FORM NO. 1

Rule 2(1)

APPLICATION FOR AN ADOPTION ORDER
[OR A PROVISIONAL ORDER]

No. ………………

In the Royal Court of Jersey

IN THE MATTER OF the Adoption (Jersey) Law 1961,

And

IN THE MATTER OF ……………………………….. a child.

Notes to applicants

·

Before filling in this form, please read the guidance notes on completing the form.

·

Please complete every Part. If you are not sure of the answer to any question, or you do not think that it applies to you, please say so.

·

If there is not enough room on the form for your reply, you may continue on a separate sheet. If you do continue on a separate sheet, please put at the head of the sheet:

○

the child’s full name,

○

the number of the Part of this form that you are completing and

○

the paragraph reference.

·

Please use black ink when filling in the form.

I/We the undersigned ………………………………….……………………………

(and …………………………………………………………………………………..)

wish to adopt ………………………………………………………..………………^[1]

and give the following details in support of my/our application

IF YOU WANT YOUR IDENTITY TO BE KEPT CONFIDENTIAL, you must say so:

I/We want my/our identity to be kept confidential and wish to apply for a serial number^[2]

     5 Yes      5 No

Part 2 About the child

a)       The child is a

          5 Boy     5 Girl

b)       The child was born on^[11]

          55/55/5555

          and is the person to whom the attached certified copy of the entry in the Register of Births or the Adopted Children Register relates

or       To the best of my/our knowledge the child was born on or about¹²

          55/55/5555

          in (give place and country of birth)

c)       The child’s nationality is

d)       I/we confirm that the child is not and has never been married or been a civil partner^[12]

          5 Yes     5 No

e)       The child has had his/her home with me/us continuously since

          55/55/5555

f)       The child was placed with me/us for adoption by the Fostering and Adoption Service on

          55/55/5555

g)      I/We have notified in writing the Fostering and Adoption Service of my/our intention to apply for an adoption order (give details)^[13]

Date notified

Name of your contact in the Fostering and Adoption Service

Telephone No.

h)         5 No freeing order has been made in respect of the child^[14]

            or

            5 the following freeing order has been made in respect of the child

Court

Case number

Type of order

Date of order

Care

i)        5 The Minister does not have parental responsibility for the child

          or

          5 The Minister does have parental responsibility for the child

Maintenance

j)        5 No maintenance order/agreement has been made in respect of the child^[15]

          or

          5 The following maintenance order/agreement has been made

Person liable to pay
maintenance

Address
(including postcode)

Court and date
of order

Date of maintenance
agreement

About other orders or proceedings that affect the child

k)       5 To the best of my/our knowledge, no proceedings relating to the child (other than any freeing order, or any maintenance order as given above) have been completed or commenced in any court^[16].

          or

          5 The following proceedings relating to the child have been completed/commenced (in addition to any freeing order, or maintenance order given above)

Type of order made
(or applied for)

Date of order
(or date of next hearing)

Name of court

Case number
(or serial number)

Case concerning a related child

l)        5 To the best of my knowledge, no proceedings relating to a full, half or step brother or sister of the child have been completed or commenced in any court.

          or

          5 The following proceedings relating to a full, half or step brother or sister of the child have been completed/commenced (please give details below and, if you were a party to any proceedings that have been completed, attach a copy of the final order)

Relationship to child (e.g. sister, half-brother)

Type of order made
(or applied for)

Date of order made (or date of next hearing)

Name of Court

Case number
(or serial number)

Part 3 About the child’s parents or guardian

The child’s mother^[17]

a)       The name of the child’s mother is

          First name(s) in full

          Last name

The child’s father¹⁸

d)       The name of the child’s father is

          First name(s) in full

          Last name

b)       Her address is (if deceased, please write ‘Deceased’ in the address box)

e)       His address is (if deceased, please write ‘Deceased’ in the address box)

c)       Her nationality is

f)        His nationality is

g)       Does he have parental responsibility for the child?^[18]

                    5 Yes        5 No

          If No, does he intend to apply for an order under Article 5 of the Children (Jersey) Law 2002 (a parental responsibility order) or a residence or contact order in respect of the child?

                    5 Yes        5 No

                    5 Don’t know

The child’s guardian^[19]

h)       The name of the child’s guardian is

          First name(s) in full

          Last name

i)       His/Her address is

Parent/guardian consent to adoption

Note: You do not need to complete paragraph (j) or (k) if the child you are applying to adopt is the subject of a current freeing order^{[20] [21]}.

