Voluntary Relinquishment of Parental Rights
Parent Information
Full Name
Address
Phone Number
Child Information
Full Name
Date of Birth
Statement of Relinquishment
I, the undersigned parent, voluntarily relinquish all parental rights and responsibilities to the above-named child. I understand the legal consequences of this action.
Witness Information (if required)
Witness Name
Witness Signature
Date
Parent Signature
Date
Notary (if required)
Date