I
[See Regulations 2 (5), 6 (13) and 7 (17)]Certificate Declaring the Child Legally Free for Adoption1. In exercise of the powers vested in the Child Welfare Committee ...................... under section 38 of the Juvenile Justice (Care and Protection of Children) Act, 2015 (2 of 2016), child............... date of birth...............placed in the care of the Specialized Adoption Agency/Child Care Institution(name and address) vide order no................ dated ......................... of this Committee, is hereby declared legally free for adoption on the basis of the following:
Inquiry report of the Probation Officer/ Child Welfare Officer/ Social Worker/ Case Worker/any other (as the case may be);Deed of surrender executed by the biological parent(s) or the legal guardian of the child before this Committee on (date);Declaration submitted by District Child Protection Unit and the Child Care Institution or Specialized Adoption Agency concerned to the effect that they have made restoration efforts as required under sub section (1) of section 40 of the Act, the rules framed thereunder and the Adoption Regulations, but, nobody has approached them for claiming the child as biological parents or legal guardian as on date of the said declaration.Consent of older child, in case applicable.2. This is to certify that:
The biological parent(s)/legal guardian, wherever available, has/have been counselled and duly informed of the effects of their consent including the placement of the child or children in adoption which would result in the termination of the legal relationship between the child and his or her family of origin.The biological parents/legal guardian have given their consent freely, in the required form, and the consent have not been induced by payment or compensation of any kind and the consent of the mother (where applicable), has been given only after the birth of the child.The Specialized Adoption Agency/Child Care Institution to which the aforesaid child is entrusted shall arrange to post the photograph and other essential details of the child in the Child Adoption Resource Information and Guidance System and shall place such child in adoption as per the procedure laid down in the Act and Adoption Regulations.[Note: strike out the box(es) which are not relevant to the case][Note: Only one certificate may be issued in case of siblings or twins stating the relationship.][Note: To facilitate adoption in the best interest of the child, the Specialized Adoption Agency or District Child Protection Unit concerned, as the case may be, is permitted to post the profile of the child, including photograph, Child Study Report, Medical Examination Report and this certificate in the Child Adoption Resource Information and Guidance System]
Child Welfare CommitteeDate and PlaceSignature of any three membersDate and Stamp
| To: |
Specialized Adoption Agency/ District Child Protection Unit –to post this certificate in Child Adoption Resource Informationand Guidance System (CARINGS).
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| Copy to: |
District Child Protection Officer (DCPO), Name of theDistrict.
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II
[See regulations 2(6), 6(15), 7(18), 58(5)(a) and 58(6)(a)]Child Study ReportChild Adoption Resource Information and Guidance System (CARINGS)Registration No:Aadhar Card No:Name of the Specialized Adoption Agency (SAA)/ Child Care Institution (CCI):The detailed report on the child shall include identifying information supported by documents. Child Study Report should be prepared as soon as the child is declared legally free for adoption by the Child Welfare Committee.
Name and address of the Institution:-I. General Information:1. Name of the Child. ---------------------- (given by biological mother or parents or by the Specialized Adoption Agency/ Child Care Institution or Child Welfare Committee)
2. Present age and date of birth:
6. Type of child: Orphan/ abandoned/ surrendered
7. Date of admission of the child to the Specialized Adoption Agency/Child Care Institution:
8. Date of production before Child Welfare Committee:
9. Date declared as legally free for adoption by the Child Welfare Committee:
II. Social Data. - Please do not give identifying information about the natural parent.1. How did the child come to your institution?
(a)Admitted directly by parent or any other guardian:(b)Placed by Child Welfare Committee directly:(c)Transferred from any other institution, if so name of the institution:2. Reasons for seeking protection in the Institution:
3. Attitude of the child towards other children, if applicable
4. Behaviour and relationship of the child towards staff and other adults including strangers:
6. If the child is enrolled in school, give a detailed report about his or her standard, attendance, general interest in studies, progress, if any:
7. General personality and description of the child:
8. Play activity and any specific talent: Milestones of the child (for children below 18 months). Please mark Yes or No (based on age appropriate responses)
Does the child:-(d)Grasp objects in its hand(f)Sit with full support or Sit without support(g)Stand with support or Stand without support(h)Walk with support or Walk without support9. Dietary Habits:
Intake of liquid food:Semi-solid food:Solid food:10. Developmental Assessment (language spoken, behaviour, basic play skills, physical activity and communication and social skills etc.):
11. Social Background: (This should include his social history i.e. brief background of the birth parents and circumstances necessitating the child's surrender or abandonment, etc. Please do not give identifying information such as name and address of birth parents or relatives.)
12. I ______________ Social Worker hereby certify that the information given in this form about child _______ is correct.
