The child is not less than six weeks old, having been born on the ...................................... day of ............................, 19........................

6. I know that the religion of the applicant is ............................................................ .....................................

7. I understand that the nature and effect of an adoption order is that I shall lose all parental rights and that I shall be freed from all parental duties with respect to the child and that these rights and duties shall be transferred to the adopter.

8. I have been informed and I understand that An Bord Uchtála (Adoption Board) may make an adoption order in respect of the child referred to in paragraph 1 at any time after the signing of the consent.

9. I hereby freely give my consent to the making of an adoption order in pursuance of the application referred to above and I know that the applicant is a widower.

10. I have been informed and I understand that this consent may be withdrawn at any time before the making of the adoption order, by informing An Bord Uchtála, 65 Merrion Square, Dublin 2, and that on the making of the adoption order my consent becomes irrevocable.

11. I have been informed and I understand that I am entitled to be heard in person or to be represented by counsel or solicitor on the application for the adoption order or to be consulted again in relation to the application and that I should indicate my wishes in this respect in writing.

12. My wishes in respect of the matters referred to in paragraph 11 above are as follows:—

(i) I do/I do not wish to be informed of the date on which the Board will, if I wish, hear me or my counsel or solicitor on the application for the adoption order. (b)

(ii) I do/I do not wish to be heard in person or to be represented by counsel or solicitor on the application for the adoption order (b).

(iii) I do/I do not wish to be consulted again in relation to the application for the adoption order. (b)

13. I understand that this affidavit may be used as evidence that I consent to the adoption order being made.

Signature ............................................................ ..........................

Sworn at ........................................................... in the county of .................................................

on this .......................................... day of ............................................................ ....., 19...............,

before me, ............................................................ ............... (name) and I know the deponent

(or, and I know ............................................................ ............................................................ ......

who certifies to me that he knows the deponent).

Signature ............................................................ .........................

Description (c) ............................................................ ...................

(a) Where the identity of the applicant is not known to the consenting party the applicant should request the Board to assign a serial number to the application and this number should be inserted here.

(b) Delete words which do not apply.

(c) If the affidavit is being sworn in the State it should be sworn before a Commissioner for Oaths; if it is being sworn elsewhere it should be sworn before a Notary Public or other person duly authorised to administer oaths.

FORM 6

INTERIM ORDER.

Whereas an application has been made to An Bord Uchtála (hereinafter called "the Board") by ............................................................ ........... by occupation........................................................and resident at ............................................................  and his wife*............................................................ ............................................ hereinafter called the applicant/applicants* for an adoption order under the Adoption Acts, 1952 to 1976 (hereinafter call " the Acts "), authorising him/her/them* to adopt ...............................................* born on the............................................................ .. /*the probable date of whose birth has been determined by the Board to be the............................................................ :

AND WHEREAS the Board is satisfied that the requirements of the Acts with regard to the qualifications and suitability of the applicant/each of the applicants* to adopt the child and to the eligibility of the child to be adopted by the applicant/applicants* have been fulfilled or is of opinion that such requirements are likely to be fulfilled before the expiration of the probationary period mentioned hereunder:

AND WHEREAS all the consents required by the Acts have been obtained or dispensed with in accordance with the provisions of the Acts:

AND WHEREAS the Board is satisfied that the child is identical with ...................................................... to whom the entry numbered ............................................................ .... made on the ......................................... day of ............................................, 19.................., in the Register of Births for the District of ........................ in the county of.. ........................................ relates:

NOW, THEREFORE, the Board orders as follows:—

1. This application shall stand adjourned until further order;

2. The applicant/applicants* shall have custody of the child for a probationary period beginning on the .................................................. and ending on the ............................................................ ... subject to the following conditions:*

GIVEN under the Official Seal of the Board this .........................

day of ................................................, 19.................

Chairman/Registrar/a person authorised by the Board to attest the seal of the Board.*............

*Delete words which do not apply.

FORM 7A

ADOPTION ORDER.

WHEREAS an application has been made to An Bord Uchtála (hereinafter called "the Board") by ........................... by occupation ......................................and resident at .............................................. and his wife...................................................... (hereinafter called the "applicants") for an adoption order under the Adoption Acts, 1952 to 1976 (hereinafter called " the Acts "), authorising them to adopt ................................ born on the ................................................:

AND WHEREAS the Board is satisfied that the requirements of the Acts with regard to the qualifications and suitability of each of the applicants to adopt the child and to the eligibility of the child to be adopted by the applicants have been fulfilled:

AND WHEREAS all the consents required by the Acts have been obtained in accordance with the provisions of the Acts:

AND WHEREAS the Board is satisfied that the child is identical with................................................... to whom the entry numbered ............................................................ ... made on the .......................................... day of ..........................................., 19....................., in the Register of Births for the District of ................................ in the county of ................................................... relates :

NOW, THEREFORE, the Board hereby makes an order for the adoption of the child by the applicants.