Instead, go straight to Part 4 General. You should give the details of the freeing order in Part 2 About the Child above. Otherwise, please tick the box that applies to your circumstances and give any further information requested.

j)        5 The child’s parent(s)/guardian(s) has/have consented to the making of an adoption order [and if available his/her/their written consent in Form 5 is attached]

          or

          5 The child was placed with me/us for adoption by the Fostering and Adoption Service with the consent of each parent/guardian (and the mother’s consent was given when the child was at least 6 weeks old), and no parent/guardian opposes the making of an adoption order

          or

k)       5 The following parent(s)/guardian(s) of the child has/have not consented to the making of an adoption order: (give name(s) below)

and I/we ask the Court to dispense with his/her/their consent on the following grounds: (please tick the grounds that apply)

5 he/she/they cannot be found

5 he/she is/they are incapable of giving consent

5 he/she is/they are withholding consent unreasonably

5 he/she/they has/have persistently failed without reasonable cause to exercise his/her/their rights, duties, obligations and liabilities as a parent or guardian in respect of the child

5 he/she has/they have abandoned or neglected the child

5 he/she has/they have persistently ill-treated the child and for that reason the rehabilitation of the child within his/her/their household is unlikely

5 he/she has/they have seriously ill-treated the child

5 he/she is/they are incapable of caring for the child or are of such habits or mode of life as to be unfit to have care of the child

You must attach a brief statement of facts setting out a summary of the history of the case and any other facts to satisfy the Court that the grounds for your request apply.

IMPORTANT: The Court will send a copy of your statement of facts to each parent or guardian of the child. If you intend to ask the Court to keep your identity confidential, you should make sure that the statement of facts does not include any information that could identify you, where you live, or where the child goes to school or nursery.

Part 4 General

Child’s name on the adoption order^[22]

If the adoption order is made, I/We want the child to be known as –

First name(s) in full

Last name

Health reports^[23]

Separate reports on my/our health and the health of the child made by a registered medical practitioner on (give date(s))

are attached to this application

Declarations

I/We accordingly apply for an adoption order [a provisional adoption order] in respect of the child.

[If you are applying for a provisional order:

I/we intend to adopt the child under the law of or within [………… name of country] which is the country of my/our domicile, and evidence as to the law of adoption in that country is lodged with this application.

I/we desire to remove the child from Jersey.]

I/We have not received or given payment or reward in respect of the proposed adoption (except as follows –) (give details below)

To the best of my/our knowledge, only person(s) or organisation(s) named in Part 2 of this application have taken part in the arrangements for the child’s adoption.

Part 5 Statement of truth

I believe that the facts stated in this application are true.

Signature of first applicant

Print full name

I believe that the facts stated in this application are true.

Signature of second applicant

Print full name

Signed

Signed

Date

Date

What to do now

Once you have completed and signed this form, you should take or send the form and three copies to the Court, [together with the court fee*] and the following documents:

·

a certified copy of the full entry in the Register of Births that relates to the child or, where the child has been adopted, a certified copy of the entry in the Adopted Children Register;

·

a form of consent in Form 5 of any parent or guardian whose consent is required, or, if you are asking the Court to dispense with the consent of any parent or guardian to the adoption, a brief statement of the facts relied on in support of the request, and two copies of the statement;

·

a copy of any freeing order relating to the child;

·

if you were a party to any other proceedings relating to the child –

·

a copy of any other final order relating to the child that has effect and, if possible, a copy of any maintenance agreement or maintenance award relating to the child, and

·

a copy of any final order relating to a full, half or step brother or sister of the child that has effect;

·

a copy of each of the reports by a registered medical practitioner on the health of the child and the applicant(s).

·

Note: You do not have to supply health reports if:

·

he/she is your child, or the child of your spouse who is applying with you;

·

the child has reached the upper limit of the compulsory school age;

·

where a parent of the child has died, a certified copy of the entry in the Register of Deaths;

·

if you are submitting evidence of marriage or civil partnership, a certified copy of the entry in the Register of Marriages or the Register of Civil Partnerships;

·

where your husband, wife or civil partner has died, a certified copy of the entry in the Register of Deaths;

·

a copy of any decree absolute of divorce or decree of nullity of your marriage;

·

in relation to a civil partnership, a copy of any dissolution order or nullity order of your civil partnership;

·

any documentary evidence supporting the reasons why you are applying to adopt the child without your husband, wife or civil partner, such as a decree of judicial separation;

·

if your name as entered on the application form is different from the name shown on any evidence of marriage or civil partnership you are sending with your application, any documentary evidence to explain the difference.

APPLICATION FOR AN ADOPTION ORDER (Form No. 1)

Notes on completing the Form

Important

In these notes, any reference to a birth certificate, death certificate, marriage certificate or certificate of civil partnership means a certified copy of the entry in the Register of Live Births, the Register of Deaths, the Register of Marriages or the Register of Civil Partnerships, as appropriate. A photocopy is not acceptable. The birth certificate you send to the Court for the child you are applying to adopt must be a certified copy of the full entry in the Register of Births.

Take or send the completed application form to the Judicial Greffe together with the court stamps and any documents you are attaching in support of your application. If you are not sure about the court fee payable for your application, or you think that you may be exempt from paying all or part of the fee, you should contact the Judicial Greffe, or go to www.gov.je/familycare for information.

Notes on the application form

Note 1

Enter the name of the child you are applying to adopt, surname last. You must enter the full first name(s) and the surname of the child exactly as they are shown on the birth certificate (or, if the child has previously been adopted, the certified copy of the entry in the Adopted Children Register) you are sending with your application (see note 12).