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Signature: |
| Place: |
Name: |
| Date: |
Designation: |
| (Signature of the male applicant) |
(Signature of the female applicant) |
| (Name of the male applicant) |
(Name of the female applicant) |
| Place and Date: |
Place and Date: |
III
[See regulations 2(13), 6(15), 7(18), 58(5)(a) and 58(6)(a)]Medical Examination Report of the ChildA duly registered physician should complete the report. If any information is not available, please state "Not Available". (if the child is below 1 year, he/she should be examined by Paediatrician)Child Adoption Resource Information and Guidance System (CARINGS)Registration No.Health Status: Normal/Special NeedDate of Admission:Name of the Specialized Adoption Agency:Name of the Child Care Institution:
| A. |
General Information |
| 1. |
Name of the child : |
| 2. |
Date and year of birth : |
| 3. |
Sex: |
| 4. |
Place of birth: |
| 5. |
Nationality: |
| 6. |
Name of the present institution: Placed since: |
| 7. |
Weight at birth (in kg. at admission): kg. |
| 8. |
Head Circumference : |
| 9. |
Length at birth (in cm. at admission): cm. |
| 10. |
Was the pregnancy and delivery normal? Yes or No or Do notknow
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| 11. |
Where has the child been staying? |
| With his or her mother: from to |
| With relatives: from to |
| In private care: from to |
| In institution or hospital: from to |
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(Please state the name of the institution or institutionsconcerned)
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Note: In case of new born children, refer to Medical Test fordifferent age groups in Schedule IV [paragraph (A) New Born].
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| B. |
Medical Details |
| 1. |
Has the child had any diseases during the past ? (if yes,please indicate the age of the child in respect to each disease,as well as any complication): Yes or No or Do not know
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| 2. |
If yes: |
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Children's ordinary diseases (whooping cough, measles,chicken-pox, rubella, mumps):
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Tuberculosis: |
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Convulsions (incl. Febrile convulsions): |
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Any other disease: |
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Exposure to contagious disease: |
| 3. |
Has the child been vaccinated against any of the followingdiseases:
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Yes or No or Do not know |
| 4. |
If yes: |
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Tuberculosis (B.C.G.) |
Date of immunisation: |
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Diphtheria |
Date of immunisation: |
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Tetanus |
Date of immunisation: |
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Whooping cough |
Date of immunisation: |
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Poliomyelitis |
Date of immunization: |
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Hepatitis A |
Date of immunisation: |
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Hepatitis B |
Date of immunisation: |
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MMR (Measles) |
Date of immunization: |
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Other immunizations |
Date of immunisation: |
| 5. |
Has the child been treated in hospital? |
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Yes or No or Do not know |
| 6. |
If yes state name of hospital, age of child, diagnosis, andtreatment:
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| 7. |
Give, if possible, a description of the mental development,behaviour and skills of the child.
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| (i) |
Visual |
When was the child able to fix? |
| (ii) |
Aural |
When was the child able to turn its head after sounds? |
| (iii) |
Motor |
When was the child able to sit byitself?When was the child able to standwith support?When was the child able to walk without support?
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| (iv) |
Language |
When did the child start to speakmonosyllables?When did the child start to saysingle words?When did the child start to speak sentences?
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| (v) |
Contact |
When did the child start to smile?How does the child communicate withadults and other children?How does the child react towards strangers?
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| (vi) |
Emotional |
How does the child show emotions (anger, uneasiness,disappointment, joy)?
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| C. |
Medical Examination Details: |
| 1. |
Date of the Medical Examination |
| 2. |
Colour of hair: |
| 3. |
Colour of eyes: |
| 4. |
Colour of skin: |
| 5. |
Through my complete clinical examination of the child I haveobserved the following evidence of disease, impairment orabnormalities (in case applicable):
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| (i) |
Head (form of skull, hydrocephalus, craniotabes ) |
| (ii) |
Mouth and pharynx (harelip or cleft palate, teeth) |
| (iii) |
Eyes (vision, strabismus, infections) |
| (iv) |
Ears (infections, discharge, reduced hearing, deformity) |
| (v) |
Any dysmorphic facies? If yes, describe |
| (vi) |
Organs of the chest (heart, lungs) |
| (vii) |
Lymphatic glands (adenitis) |
| (viii) |
Abdomen (hernia, liver, spleen) |
| (ix) |
Genitals (hypospadia, testis, retention) |
| (x) |
Spinal column (kyphosis, scoliosis) |
| (xi) |
Extremities (pes equines, valgus, varus, pes calcaneovarus,flexation of the hip, spasticity, paresis)
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| (xii) |
Skin (eczema, infections, parasites) |
| (xiii) |
Other diseases? |
| 6. |
Are there any symptoms of syphilis in the child? Result ofsyphilis reaction made (date and year): Positive or Negative orNot done
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| 7. |
Any symptoms of tuberculosis? |
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Result of tuberculin test made (date and year): Positive orNegative or Not done
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| 8. |
Any symptoms of Hepatitis B? |
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Result of tests for Hbs Ag (date and year):Positive orNegative or Not done
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Result of test for anti-HBs (date and year): Positive orNegative or Not done
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Result of tests for HBeAg (date and year): Positive orNegative or Not done
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Result of tests for anti HBe (date and year): Positive orNegative or Not done
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| 9. |
Any history of Jaundice and blood transfusion? |
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Results of tests for HBsAG (date and year)? |
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If positive, whether specialist consultation taken (yes/ no,date and year); and further tests/ treatment undertaken (attacha copy of the documents)
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| 10. |
HIV Test (refer to Standard Medical Test at Schedule IV) |
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HCV (Hepatitis C) (refer to Standard Medical Test at ScheduleIV)
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| 11. |
Does the urine contain: |
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Sugar? |
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Albumen? |
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Phyenylketone? |
| 12. |
Stools (diarrhoea, constipation): |
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Examination for parasites: Positive or Negative or Not done |
| 13. |
Is there any mental disorder or retardation of the child? |
| 14. |
Give a description of the mental development, behaviour andskills of the child.