GIVEN under the Official Seal of the Board this .......................

day of ............................................................ ., 19..........

Chairman/Registrar/a person authorised by the Board to attest the seal of the Board.*

*Delete words which do not apply.

FORM 7B

ADOPTION ORDER.

WHEREAS an application has been made to An Bord Uchtála (hereinafter called "the Board") by ............................................................ .. by occupation..........................................................and resident at ..................................................... and his wife*............................................................ (hereinafter called "the applicant/applicants"*) for an adoption order under the Adoption Acts, 1952 to 1976 (hereinafter call "the Acts "), authorising him/her/them* to adopt ..................................................* born on the.............................................../* the probable date of whose birth has been determined by the Board to be the.:............................................................ ............:

AND WHEREAS the Board is satisfied that the requirements of the Acts with regard to the qualifications and suitability of the applicant/each of the applicants* to adopt the child and to the eligibility of the child to be adopted by the applicant/applicants* have been fulfilled:

AND WHEREAS all the consents required by the Acts have been obtained or dispensed with in accordance with the provisions of the Acts:

AND WHEREAS the Board is satisfied that the child is identical with........................................... to whom the entry numbered ...................................... made on the .......................................... day of ...................... 19........... , in the Register of Births for the District of ......................... in the county of ........................................................... relates:

NOW, THEREFORE, the Board hereby makes an order for the adoption of the child by the applicant/applicants.*

GIVEN under the Official Seal of the Board this .......................

day of ............................................................ ...., 19........

Chairman/Registrar/a person authorised by the Board to attest the seal of the Board.*

*Delete words which do not apply.

FORM 7C

ADOPTION ORDER.

WHEREAS an application has been made to An Bord Uchtála (hereinafter called "'the Board") by .................. by occupation...................................and resident at ...................................... and his wife*........................................... (hereinafter called "the applicant/applicants"*) for an adoption order under the Adoption Acts, 1952 to 1976 (hereinafter called "the Acts"), authorising him/her/them* to adopt ................................................* born on the....................................................../* the probable date of whose birth has been determined by the Board to be the ............................................................ ..............................:

AND WHEREAS the Board is satisfied that the requirements of the Acts with regard to the qualifications and suitability of the applicant/each of the applicants* to adopt the child have been fulfilled:

AND WHEREAS the Board is satisfied that in the particular circumstances of this case it is desirable to make an adoption order notwithstanding that the child was more than seven years of age at the date of the application for this order:

AND WHEREAS the Board is satisfied that the child is otherwise eligible to be adopted by the applicant/applicants*:

AND WHEREAS the Board has given due consideration to the wishes of the child having regard to his/her* age and understanding:

AND WHEREAS all the consents required by the Acts have been obtained or dispensed with in accordance with the provisions of the Acts:

AND WHEREAS the Board is satisfied that the child is identical with............................ ...............................to whom the entry numbered ..................................................... made on the ........................................................... day of ......................................... 19................, in the Register of Births for the District of ...................... in the county of .................... relates:

NOW, THEREFORE, the Board hereby makes an order for the adoption of the child by the applicant/applicants*.

GIVEN under the Official Seal of the Board this .......................

day of ............................................................ , 19........

Chairman/Registrar/a person authorised by the Board to attest the seal of the Board.*

*Delete words which do not apply.

FORM 8

APPLICATION FOR REGISTRATION OF ADOPTION SOCIETY.

I, the undersigned person, being duly authorised on behalf of the adoption society called ........................................................ hereby apply to An Bord Uchtála (hereinafter called "the Board") to have the society registered under the Adoption Acts, 1952 to 1976, as an adoption society. The following are particulars of the society:

1.

Address of society's headquarters. ............................................................ ..................................

(Block letters)

............................................................ ............................................................ ...............................

2.

Date of establishment ............................................................ .....................................................

3.

Objects of the society. (A copy of the society's constitution or other instrument (if any) governing its activities should be attached) ............................................................ .....................

............................................................ ............................................................ ...........................

4.