Note 2

If you do not want your identity to be made known to the parents or guardians of the child you are intending to adopt, the Court will issue you with a serial number. Any documents sent to the parents/guardians will show the serial number, not your personal details. If you are required to attend the same court hearing, the court will make arrangements to ensure that your identity is protected.

Part 1 About You

Note 3

If the name you have entered is different from your name as it is shown on any evidence of marriage or civil partnership you are sending with your application form (for example, because you have changed your name by deed poll), please attach a continuation sheet explaining the reason for the difference, and a copy of any supporting documents (such as the deed poll).

Note 4

The occupation you give here will appear on the adoption order and will subsequently be entered in the Adopted Children Register. Please note that failure to give full details may result in a delay in issuing the child’s adoption certificate. It is important that you enter the full title of your occupation (or former occupation if you are retired), for example, ‘secondary school teacher’ or ‘ballet teacher’, not ‘teacher’; ‘self-employed carpenter’, not ‘self-employed’; ‘retired police officer’, not ‘retired’. Abbreviations or general descriptions such as ‘self-employed’, ‘part-time worker’, or ‘retired’, cannot be accepted. Please note also that company names cannot be entered in the Register and it is not sufficient to enter that you are an ‘employee’ or ‘worker’ with any particular company; you must give your occupation. If you are unemployed or currently unable to work because of disability, you should give your last occupation. If you are a member of H.M. Forces, you should give your rank and/or profession.

Note 5

Enter your relationship to the child you are applying to adopt, for example, step-parent, foster parent, grandparent, aunt, uncle, other relative (please specify). If you do not currently have any relationship to the child other than as prospective adopter, please enter ‘none’.

Note 6

An adoption order cannot be made unless you are domiciled in a part of the United Kingdom, the Channel Islands or the Isle of Man. ‘Domicile’ is normally taken to mean the place where you have your permanent home. If you are in any doubt as to whether you meet these conditions, you should seek legal advice.

Note 6A

You do not need to be domiciled in Jersey if you are applying for a provisional order. You must insert the country in which you are domiciled. You must provide evidence of the law of adoption in that country. For this purpose an affidavit as to that law, sworn by a person who is conversant with it and who practises, or has practised, as a barrister or advocate in that country or is a duly accredited representative of the Government of that country, will be admissible if filed with the application.

Note 6B

If you are adopting as a couple but are not married or in a civil partnership together it will be necessary, in considering the application for adoption, for the Court to be satisfied that you are living as a couple in an enduring family relationship. That will be a question of fact in each case.

Note 7

If you are applying to adopt alone and you are the partner (including husband, wife or civil partner) of the child’s father or mother or other parent, you should complete paragraph (l) and then go straight to Part 2 About the Child. Paragraphs (m) to (r) do not apply to you.

Note 8

If you are applying to adopt alone and you are the partner (but not the husband, wife or civil partner) of a person who is not the parent of the child you wish to adopt, you should complete paragraph (m). Please give your reasons for applying to adopt alone. If there is not enough room for your reply, you may continue on a separate sheet. You should then go straight to Part 2 About the Child. Paragraphs (n) to (r) do not apply to you.

Note 9

If you are applying to adopt alone and

·

you have never been married/had a civil partner, please complete paragraph (n);

·

you are divorced, or your civil partnership has been dissolved, please complete paragraph (o) and attach a copy of the Decree Absolute or the Dissolution Order to your application;

·

you are a widow or widower or a surviving civil partner, please complete paragraph (p) and attach the death certificate of your deceased husband, wife or civil partner to your application.

Note 10

Tick this box to signify that the agreement of your husband/wife/civil partner to the making of the adoption order has been obtained. Please attach a duly completed Form No. 5A (Agreement of spouse or civil partner to an adoption order) to the application form.

Note 10A

·

your husband/wife or civil partner cannot be found, or

·

your husband/wife or civil partner is incapable of giving agreement, or

·

your husband/wife or civil partner is unreasonably withholding agreement, or

·

the welfare of the child justifies the making of the order without the agreement of your husband/wife or civil partner.

Note 11

If you are applying alone for an adoption order in respect of your own child you will need to satisfy the court that:

·

the other natural parent has died, or

·

the other natural parent cannot be found, or

·

there is some other reason (which you must set out on your application form) justifying the other parent’s exclusion from your application.

You must show on the application form which of those grounds applies in your case by ticking the appropriate box.

You should also attach to your application any documentary evidence on which you propose to rely, such as the death certificate.

Part 2 About the Child

Note 12

If the child has previously been adopted, a certified copy of the entry in the Adopted Children Register should be attached and not a certified copy of the full entry in the Register of Births. Where you are unable to attach a certificate, enter the place (including the country) of the child’s birth, if known.

No application may be made in respect of a person who is aged 18 or more at the time of the application.

Note 13

The Court cannot make an adoption order in relation to any person who is or has been married, or any person who is or has been a civil partner.