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| 15. |
Any additional comments? |
| Note: |
| 1. |
Refer to Infants between 1 month to 1 year of age in Section‘B' of Medical Test in Schedule IV.
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| 2. |
Refer to Age 1-3 years and more than 3 years of Medical Testin Schedule IV [paragraph (C)].
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| D. |
Report concerning the psychological and socialcircumstances of the child (wherever required, assistance may betaken from special educator, physiotherapist, speech therapistand the social worker)
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Please decide on each heading. |
| (i) |
Activity with toys (age appropriate as applicable): |
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| 1. |
The child's eyes follows rattles or toys, that are moved infront of the child
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| 2. |
The child holds on to a rattle |
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| 3. |
The child plays with rattles: putting it in the mouth, shakingit, moving it from one hand to the other etc.
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| 4. |
The child puts cubes on top of each other. |
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| 5. |
The child plays purposely with toys: pushes cars, puts dollsto bed, feeds dolls etc.
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| 6. |
The child plays role-play with toys with other children. |
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| 7. |
The child draws faces, human beings or animals with distinctfeatures.
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| 8. |
The child cooperates in structured games with other children(ballgames, card games etc).
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| (ii) |
Vocalization or language development (age appropriate asapplicable):
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| 1. |
The child vocalizes in contact with caregiver |
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| 2. |
The child repeats different vowel-consonant combinations(ba-ba, da-da, ma-ma etc.)
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| 3. |
The child uses single words to communicate |
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| 4. |
The child speaks in sentences |
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| 5. |
The child understands prepositions as: on top of, under,behind etc.
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| 6. |
The child uses prepositions as: on top of, under, behind etc. |
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| 7. |
The child speaks in past tense |
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| 8. |
The child writes his own name |
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| 9. |
The child reads simple words |
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| 10. |
Any other observation |
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| (iii) |
Motor development (age appropriate as applicable): |
| 1. |
The child turns from back to stomach from age: _____________ |
| 2. |
The child sits without support from age: ___________________ |
| 3. |
The child crawls or moves forward from age:_________________ |
| 4. |
The child walks with support of furniture from age: ________ |
| 5. |
The child walks alone from age:__________________________ |
| 6. |
The child climbs up and down stairs with support from age:____
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| 7. |
The child climbs up and down stairs without support fromage:__
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| (iv) |
Contact with adults (age appropriate as applicable): |
| 1. |
The child smiles in contact with known caregiver |
| 2. |
The child is more easily soothed when held by known caregiver |
| 3. |
The child cries or follows known caregiver, when the caregiverleaves the room
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| 4. |
The child actively seeks known caregiver when he or she isupset or has hurt him or herself
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| 5. |
The child seeks physical contact with all adults, that comeinto the ward
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| 6. |
The child communicates his feeling in words to caregivers |
| (v) |
Contact with other children (age appropriate asapplicable):
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| 1. |
The child shows interest in other children by looking orsmiling at their activity
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| 2. |
The child enjoys playing beside other children |
| 3. |
The child engages actively in activities with other children |
| (vi) |
General Level of Activity: |
| 1. |
Active |
| 2. |
Overactive |
| 3. |
Not Very Active |
| (vii) |
General mood : |
| 1. |
Sober |
| 2. |
Emotionally indifferent |
| 3. |
Fussy, difficult to soothe |
| 4. |
Happy, contentIn case of special needs child, specify the category of thechild.
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| Overall Observation of the child: |
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Signature of theExaminee PhysicianDesignation andRegistration No.StampDate
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| E. |
Acceptance of Medical Examination Report by ProspectiveAdoptive Parent(s)
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We have read and understood the contents of theMedicalExamination Reportand are willing to accept __________ asour adoptive child.
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| (Signature of the male applicant) |
(Signature of the female applicant) |
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| (Name of the male applicant) |
(Name of the female applicant) |
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| Date: |
Date: |
| Place: |
Place: |
IV