Full names, addresses, occupations, experience in social work and related qualifications (if any) of

(a) all members of the Committee controlling the activities of the society and

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( a )

attach separate lists

(b) all persons employed by the society, whether voluntary or paid, on work connected with adoption.

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( b )

5. Has the society under its control any home, hostel, orphanage or other such institution in which children under the age of seven years are

maintained? ............................................................ ............................................................ ............................

6. If the answer to question 5 is "yes", state

(a) The address of such institution ............................................................ .........................................

............................................................ ............................................................ ..............................

............................................................ ............................................................ ..............................

(b) Whether it is exclusively an institution for children (if not, give brief particulars) and whether it is exclusively for boys or exclusively for girls ........................................

(c) Number of children for whom accommodation and care can be provided in the institution ...........................................

(d) Approximate number of children normally in the institution........................................................

(e) In what religion the children are brought up............................................................ ....................

(f) How the institution is mainly financed ............................................................ ..............................

(g) Whether the society, if registered, propose to concern themselves only with the children in this institution (if not, give brief particulars) ..........................

............................................................ ............................................................ ...............................

7. If the answer to question 5 is " no ", state briefly how the society propose to function as a registered adoption society, in what children they propose to interest themselves or in what circumstances do they propose to arrange adoptions ............................................................ ............................................................ ..........................

............................................................ ............................................................ .....................................................

The society hereby undertake, if registered, to make available to the Board when requested, in relation to any and every child with whose proposed adoption the society is concerned, all material facts known to the society relating to the child, and to the proposed adopters, for the assistance and guidance of the Board prior to the making of an adoption order.

STATUTORY DECLARATION.

I, ............................................................ ................., do solemnly and sincerely declare that the foregoing particulars stated in this application are true and I make this solemn declaration conscientiously believing the same to be true and by virtue of the Statutory Declarations Act, 1938 .

Signature ............................................................ .....................

Office held in the society......................................................

Address ............................................................ .......................

............................................................ ........................

Date ............................................................ .......................

Declared before me (a) ............................................................ ................... by the said applicant who is personally known to me (or who is identified to me by ......................................................... who is personally known to me) at ............................................................ ............................................................ ....

Signed ............................................................ ...................

Description ............................................................ ...........

This ............................ day of....................., 19...............

(a) This declaration should be made before a Notary Public or a Commissioner for Oaths or a Peace Commissioner.

FORM OF ENTRY IN ADOPTION SOCIETIES REGISTER

Form 9

Serial No.

Name of Society

Address of Society's Headquarters

Name and address of Chairman/ President of Society

Name and address of Secretary of Society

Date of application for registration

Date of registration

Remarks

FORM 10

ADOPTION ACTS, 1952 to 1976.

Memorandum to be furnished by a registered adoption society to

a mother, father or guardian who proposes to place a child with

a registered adoption socety for adoption.

Consent to the placing for adoption of ............................................................ ............ (here set out name of child) born on ............................................. day of ............................................................ ................., 19........

If an adoption order is made in respect of the child, all your rights and duties in regard to the child will be transferred permanently to the adopters and the child will be regarded as the child of the adopters. If the child is illegitimate and the natural father is under legal obligation to make any payments for the child's benefit, he will not be legally bound to continue these payments, unless the mother is the adopter.

Subject to section 3 of the Adoption Act, 1974 , an Bord Uchtála (Adoption Board) will not make an adoption order without the consent of

(a) the mother of the child,

(b) the father of the child (in the case of any child who has been legitimated by the marriage of its parents), and

(c) any person appointed by will or deed or by Court Order to be the child's guardian,

unless the mother, father or guardian, as the case may be, cannot be found or is unable to give consent because of mental infirmity in which case An Bord Uchtála may dispense with consent.

Section 3 of the Adoption Act, 1974 , provides that if a child is given for adoption, and a person whose consent to the making of the adoption order is required fails, neglects or refuses to give consent, or withdraws a consent already given, the applicant for the adoption order may apply to the High Court and, if that Court is satisfied that it is in the best interest of the child to do so, it may give custody of the child to the person who has applied for the adoption order and it may authorise An Bord Uchtála to dispense with such consent, whereupon An Bord Uchtála may make the adoption order.

A consent may be withdrawn at any time before the making of an adoption order.

In order to ensure, therefore, that you will be informed of any proposal to have the child adopted, you should notify the society of any change in address.