Note 14

Except where the applicant or one of the applicant’s is a parent of the child, you must notify the Fostering and Adoption Service in writing of your intention to apply for an adoption order. You must give notice of your intention not less than 3 months before the date of your application to the Court. If the child has been living outside the British Islands, or you are applying for a provisional order, this needs to be done 6 months before the date of your application to the Court.

Note 15

Give details of the name of the court that made the freeing order, the nature of the order, the case number and the date the order was made.

Note 16

If some person or body is liable to pay maintenance for the child under a court order, or a maintenance agreement, give the name and address of the person or body liable to pay. In the case of a maintenance order, give the name of the court and the date the order was made; otherwise, give the date of the maintenance agreement.

Note 17

If there are earlier, or current, court proceedings relating to the child you are applying to adopt (for example, proceedings for a care order, a contact order, a parental responsibility order or a residence order), give the name of the court, the nature of the proceedings and the date and effect of any order made, or the date of the next hearing if proceedings are current. You do not need to repeat the details of any freeing order, or maintenance order or agreement you have already given.

Important: if you have previously applied for an adoption order in respect of the same child and the order was refused, you will need to satisfy the court that there has been a change of circumstances since you last applied, or that there is some other reason why the court should hear your current application. Please set out your reasons for making this application on a separate sheet, explaining why you think the application should be heard. Please put the child’s full name, the number of the Part and the paragraph reference at the head of the sheet and attach it to your application form.

Note 17A

Tick this box to signify that the agreement of the child subject to the application for an adoption order has been obtained. Please attach a duly completed Form No. 5 (Agreement of child subject to an adoption order) to the application form.

Note 18

If the child has previously been adopted, give the names of his/her adoptive parents, not those of his/her natural parents.

Note 19

If the child’s parents were not married to each other or not in a civil partnership at the time of his/her birth, the child’s father may have parental responsibility because:

·

the child’s father and the child’s mother have married since the child was born;

·

the child’s father has a parental responsibility agreement with the mother, or has been granted a parental responsibility order;

Give details of any court order or agreement in respect of parental responsibility in paragraph (k) of Part 2 About the child.

Note 20

If the child has no guardian, enter ‘not applicable’. Otherwise, enter the details of any person appointed to be the child’s guardian by deed or will or otherwise in writing in accordance with Article 7 of the Children (Jersey) Law 2002. If the child has more than one guardian, please give the name and address of any other guardian(s) on a separate sheet, putting the child’s full name, the number of the Part and the paragraph reference at the head of the sheet.

Note 21

If the child you are applying to adopt is already the subject of a current freeing order, you do not need to ask the Court to dispense with the consent of the child’s parent(s) or guardian(s) to your application. You do not have to complete paragraph (j) or (k), but please ensure that you have entered the details of the freeing order in Part 2, About the Child.

You do not need to ask the Court to dispense with the consent of the child’s parent(s) or guardian(s) to your application if:

·

the child’s parent(s)/guardian(s) has/have consented to the making of an adoption order; or

·

the child was placed with you for adoption by an adoption agency with the consent of each parent/guardian (and the mother’s consent was given when the child was at least 6 weeks old), and no parent/guardian opposes the making of an adoption order.

Please complete paragraph (j) showing which of these conditions applies in your case.

If the child’s father does not have parental responsibility for the child, you do not need that parent’s consent to your application for an adoption order.

Note 22

If you are asking the court to dispense with the consent of any parent or guardian, the Court can only dispense with that person’s consent on one or more of the grounds shown at paragraph (k) on the Form. You must –

·

complete paragraph (k) indicating which of these grounds applies to your request, and

·

provide a brief statement of the facts.

Part 4 General

Note 23

Please enter the name by which you want the child to be known following the adoption. This is the name that will be entered on the Adopted Children Register. You may wish the child to have a new name following the adoption, but there is no obligation to change the child’s name if you do not want to do so.

Note 24

You do not need to send a medical report on your health (or the health of the other applicant, if there is one) or the health of the child with your application if:

·

he/she is your child, or the child of your spouse, who is applying with you; or

·

the child has reached the upper limit of the compulsory school age.

In any other case you must attach separate health reports in respect of each applicant and the child.

FORM NO. 2

Rule 2(4)

NOTICE OF AN APPLICATION FOR AN ADOPTION ORDER OR A PROVISIONAL ADOPTION ORDER

(GENERAL TITLE – FORM 1)

To ....................................................... of ....................................................

Whereas an application for an adoption order/a provisional adoption order in respect of ............................................................................... ⁽¹⁾, an child of the ................... sex born on the ....................................... day of ..................., 19/20........, has been made [by.............................................  ........................................ and ..................................................] ⁽²⁾ or [under the serial number ........................................................................];

And whereas ............................................. of ......................................... has been appointed guardian ad litem of the said child:

Take notice:

A.⁽³⁾ [That the said application will be heard in the Royal Court, Royal Square, Jersey, on the ................... day of ..................., 20............, at ............................... o’clock, and that you may then appear and be heard on the question whether an adoption order/a provisional adoption order should be made.]