[See regulation 29(1)(f)]Medical Test for Children Admitted into Institutions(1)Medical test for a child admitted into an institution can be broadly divided into two categories:(a)To diagnose an illness/ condition that requires specific treatment, and thus testing would help in restoring the health of the child.(b)To diagnose an illness/ condition of a nature that implies that the child will require special attention (medical and parental) beyond what a normal child needs, and therefore the family that adopts him/ her should be aware of the condition.(2)Following shall be considered while conducting the medical test:(a)The interest of the child has to be foremost.(b)If the test results warrant further testing, specific therapy or consultation with specialists, should be undertaken by the agency/ institution where the child is staying.(3)Medical Tests for different age groups:A. Newly born:(a)Preterm newborns or those newborns weighing <2000g at birth or admission should be evaluated by a specialist neonatologist or paediatrician. These babies should undergo screening for Retinopathy of prematurity.(b)Screening for hypothyroidism by thyroid function test (T4,TSH)(c)Hearing screening: Otoacoustic Emissions (OAEs) or Brain stem evoked response audiometry (BERA)(d)Screening for critical congenital heart disease: Pulse oximetryIf any of these screening tests is abnormal, further confirmatory tests and specialists' opinion should be mandatory, before labelling the child as special need.B. Infants between 1 month to 1 year of age(a)Infants should be evaluated by a pediatrician(b)Screening for hypothyroidism by thyroid function test (T4,TSH)(c)Hearing screening: Otoacoustic emission (OAE) or Brain stem evoked response audiometry (BERA)(d)Complete blood count, liver function test and renal function test (CBC, LFT and RFT)(e)HIV testing in children older than 4-6 weeks of age(f)HCV testing in children older than 3 months of ageIf any of these screening tests is abnormal, further confirmatory tests and specialists' opinion should be mandatory, before labelling the child as special need.C. Age 1-3 years and more than 3 years(a)In high risk areas (central and western states of India and tribal populations), screening for sickle cell anaemia is advised by complete blood count and either of these-haemoglobin electrophoresis or solubility testing for haemoglobin S or isoelectric focusing or high-performance liquid chromatography (HPLC).If a child is found to be a carrier/trait for beta thalassemia or sickle cell anaemia on screening, he or she is unlikely to be affected or have transfusion requirement, and hence should not be considered as special need.(b)HIV - Procedure for diagnosis in infants and children below 18 months of age:-(i)HIV serological testing is used for the diagnosis of HIV in adults and children above 18 months of age.(ii)Serological tests are not reliable and difficult to interpret in infants and children below 18 months of age because of passage of maternal HIV antibody across the placenta.(iii)In children younger than 18 months, diagnosis of HIV infection is based on: a positive virological test for HIV or its components (HIV RNA or HIV DNA or ultrasensitive [Us] HIV p24 Ag) confirmed by a second virological test performed on a separate specimen taken more than 4 weeks after birth.(iv)The WHO guidelines strongly recommend that all HIV-exposed infants have HIV virological testing at 4-6 weeks of age or at the earliest opportunity thereafter.(v)If the child is older than 9 months, an HIV serological test is recommended prior to any virological testing, and a virological test should be performed for those with a reactive HIV serological test.(vi)In the non-breastfed or never-breastfed infant, a negative serological test result at or above the age of 9 months can be used to rule out HIV infection.(vii)In infants with an initial positive virological test result, it is strongly recommended that antiretroviral therapy (ART) be started without delay and, at the same time, a second specimen collected to confirm the result.(viii)All the infants with unknown or uncertain HIV exposure being seen in health-care facilities at or around birth or at the first postnatal visit (usually 4-6 weeks), or other child health visit, have their HIV exposure status ascertained.(ix)If the infant is seen <72 hrs after the delivery and HIV exposure is identified, post-exposure prophylaxis (PEP), counseling on safe breastfeeding and an HIV virological test at 4-6 weeks is recommended.(x)For infants first seen at 4-6 weeks or the earliest thereafter and in whom HIV exposure is documented, HIV virological testing should be performed and the mother should receive safe infant-feeding counseling.(xi)A negative HIV serological test in the mother does not per se exclude HIV exposure; the possibility of very recent incident infection of the mother during this pregnancy should be kept in mind.In infants and children less than 18 months of age, a positive HIV serological test confirms HIV exposure but cannot definitively diagnose HIV. HIV serological testing can be used to exclude HIV infection.(c)HCV diagnosis in infants and children:-(i)Hepatitis C infection (HCV) is a chronic viral infection of the liver that affects 1-2% of adults and about 0.15 to 0.4% of children and adolescents.(ii)In children, the infection is mostly acquired from mothers (vertical transmission).(iii)Screening is by testing for HCV antibody in blood. The mother's HCV antibody crosses the placenta and can stay in the blood of an infant for up to 18 months. Thus the anti-HCV antibody test cannot be done to screen for HCV in infants <18 months of age.(iv)The American Academy of Pediatrics (AAP) recommends testing with antibody test after 18 months of age in high-risk children. Positive antibody test should be confirmed by HCV-PCR.(v)If the baby is born to a known HCV positive mother (or in babies in adoption homes), testing with the HCV-PCR can be done. This should be done after 3 months of age due to a high rate of temporarily positive tests in infants under 3 months of age. Two negative HCV-PCR tests separated by at least 2-3 months are needed to confirm that there is not an infection with the hepatitis C virus.
V
[See regulation 7 (3)]Deed of SurrenderCase No. .............In Re. .....................1. I/We, the undersigned......................... (Family name/First name(s)) residing at ..........................................., surrender my/our child(ren) ................................ (named) Aged............, having date of birth ..................... on our own and without any coercion, compulsion, threat, payment, consideration, compensation of any kind;
2. I/we have been counselled and informed:
(a)about the implication that I/we can withdraw our consent until 60th day of this surrender deed after which my/our consent will be irrevocable and I/we shall have no claim over the child or children.(b)have been made aware of the implications of surrender and are conscious of the fact that after the 60th day from date of the surrender deed, the legal parent-child relationship between my/our child or children and me/us will be terminated.(c)understand that my/our child may be adopted by person(s) residing in India or abroad and give my/our consent for this purpose.(d)understand that the adoption of my/our child will create a permanent parent-child relationship with the adoptive parent(s) and then cannot claim back the child.3. I/we wish/do not wish (please tick whichever is applicable) my/our identity and address to be disclosed to my/our child when he/she returns for root search.