Section 4 of the Adoption Act, 1974 , provides that an adoption order shall not be made in the case where the applicants, the child and his parents or, if the child is illegitimate, his mother, are not all of the same religion, unless every person whose consent to the making of the adoption order is required, knows, when giving such consent, the religion (if any) of each of the applicants.

(Perforate on this line)

............................................................ ............................................................ ............................................................ .....

RECEIPT FOR FORM 10.

(Detach here)

To the registered adoption society called ............................................................ ..........................................

............................................................ ............................................................ ............................................................ ......

I hereby consent to the placing for adoption of the child ............................................................ ...... (here set out name of child) born on ......................................... day of ..................................., 19.........

Here you may state your wishes as to the religion, if any, of the person(s) with whom the child is to be placed for adoption .........................................

............................................................ ............................................................ ..................................................

I have received from you a statement in Form 10. That statement was attached to this receipt and I have myself torn it off. I understand that statement.

Name (in block letters) ............................................................ ........................................

Signature ............................................................ ...........................................................

Address ............................................................ ............................................................ ..

Signature of Witness............................................................ .........................................................

Address............................................................ ............................................................ .

Occupation or Description ............................................................ ......................................................

Date ............................................................ ...

I certify that on behalf of ............................................................ ............................................................ ..

I have handed the statement attached to this receipt to ............................................................ ............

............................................................ .................................... and explained its contents to her/him.

I am satisfied that she/he understands it.

Signature ............................................................ ............................................................ .

Date ............................................................ ............................................................ 

FORM 11

NOTICE OF MAKING OF ADOPTION ORDER.

(To be published by the Board in Iris Oifigiúil).

In pursuance of the powers vested in it by the Adoption Acts, 1952 to 1976, An Bord Uchtála has made an order for the adoption of a child ............................................................ ............................................ (here insert Christian name or first name of child) by ............................................................ ................. (here insert name(s) and address of adopter(s)).

FORM 12

NOTICE OF REGISTRATION OF ADOPTION SOCIETY.

(To be published by the Board in Iris Oifigiúil).

An Bord Uchtála has registered ............................................................ .................................... in the Adoption Societies Register.

FORM 13

NOTICE OF CANCELLATION OF REGISTRATION OF

ADOPTION SOCIETY.

(To be published by the Board in Iris Oifigiúil).

An Bord Uchtála has cancelled the registration of ............................................................ ........................... in the Adoption Societies Register.

FORM 14

AN BORD UCHTÁLA.

It has been represented to An Bord Uchtála that you can give evidence in the matter of an application for an adoption order by ............................................................ ............................................................ 

You are hereby required to attend as a Witness on the hearing of the said application to be held at ................................................... on the ...................................... day of ........................................, 19.................., at ...................... o'clock and on any day to which the hearing of the said application shall be ordered, and to bring with you the following documents ............................................................ ....................................................

............................................................ ............................................................ ............................................................ ..

............................................................ ............................................................ ............................................................ ..

GIVEN under the Official Seal of the Board this ............ day

of ......................................................., 19.............. .....

Chairman/Registrar/ a person authorised by the Board to attest the seal of the Board*.

To ............................................................ .....................

............................................................ .....................

............................................................ ......................* Delete words which do not apply.

Note: If you do not obey this Summons you are liable on summary conviction to a fine not exceeding Twenty-five Pounds.

FORM 15

MEDICAL REPORT ON APPLICANT.

(This form to be completed by a registered medical practitioner)

I HEREBY CERTIFY that I have examined

............................................................ ............................................................ ........................................

(SURNAME FIRST IN BLOCK LETTERS)

of ............................................................ ............................................................ .....................................

............................................................ ............................................................ ........................................

on this date and on the basis of my examination I give the following answers to the questions set out below:—

1.

Is the applicant suffering from any functional disorder or organic disease?

............................................................ ....

2.

If so, please give particulars

............................................................ ....

............................................................ ....

3.

Do you consider that the applicant is, as far as health is concerned, suitable to adopt a child?

............................................................ ....

Signed ............................................................ ............................

Address ............................................................ ..........................

Date ............................................................ .................................

GIVEN under the Official Seal of the Board, this 22nd day of September, 1976.

AGNES B. CASSIDY,

Chairman.

I consent to the foregoing rules.

GIVEN under my Official Seal, this 22nd day of September, 1976.

PATRICK COONEY,

Minister for Justice.

EXPLANATORY NOTE.

These Rules prescribe the forms to be used for the purposes of the Adoption Acts, 1952 to 1976. They replace similar Rules made in 1965.