B.⁽³⁾ [That if you wish to appear and be heard on the question whether an adoption order/a provisional adoption order should be made, you should give notice to the undermentioned advocate/solicitor on or before the...................day of..................., 20........., in order that a time may be fixed for your appearance.]

[And further take notice that while the said application is pending, a parent or guardian of the child who has already signified his or her consent to the making of the adoption order must not, except with the leave of the Court, remove the child from the care and possession of the applicant(s). Application for such leave may be made personally to the Court.] ⁽⁴⁾

It would assist the Court if you would complete the attached form and return it to me.

Dated the ................. day of .............................., 20..........

Advocate/Solicitor for the applicant(s).

Notes

(1)

Enter the name[s] and surname of the child as shown in the heading of Form No. 1.

(2)

The name of the applicant must not be given where a serial number is specified in the application (entry No. 22) and the notice is addressed to an individual other than the spouse of the applicant. In that case complete the second entry in square brackets.

(3)

Paragraph A should be completed and paragraph B struck out where the notice is addressed to an administration of the States, a parochial authority, any other body of persons or the spouse of the applicant, or where he or she does not desire the applicant’s identity to be kept confidential (see the application, entry No. 22). Where a serial number is specified in that entry and the notice is addressed to an individual respondent other than the spouse of the applicant, paragraph A must be struck out and paragraph B completed.

(4)

Delete words in square brackets except where the notice is addressed to a parent or guardian of the child.

Perforation

To ........................................ Advocate/Solicitor. No. ................................

I have received notice of the application for an adoption order/a provisional adoption order in respect of .................................................... .......................................an child.

* Delete one or other alternative.

I *do/do not wish to oppose the application.

I *do/do not wish to appear and be heard on the question whether an adoption order/a provisional adoption order should be made.

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

(Signature)

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

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

(Date)

(Address)

FORM NO. 3

Rule 4

MEDICAL CERTIFICATE AS TO HEALTH OF APPLICANT

I examined ...................................... on .............................................. and have formed the opinion that he (or she) is physically, mentally and emotionally suitable to adopt a child.

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

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

Qualifications ............................................................................................

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

FORM NO 4

Rule 5

MEDICAL REPORT ON HEALTH OF CHILD

Note –

This form is for a medical report on a child who may be adopted. The report is for the benefit of the adopters and the Court. In order that the adopters may benefit fully from the report, it is important that the certifying doctor should explain to the adopters the nature and extent of any disability or abnormality disclosed by the examination which might affect their decision whether or not to adopt the child.

Child’s name .................................................. Date of birth.....................

Sex ............................. Weight ............................ Height..........................

A

General condition

Skin

Eyes (including vision)

Ears (including hearing)

Nose and throat

Speech

Cardio-vascular system

Respiratory system

Alimentary system

Genito-urinary system (including examination of urine for albumen, sugar and phenylpyruvic acid)

Skeletal and articular system (including examination for congenital dislocation of hip)

Nervous system (including fits)

Lymphatic system

Any other comments

Is the child physically normal having regard to the child’s age ?

B

Are there any items in the child’s history or examination which suggest that the child may be mentally abnormal having regard to the child’s age ?

C

Particulars of any illnesses from which the child has suffered.

D

If known,

Weight at birth (if child is under one year of age)

Details of birth, including result of mother’s serological tests for syphilis

Particulars, with dates, of vaccination or immunization against –

Tuberculosis (state result of Mantoux test or whether child has been successfully vaccinated with B.C.G. vaccine)

Smallpox

Diphtheria

Whooping cough

Poliomyelitis

Tetanus (active)

Any other disease.

E

Result of suitable serological test of the child’s blood for syphilis taken 6weeks or later after birth (please specify test).

F

I examined the child on the ........................... day of ...................... 20 .............., and I have informed the adopters of the state of health of the child disclosed by the examination.

Signature .............................................................. Date ...........................

Qualifications ...........................................................................................

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

FORM No. 5

Rule 6(2)

AGREEMENT OF CHILD SUBJECT TO AN ADOPTION ORDER

Whereas an application is to be/has been made by ........................................................
 ……......................................./and............................................................... [or under the serial number .........…………...........]⁽¹⁾ (the “applicant”/the “applicants”) for an adoption order in respect of ....................................................................⁽²⁾, a child.

I,......................................................⁽³⁾, of ..................................................................⁽⁴⁾, confirm that I was born on .............................................⁽⁵⁾ and that, with full understanding of what is involved in, and the effect of, the order, freely agree to my adoption.

1.          I understand that the effect of an adoption order will be to deprive my birth parents/guardian permanently of any rights as parents/guardian and to transfer them to the applicant(s).

2.          I further understand that, when the application for an adoption order is heard, this document will be used as evidence of my agreement to the making of the order.

(Signature of child)

(Date)

Notes:

1.

Insert either the name of the applicant(s) or the serial number assigned to the applicant(s) for the purposes of the application.

2.