4. I/we declare that I/We have read the above statements carefully and have fully understood the same.
Done at ................ on..............[Signature or Thumb Impression ofsurrendering person(s)]5. Declaration by Witnesses
We the undersigned have witnessed the above surrender.(a)Signature, Name and Address of the first witness......................................................................................................................................................(b)Signature, Name and Address of the second witness.....................................................................................................................................................6. Certification of child welfare committee
We hereby certify that the person and the witness(es) named or identified above appeared before me this date and signed this document in our presence.Done at ................ on..............Signature and Seal of Members/Chairperson Child Welfare Committee
VI
[See regulations 9(1), 15(3), 20(1), 40(6), 42(3), 52(1) and 53(3)]Online Registration Form and List of Documents to be uploaded
| Date of Registration: |
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| Applicant category: |
Indians living in India, theprospective adoptive parents will have to register themselves.In case of overseascitizen of India or a foreign national habitually residing inIndia, the prospective adoptive parents have to registerthemselves.In cases ofnon-resident Indian, overseas citizen of India or a foreignprospective adoptive parents habitually residing in a foreigncountry, registration shall be done by Authorized ForeignAdoption Agency (AFAA) or Central Authority (CA) or ForeignGovernment department concerned in the country of residence.In case of non-Hague countries, Indian missionabroad can process the applications of non-resident Indianprospective adoptive parents.
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| Applicant status: |
Single-unmarried/ widow/ widower/divorcee/ legally separatedorMarried couple(Date of marriage, place of marriage)
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| Personal Information: |
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Male |
Female |
| Name |
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| Date of Birth |
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| Nationality by Birth |
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| Current Nationality/ Citizenship |
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| Current residential address |
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| City/ District |
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| State |
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| Country |
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| Zip/Pin code |
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| Phone no. |
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| Mobile no. |
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| Email |
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| Occupation Details |
| Nature of occupation |
Govt. Job/ private job/ public sector job/ Business/Non-profit Organisation/ consultant/ professional/ Others/ NotWorking
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| Place of Work |
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| Annual Income |
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| No. of Biological/ Adopted Children |
Total ( ) |
| Identification Details (as applicable): |
| PAN Number |
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| Aadhar Card Number |
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| Overseas Citizens of India Card Number |
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| Passport Number |
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| Preference for Adoption: |
| Gender |
Boy/ Girl/ No Choice |
| Child Category |
Sibling/ Single |
| Health Status |
Normal/ Physically Challenged/ Mentally Challenged |
| Age |
0-2 years/2-4 years/4-6 years/6-8 years/8-10 years/10-12years/ 12-14 years/14- 18 years
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| Preference for State: |
| Name of the Agency for Home Study Report |
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| Address of the Agency |
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| Motivation for Adoption(Max 200 characters) |
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In case of Resident Indians, Overseas Citizensof India/ Foreign prospective adoptive parents residing inIndia, the prospective adoptive parents shall have to registerthemselves with all relevant documents.
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Documents to be uploaded at the time ofregistration
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| 1. |
In-country Adoption (Indians residing inIndia)
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| (1) |
Current family photograph/ Photograph of personadopting a child
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| (2) |
PAN Card of the prospective adoptive parents |
| (3) |
Birth certificate/ Proof date of birth of theparents (In case of married couple, upload Birth Certificate ofboth the applicants)
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| (4) |
Proof of residence (Aadhar card/ voter card/passport/current electricity bill/ telephone bill)
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| (5) |
Proof of income of last year (salary slip/income certificate issued by Govt. Department/ income taxreturn)
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| (6) |
Certificate from a medical practitionercertifying that the prospective adoptive parents do not sufferfrom any chronic, contagious or fatal disease and they are fitto adopt (In case of married couple, upload Medical Certificateof both the applicants)
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| (7) |
Marriage certificate/ Divorce Decree/Declaration from the competent court or affidavit on oathpertaining to divorce in case of divorce governed by personallaw where decree of divorce is not mandatory/ Death certificateof spouse whichever is applicable.
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In case of NRI/Overseas Citizens of India/ Foreign prospective adoptive parentsresiding abroad, registration will be done by the concernedauthority, i.e. Authorized Foreign Adoption Agency (AFAA) orCentral Authority (CA) or Government department or IndianMission (in cases of Indian citizens) only after completion ofHome Study Report.This is also applicable in case of OverseasCitizen of India or foreign prospective adoptive parentsresiding in India
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2. |
Inter-country Adoption in cases of NRI/Overseas Citizens of India and Foreign prospective adoptiveparents
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| (1) |
Photograph of the applicant(s) |
| (2) |
Home Study Report of Overseas Citizens of Indiaand foreign prospective adoptive parents residing in India to beuploaded later after registration)
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| (3) |
Passport (Male prospective adoptive parent) |
| (4) |
Passport (Female prospective adoptive parent) |
| (5) |
Overseas Citizen of India card of theprospective adoptive parents (if applicable)
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| (6) |
Birth Certificate (Male prospective adoptiveparent)
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| (7) |
Birth Certificate (Female prospective adoptiveparent)
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| (8) |
Proof of Residence |
| (9) |
Proof of income of last year (e.g. salaryslip/income certificate issued by Government department/ Incometax return)
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| (10) |
Certificate from a medical practitionercertifying that the prospective adoptive parents do not sufferfrom any chronic, contagious or fatal decease and they are fitto adopt.
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| (11) |
Police Clearance certifying the antecedents ofmale prospective adoptive parent.
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| (12) |
Police Clearance certifying the antecedents offemale prospective adoptive parent.
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| (13) |
Marriage Certificate (in case of couple) |
| (14) |
Copy of divorce decree/ Declaration from thecompetent court or affidavit on oath pertaining to divorce incase of divorce governed by personal law where decree of divorceis not mandatory/ death certificate of the spouse (ifapplicable).
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| (15) |
Undertaking from the relative in case of singlePAP (if applicable).
