STATEMENT OF UNDERSTANDING:

NAMING AND LOCATING ANY AND ALL POSSIBLE BIRTHFATHERS

I, ____________________, hereby acknowledge the seriousness of being completely truthful and fully disclosing about the identity of the birthfather. This includes: the names and any information leading to the correct address, phone number or other contact information for any and all possible birthfathers of the child whom I am planning to place for adoption. This understanding further includes the following: I understand that a birthfather, even if I dislike him or do not feel he should have any rights, does, under the law have the right to be notified of an adoption plan for a child to whom he is physically (biological father) or legally related (e.g. the husband₁ even if not the biological father). If I have concerns for my safety, confidentiality or other similar concerns, I know that I must discuss these with the Agency. The Agency will take appropriate measures to address these concerns.

I understand, however, that no degree of concern_, or even fear, excuses or alleviates my absolute responsibility to identify and assist the Agency in determining how to locate the birthfather(s). I will not have to speak with the birthfather(s)_, directly, but a representative of the Agency must speak with him to determine his interests (if any) in the child. Failure to do so could easily mean totally jeopardizing both the adoption plan, even years following placement, and any harmony in the lives of all involved (the birth parents, the child, the adoptive family, the Agency and/or attorney, and any others). Also, failure to speak with the birthfather could mean that the child and adoptive family will be without crucial medical information that could involve serious health matters (e.g. fatal allergic reactions common in the family; genetically linked medical disorders etc).

Failure to honor this serious responsibility could lead to a situation parallel to those splashed on the cover of magazines and those covered on TV newsmagazine shows". However afraid, anxious, confused or angry, I understand that I must not omit to tell the Agency and all allied professionals the full and complete truth about the identity and whereabouts of any and all possible birthfathers I hereby agree to honor this responsibility fully and to raise, immediately, any and all concerns about this responsibility

Signed under the pains and penalties of perjury, this _______ day of ___________.

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Name Date

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Witness Date