Insert the name and surname of the child.

3.

Insert the name and surname of the child.

4.

Insert the address of the child.

5.

Insert date of birth of the child.

FORM No. 5A

Rule 6(3)

AGREEMENT OF SPOUSE OR CIVIL PARTNER TO AN ADOPTION ORDER

Whereas an application is to be/has been made by ........................................................
 ……..................................... [or under the serial number ...................…….............]⁽¹⁾ (the “application”) for an adoption order in respect of ............................................................⁽²⁾, a child;

I,.....................................................⁽³⁾, of ...................................................................⁽⁴⁾, confirm that, with full understanding of what is involved in, and the effect of, the order, freely agree to the making of an adoption order in pursuance of the application.

I further understand that, when the application for an adoption order is heard, this document may be used as evidence of my agreement to the making of the order unless I inform the Court that I no longer agree.

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

(Signature)

……………………………………

(Date)

Notes:

1.

Insert either the name of the applicant or the serial number assigned to the applicant for the purposes of the application.

2.

Insert the name and surname of the child.

3.

Insert the name and surname of the agreeing party.

4.

Insert the address of the agreeing party.

FORM No. 6

Rule 6

CONSENT TO AN ADOPTION ORDER OR A PROVISIONAL ADOPTION ORDER

(GENERAL TITLE – FORM 1)

Whereas an application is to be/has been made by ..............................  ……................../and............................................................... [or under the serial number .........………............]⁽¹⁾ for an adoption order/a provisional adoption order in respect of .................................................................⁽²⁾, an child;

[And whereas the child is the person to whom the birth certificate⁽³⁾ now produced and shown to me marked “A” relates]⁽⁴⁾

I, the undersigned ................................., of ...................................... being⁽⁵⁾ the mother⁽⁶⁾/father⁽⁷⁾/guardian of the child, hereby state as follows –

1.          I understand that the effect of an adoption order will be to deprive me permanently of my rights as a parent/guardian and to transfer them to the applicant(s) [or I understand that the effect of a provisional adoption order will be to enable the applicant(s) to remove the child from Jersey for the purpose of adopting the child abroad and to give the applicant(s) custody of the child pending the child’s adoption]; and in particular I understand that, if an order is made, I shall have no right to see or get in touch with the child or to have the child returned to me.

2.          I further understand that the Court cannot make an adoption order without the consent of each parent or guardian of the child unless the Court dispenses with a consent on the ground that the person concerned has abandoned, neglected or persistently ill-treated the child, or cannot be found, or is incapable of giving consent, or is unreasonably withholding consent or has persistently failed without reasonable cause to discharge the obligations of a parent or guardian.

3.          I further understand that, when the application for an adoption order is heard, this document may be used as evidence of my consent to the making of the order unless I inform the Court that I no longer consent⁽⁸⁾.

4.          I hereby consent to the making of an adoption order/a provisional adoption order in pursuance of the application [on condition that the religious persuasion in which the child is proposed to be brought up is ..................................................]⁽⁹⁾.

5.          As far as I know, no other person or body has taken part in the arrangements for placing the child in the care and possession of the applicant(s) [except ................................................................................. ......................, of ................................................................................]⁽¹⁰⁾

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

(Signature)

This form, duly completed, was signed by the said .......................... .......................................................................before me⁽¹¹⁾ at ................... on the ................... day of ......................................, 20 ..............

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

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

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

WARNING.

It is an offence to receive or give any reward or payment for, or in consideration of, the adoption of the child or for giving consent to the making of an adoption order, other than a payment to an administration of the States or a parochial authority for their expenses incurred in connection with the adoption.

Notes:

(1)

Insert either the name of the applicant or the serial number assigned to the applicant for the purposes of the application.

(2)

Insert the name(s) and surname as known to the consenting party.

(3)

If the child has previously been adopted, a certified copy of the entry in the Adopted Children Register should be attached and not a certified copy of the original entry in the Registers of Births; and the description of the consenting party should include the words “by adoption” where appropriate.

(4)

Delete the words in square brackets except where the consenting party is the mother or father of the child and the birth certificate has not already been identified by the other parent.

(5)

Delete all but one of the descriptions which follow.

(6)

The mother’s consent cannot be given before the child is 6weeks old.

(7)

“Father” does not include the natural father of an illegitimate child.

(8)

Notice will be given of the date of the hearing of the application by the Court. After the making of the application the consenting parent or guardian cannot remove the child from the care and possession of the applicant except with the leave of the Court.

(9)

Delete the words in square brackets if the applicant is named or if, although the applicant is not named, the consenting party does not desire to impose a condition as to religious upbringing.

(10)

Enter the name of any administration of the States, parochial authority or person who is known to have arranged, or to have taken part in the arrangements, for the child to be placed in the care and possession of the applicant.

(11)

In Jersey the document should be signed before a Jurat of the Royal Court, an advocate or solicitor of the Royal Court, a notary public or an officer of an administration of the States for which the Minister of Health and Social Services is assigned responsibility. Outside Jersey it should be signed before a person authorized to administer an oath for any judicial or legal purpose, a British consular officer, a notary public or, if the person signing it is serving in the armed forces, a commissioned officer.