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| (16) |
In case of Overseas Citizens of India/ Foreignprospective adoptive parents living in India, a copy of NoObjection Certificate from their Embassy/ High Commission foradoption and assurance for post adoption follow up in case theprospective adoptive parents relocate from India (ifapplicable).
|
| (17) |
1st Reference Letter from a respected member ofthe society known to the PAPs.
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| (18) |
2nd Reference Letter from a respected member ofthe society known to the PAPs.
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Other documents to be uploaded after referral |
| (19) |
Consent of the older child/children in thefamily (more than five years of age)
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| (20) |
Consent of the older child to be adopted |
| (21) |
Permission of the receiving country as perArticle 5 or 17 of the Hague Adoption Convention (applicable incase of Hague ratified country).
|
| (22) |
In case of prospective adoptive parentsresiding abroad, undertaking from the prospective adoptiveparents to allow personal visits by the representative of theAuthorized Foreign Adoption Agency (AFAA) or CA (CentralAuthority) or concerned Government department or Indian Mission,as the case may be, for follow-up of the progress of the childas required under the Adoption Regulations.
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| (23) |
In case of Overseas Citizen of India/foreignprospective adoptive parents living in India, undertaking fromthe concerned Specialized Adoption Agency to provide postadoption follow-up.
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| (24) |
In case of Overseas Citizen of India/foreignprospective adoptive parents living in India, undertaking toallow personal visits of the representative of the SpecializedAdoption Agency or District Child Protection Unit or StateAdoption Resource Agency at least for a period of two years fromthe date of adoption.
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| (25) |
Undertaking from the Authorized ForeignAdoption Agency to provide progress report of the child for aperiod of two years and make alternate arrangement in case ofdisruption.
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In case of NRI and Overseas Citizen of Indiaprospective adoptive parents residing abroad, registration willbe done by the concerned authority, i.e. Authorized ForeignAdoption Agency (AFAA) or Central Authority (CA) or Governmentdepartment or Indian Mission (in cases of Indian citizens) forthe purpose of relative adoption only after completion of HomeStudy Report.
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3. |
Inter-country Relative Adoption |
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At the time of registration, all requisitedocuments to be uploaded in Child Adoption Resource Informationand Guidance System as stated above in cases of inter-countryAdoption[(1)-(15)].
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Other documents to be uploaded after referral |
| (1) |
Consent of the older child/children in thebiological family (more than five years).
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| (2) |
Consent of the older child to be adopted. |
| (3) |
Permission of the receiving country as perArticle 5 or 17 of the Hague Adoption Convention (applicable incase of Hague ratified country).
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| (4) |
Relationship of the prospective adoptiveparents to the relative child (family tree)
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| (5) |
Recent family photographs of the child,adoptive parents and biological parents.
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| (6) |
Consent of the biological family as provided inSchedule XIX. |
| (7) |
Permission from the Child Welfare Committee tothe legal guardian to surrender the child in adoption with therelative as provided inSchedule XXII(if applicable).
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| (8) |
Family background report by District ChildProtection Unit as provided inSchedule XXI.
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In case of In-country Relative Adoption, theprospective adoptive parents have to register for such adoptionsin Child Adoption Resource Information and Guidance System andhandover relevant documents to District Child Protection Unit toupload in Child Adoption Resource Information and GuidanceSystem
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4. |
Documents to be uploaded in any case ofIn-country Relative Adoption
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| (1) |
Proof of residence of the prospective adoptiveparents.
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| (2) |
Consent of the older child of the prospectiveadoptive parents for such adoption (required only in case thechild is more than 5 years.)
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| (3) |
Consent of the biological parents (as providedinSchedule XIXof the Adoption Regulations)
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| (4) |
Permission from the Child Welfare Committee tothe legal guardian to surrender the child in adoption with therelative as provided inSchedule XXII(if applicable).
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| (5) |
Affidavit by prospective adoptive parents insupport of their relationship, financial and social status asprovided inSchedule XXIVof the Adoption Regulations.
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| (6) |
Adoption order from court. |
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In case of Adoption of child/ children bystep-parent, the biological and step parents have to register inChild Adoption Resource Information and Guidance System andprovide relevant documents by uploading the same online throughCARINGS.
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5. |
Documents to be uploaded in case of Adoptionof child/ children by step-parent
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| (1) |
Proof of residence of the biological parent andspouse adopting the child/ children along with the proof of thembeing legally wedded.
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| (2) |
Consent of the biological parent(s), spouseadopting the child/ children as provided inSchedule XXof the Adoption Regulations.
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| (3) |
Documents as required to be attached withSchedule XXof the Adoption Regulations, in caseapplicable.
|
| (4) |
Adoption order from court. |
VII
[See regulations 2(11), 9 (10) and 20 (2)]Home Study Report of Resident Indian Parent/ Overseas Citizen of India/ Foreigner Living in IndiaMR. _______________________________MS. _______________________________Adoption of orphan/ abandoned/ surrendered children can be processed by following procedures as laid down in Adoption Regulations. All prospective adoptive parents are required to register in Child Adoption Resource Information and Guidance System (CARINGS) and adopt from authorized institutions.
| Carings Registration No. |
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| Date of Registration |
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| Pan Card No. |
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| Aadhar Card No, If Available |
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| Passport No, If Applicable |
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| Name of the Social Worker |
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| Date of Home Visit |
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1. What is your motivation behind adopting a child
________________________________________________________________________________________________________________________________________________________________________________________________________________________2. Will you be able to support an older child, a child with an addressable medical condition or a child with special need?
Yes/ No3. Have you met any adoptive families or children who were adopted - if yes, how was your experience and response
________________________________________________________________________________________________________________________________________________4. Are there any areas where you may need counseling or professional help in supporting the child you wish to adopt - please provide complete details?
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________5. Please describe how the prospective adoption would affect other members residing with you and their support to the child.
B. Family background information:
| Particulars |
Male Applicant |
Female Applicant |
| Name (underline Family name) |
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| Date of birth |
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| Place of birth |
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| Citizenship |
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| Address |
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| Email ID |
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| Contact Phone No. and Mobile No. |
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| Religion |
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| Language(s) spoken at home |
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| Date of Marriage |
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| Date of Earlier Marriage (if any) |
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| Date of divorce (if any) |
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| Educational Qualification |
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| Employment/ Occupation |
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| Name and Address of the present Employer/ Business concern |
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| Annual Income |
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| Health Status |
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Photograph of theprospective adoptiveparents
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| Details about Parents of the Applicants |
Male Applicant |
Female Applicant |
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Father |
Mother |
Father |
Mother |
| Name in full |
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| Age |
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| Nationality/ Citizenship |
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| Occupation |
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| Previous occupation |
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Presently residing with prospective adoptive parent (IndicateYes/ No)
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| Name of the Child |
Sex |
Date of Birth |
Educational Status |
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| Name |
Nature of Relationship |
Age |
Gender |
Occupation |
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| Male Applicant |
| Organization |
EmployerDetails(Name and Address)
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Job Title |
From To |
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| Female Applicant |
| Organization |
EmployerDetails(Name and Address)
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Job Title |
From To |
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1. Factual Assessment:
(i)Have you verified the contents of the facts mentioned in Part I of the template? Yes/ No(ii)Are you satisfied about the facts mentioned in the documents vis-à-vis observation during interviews and visits? Yes/ No2. Psycho-social Assessment:
2.1Interaction with the prospective adoptive parents(i)Have you interacted with the prospective adoptive parents individually and/or jointly?(ii)Are the prospective adoptive parent(s) well prepared for adoption? In case of single prospective adoptive parent, please mention about family support system.(iii)Do you think that prospective adoptive parents have expressed their genuine feeling for parenting?2.2Home visit findings:(i)When did you visit the home of the prospective adoptive parents? Who were the members present during your visit?(ii)Whom did you interact during the home visit?(iii)Have you met any neighbour/relative? Give a detailed description about the interaction?(iv)Whether the home environment is conducive for the child? If no, what steps can be taken to improve the situation? Have you advised the prospective adoptive parents?(v)Are the prospective adoptive parent(s) well prepared for adoption?(vi)Do you think that prospective adoptive parent(s) have expressed their genuineness during the interaction?(vii)Did the prospective adoptive parent(s) have any doubt about parenting issues or any other issues? Have you cleared their doubts?2.3Interaction with the family members:(i)Have you interacted with other family members of the prospective adoptive parents? What is their opinion about the proposed adoption? Are they positive about the adoption?(ii)Are there any other family member(s) whom you could not interact but they might have a larger role in the proposed adoption? If so, how did you do their assessment? Did you take their views subsequently?(iii)Have you interacted with older child(ren) present in the home of the prospective adoptive parents? If yes, please give details.(iv)Have you noticed any adverse remarks from the family members? If so, how far those remarks may have an impact on the adoption process?2.4Financial capacity:(i)What is your opinion about the financial status of the prospective adoptive parent(s)? Are they financially sound to welcome another member into their family?(ii)Have you observed any financial situation which is not disclosed in Part-I?2.5Physical and emotional capacity:(i)Are the prospective adoptive parents(s) in a good physical and emotional state to take care of a child?(ii)Have you observed any physical or psychological issues with the prospective adoptive parent(s) or any other family member that is going to affect the life of the upcoming child? If so, give details.(iii)Provide details of number of rooms in the house and if there is adequate space for the child to be supported.(iv)Are the prospective adoptive parent(s) emotionally equipped enough to take care of a child?3. Recommendation for adoption.
3.1Do you recommend the prospective adoptive parent(s) for adoption? Put your views and rationale for recommending the prospective adoptive parents for adoption including the parent(s) suitability. (Attach additional sheets, if required)3.2In case you do not recommend the prospective adoptive parents for adoption, appropriate reasons for taking such decision must be given in detail.Signature, name, designation of Social Worker
VIII
[See regulations 11(1) and 16(2)]Pre-Adoption Foster Care Undertaking(In the Form of an Affidavit)We, Mr. ______________, aged ____ years, citizen of ______________ and Mrs. ____________ aged ________ years, citizen of ______________, permanently residing at __________________ present address being _____________________ proposed Adopters of child _____________ (new full name) @ ___________ (old name) born on _________ presently in the care of ___________________________ (name and address of the Specialized Adoption Agency), do solemnly hereby declare as follows:(1)We are taking the above mentioned child in pre-adoption foster care, pending the adoption order by the Court concerned.(2)We understand that until the final adoption order from the Court concerned is received, the said child shall be under the authority and guardianship of _________________________ (name of Specialized Adoption Agency) and we shall only remain the foster parents of the child.(3)The child placed with us will be given all necessary education, medical care, attention, nutrition and treatment required.(4)In case of any untoward incident with the child, we will report the same to the Specialized Adoption Agency immediately.(5)The institution will be kept informed about the development of the child once a month till the final court order is issued.(6)We shall attend to the legal formalities and court hearing when called upon to do to.(7)We undertake to bring-up the child/children as our own.(8)We shall allow the authorized social worker/functionary of the Specialized Adoption Agency/District Child Protection Unit/State Adoption Resource Agency to visit our home for undertaking post-adoption follow up to ascertain the progress and well-being of the child/children in our family.(9)We further undertake to inform any change of place of our residence (other than as stated in this application), to the Specialized Adoption Agency, District Child Protection Unit and the State Adoption Resource Agency concerned for the purpose of post adoption follow-up.