FORM No. 7

Rule 22

NOTICE TO RESPONDENT OF FURTHER HEARING OF AN APPLICATION FOR AN ADOPTION ORDER OR A PROVISIONAL ADOPTION ORDER

(GENERAL TITLE – FORM No. 1)

To ............................................................ of ..............................................

Whereas an application for an adoption order/a provisional adoption order in respect of .................................................................⁽¹⁾, an child of the ............................ sex born on the .................................................. day of ..................., 19/20 .............., was made [by ..................................... and ................................. ]⁽²⁾ or [under the serial number ........................ ];

And whereas ......................................, of ............................................. is the guardian ad litem of the said child;

And whereas the determination of the said application was postponed and an interim order made by the Court on the ................... day of ..................., 20 .................:

Take notice –

A⁽³⁾ [That the said application will be heard further in the Royal Court, Royal Square, Jersey, on the ................... day of ..................., 20 ............, at ............................... o’clock, and that you may then appear and be heard on the question whether an adoption order/a provisional adoption order should be made.]

B⁽³⁾ [That if you wish to appear and be heard on the question whether an adoption order/a provisional adoption order should be made, you should give notice to the undermentioned advocate/solicitor on or before the ................... day of .........................., 20 ............, in order that a time may be fixed for your appearance.]

It would assist the Court if you would complete the attached form and return it to me.

Dated the ........................... day of ............................., 20 .................

Advocate/Solicitor for the applicant(s)

Notes:

(1)

Enter the name(s) and surname of the child as shown in the heading of Form No. 1.

(2)

The name of the applicant(s) must not be given where a serial number is specified in the application (entry No. 22) and the notice is addressed to an individual other than the spouse of the applicant. In that case complete the second entry in square brackets.

(3)

Paragraph A should be completed and paragraph B struck out where the notice is addressed to an administration of the States, a parochial authority, any other body of persons or the spouse of the applicant, or where the applicant does not desire his or her identity to be kept confidential (see the application, entry No. 22). Where a serial number is specified in that entry and the notice is addressed to an individual respondent other than the spouse of the applicant, paragraph A must be struck out and paragraph B completed.

Perforation

To ................................................ Advocate/Solicitor.

No. .....................

I have received notice of the further hearing of the application for an adoption order/a provisional adoption order in respect of ......................................................, an child.

*Delete one or other alternative.

I *do/do not wish to oppose the application.

I *do/do not wish to appear and be heard on the question whether an adoption order/a provisional adoption order should be made.

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

(Signature)

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

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

(Date)

(Address)

FORM No. 8

Rule 23

ADOPTION ORDER OR PROVISIONAL ADOPTION ORDER (1)

(GENERAL TITLE – FORM No. 1)

Whereas an application has been made by .............................................. of ........................................., whose occupation is ............................... [and ..................., that person’s wife or husband] [and ..................., that person’s civil partner] (hereinafter called the applicant(s)) for an adoption order/a provisional adoption order in respect of ...................⁽¹⁾, an child of the sex, the child/adopted child of ....................................... [and .......................................... ];

And whereas the Court is satisfied that the applicant is/applicants are qualified in accordance with the provisions of the Adoption (Jersey) Law 1961, to be granted an adoption order/a provisional adoption order in respect of the child and that all conditions precedent to the making of such an order have been fulfilled;

It is ordered that the applicant(s) be authorized to adopt the child [or that the applicant(s) be authorized to remove the child from Jersey for the purpose of adopting the child under the law of or within the country in which the applicant is/applicants are domiciled and that the applicant(s) do have the custody of the child pending the child’s adoption as aforesaid];

[And the following payment or reward is sanctioned .............................. ......................................;]

[And as regards costs it is ordered that ........................................ ..............................;]

[And whereas the precise date of the child’s birth has not been proved to the satisfaction of the Court but the Court has determined the probable date of the child’s birth to be the day of ..............................., 19/20 ..............;]

[And whereas the country of birth of the child has not been proved to the satisfaction of the Court [but it appears probable that the child was born within the United Kingdom, the Channel Islands or the Isle of Man];]

[And whereas the child was born in Jersey but the parish in which the birth took place has not been proved to the satisfaction of the Court;]

[And whereas it has been proved to the satisfaction of the Court that the child was born in ........................... on the ................... day of ........................................, 19/20 ..........;]

[And whereas it has been proved to the satisfaction of the Court that the child is identical with ..................................... to whom the entry numbered ............... made on the ........... day of .................., 19/20 .........., in the Registers of Births for the parish of ................... relates [or with ................... to whom the entry numbered ........................... and dated the ................... day of ..................., 19/20 ............, in the Adopted Children Register relates];]

[And whereas the name or names and surname stated in the application as those by which the child is to be known are ...........................................................;]

It is directed that the Superintendent Registrar shall make in the Adopted Children Register an entry recording the particulars set out in the Schedule to this Order;

[And it is further directed that the aforesaid entry in the Registers of Births/Adopted Children Register be marked with the word “Adopted” “Re-adopted” “Provisionally adopted” “Provisionally re-adopted”]⁽²⁾.

Dated this ................................... day of ..............................., 20 ..............

Judicial Greffier.

Date ⁽³⁾ and country ⁽⁴⁾ of birth of child

Parish ⁽⁵⁾

Name and surname of child ⁽⁶⁾

Sex of child ⁽⁷⁾

Name and surname, address ⁽⁸⁾ and occupation of adopter or adopters

Date of adoption order ⁽⁹⁾

Notes:

(1)

Enter the name(s) and surname of the child as shown in the heading of Form No. 1.

(2)

This paragraph should be deleted where the child is not proved to be identical with a child to whom an entry in the Registers of Births or Adopted Children Register relates.

(3)

Where the precise date of the child’s birth is not proved, enter the date determined by the Court to be the probable date.

(4)

Where the country of the child’s birth is not proved, the particulars of the country of birth may be omitted unless it appears probable that the child was born within the United Kingdom, the Channel Islands or the Isle of Man. In that event enter Jersey as the country of birth.

(5)

Where the child was born in Jersey but the parish in which the birth took place is not proved, or where the child is treated in accordance with Note (4) as born in Jersey, enter the parish of St. Helier.

(6)

Enter the name or names and surname stated in Form No. 1 as those by which the child is to be known or, if no name or surname is so stated, the original name or names of the child and the surname of the applicant.

(7)

Enter “boy” or “girl”, as the case may be.

(8)

If the applicant is not ordinarily resident in Jersey, enter the place abroad where the applicant ordinarily resides.

(9)

In the case of a provisional adoption order enter the words “Provisional adoption order” followed by the date of the order.

FORM No. 9

Rule 23

ADOPTION ORDER OR PROVISIONAL ADOPTION ORDER (II)

(GENERAL TITLE – FORM No. 1)

Whereas an application has been made by ............................................ of ..................................................... [and ................................................ that person’s wife or husband,] [and ..................., that person’s civil partner] for an adoption order/a provisional adoption order in respect of ........................................⁽¹⁾, an child:

It is ordered that the applicant(s) be authorized to adopt the child [or that the applicant(s) be authorized to remove the child from Jersey for the purpose of adopting the child under the law of or within the country in which the applicant is/the applicants are domiciled and that the applicant(s) do have the custody of the child pending the child’s adoption as aforesaid];

And it is directed that the Superintendent Registrar shall make in the Adopted Children Register an entry recording the particulars set out in the Schedule to this order.

Dated this ................................ day of .................................20 ............

Judicial Greffier.

Date and country of birth of child

Parish

Name and surname of child

Sex of child

Name and surname, address and occupation of adopter or adopters

Date of adoption order

FORM No. 10

Rule 24

INTERIM ORDER

(GENERAL TITLE – FORM No. 1)

Whereas an application has been made by ............................................... of ........................................... [and ................................................., that person’s wife or husband] [and ..................., that person’s civil partner] (hereinafter called the applicant(s)) for an adoption order/a provisional adoption order in respect of ..............................................⁽¹⁾, an child;

And whereas the Court is satisfied that the applicant is/the applicants are qualified in accordance with the provisions of the Adoption (Jersey) Law 1961, to be granted an adoption order/a provisional adoption order in respect of the child and that all conditions precedent to the making of such an order have been fulfilled:

It is ordered that the determination of the application be postponed and that the applicant(s) do have the custody of the child until the ..................................... day of ........................................., 20................., by way of a probationary period [or that the determination of the application be postponed to the ................... day of ..................., 20..................., and that the applicant(s) do have the custody of the child until that day by way of a probationary period] [upon the following terms, namely............................................................................].

[And as regards costs it is ordered that .................................................].

[And it is ordered that the application be further heard before the Court on the .................... day of .................................., 20..................., at ..............o’clock.]

Dated this ........................... day of ......................................., 20...........

Judicial Greffier.

Note –

(1)

Enter the name(s) and surname of the child as shown in the heading to Form No. 1.

Adoption (Jersey) Rules 1962

R&O.4325

1 March 1962

Adoption (Amendment) (Jersey) Rules 1965

R&O.4666

21 April 1965

Adoption (Amendment No. 2) (Jersey) Rules 1974

R&O.5995

17 June 1974

States of Jersey (Amendments and Construction Provisions No. 5) (Jersey) Regulations 2005

R&O.45/2005

9 December 2005

Adoption (Amendment No. 3) Rules 2012

R&O.44/2012

2 April 2012

Adoption (Amendment No. 4) Rules 2014

R&O.165/2014

2 October 2014

Adoption (Amendment No. 5) Rules 2015

R&O.129/2015

29 October 2015

31

spent, omitted from this revised edition[38]

32

spent, omitted from this revised edition

33

31

First Schedule

Schedule 1

Second Schedule

Schedule 2