| Mr. __________________ |
Mrs. _____________ |
| Prospective Adoptive Father |
Prospective Adoptive Mother |
| Date: ____________ |
|
| Witness: |
|
| Name: |
Name: |
| Signature: |
Signature: |
| Address: |
Address: |
IX
[See regulations 12(1), 15(14) and 55(1)]List of (Attested/ Notarised) DocumentsTo be filed along with the Adoption Petition in the Court1. In-country Adoption
To be obtained from the Prospective adoptive parents(PAPs) by the Specialized Adoption Agency(1)Current family photograph/ photograph of the couple or person adopting a child(2)PAN Card of the prospective adoptive parents(3)Birth certificate/Proof of date of birth of the prospective adoptive parents(4)Proof of residence (aadhar card/ voter card/ passport/current electricity bill/telephone bill)(5)Proof of income of last year (salary slip/income certificate issued by Govt. department/income tax return)(6)Certificate from a medical practitioner certifying that the prospective adoptive parents do not suffer from any chronic, contagious or fatal disease and they are fit to adopt (In case of married couple, upload Medical Certificate of both the applicants)(8)Divorce Decree/ Declaration from the competent court or affidavit on oath pertaining to divorce in case of divorce governed by personal law where decree of divorce is not mandatory/Death certificate of spouse in case of single prospective adoptive parent (if applicable).(9)Two reference letters from acquaintances or relatives in support of adoption.(10)Consent of the older child/children in the adoptive family (if more than 5 years)To be arranged by the Specialized Adoption Agency(11)Child Study Report signed by the prospective adoptive parents along with recent photograph of the child.(12)Medical Examination Report of the child signed by the prospective adoptive parents.(13)Certificate of Child Welfare Committee declaring the child 'legally free for adoption'.(14)Home Study Report of the prospective adoptive parents along with their recent family photograph.(15)Recognition certificate of the agency as Specialized Adoption Agency.(16)Consent of the older child/children to be adopted.(17)Decision of the Adoption Committee (only in case of In-country adoption).(18)Affidavit by the Chief Functionary of the Specialized Adoption Agency to Court in support of adoption of child.(19)Pre-adoption foster care affidavit.2. Adoption by NRI/ Overseas Citizen of India/Foreign prospective adoptive parents residing in a foreign country
To be provided by the Authorized Foreign Adoption Agency(AFAA) or Central Authority(CA) or Government department or Indian Mission abroad to the Specialized Adoption Agency(1)Photograph of the applicant(s)(3)Passport (Male prospective adoptive parent)(4)Passport (Female prospective adoptive parent)(5)Overseas Citizen of India card of the prospective adoptive parents (if applicable)(6)Birth certificate/Proof of date of birth of the prospective adoptive parents(8)Proof of income of last year (e.g. salary slip/income certificate issued by Government department /Income tax return)(9)Certificate from a medical practitioner certifying that the prospective adoptive parents do not suffer from any chronic, contagious or fatal decease and they are fit to adopt.(10)Police Clearance Certificate (Male prospective adoptive parent)(11)Police Clearance Certificate (Female prospective adoptive parent)(12)Marriage Certificate (in case of couple)(13)Two reference letters from acquaintances or relatives in support of adoption.(14)Divorce Decree/Declaration from the competent court or affidavit on oath pertaining to divorce in case of divorce governed by personal law where decree of divorce is not mandatory/Death certificate of spouse in case of single prospective adoptive parent (if applicable).(15)Consent of the older child/children in the adoptive family (if more than 5 years)(16)Authorization Certificate of Authorized Foreign Adoption Agency (not required in case of Central Authority or Government department or Indian Mission)(17)Undertaking from the Authorized Foreign Adoption Agency concerned for furnishing post adoption follow-up report and for necessary action in case of disruption (not required in case of CA or Government department or Indian Mission)(18)Permission of the receiving country as per Article 5/17 of the Hague Adoption Convention.(19)Undertaking for permitting home visit to the social worker during post-adoption follow-up.(20)Power of Attorney from the prospective adoptive parents in favour of the authorized functionary of the Specialized Adoption Agency to file the adoption application on their behalf in the court.To be arranged by the Specialized Adoption Agency(21)Child Study Report signed by the prospective adoptive parents along with recent photograph of the child.(22)Medical Examination Report of the child signed by the prospective adoptive parents.(23)Certificate of Child Welfare Committee declaring the child 'legally free for adoption'.(24)Recognition certificate of the agency as Specialized Adoption Agency(25)Consent of the older child/children to be adopted(26)Affidavit by the Chief Functionary of the Specialized Adoption Agency to Court in support of adoption of child.(27)Pre-adoption foster care affidavit (wherever required)(28)NOC issued by CARA in favour of adoption of a child by a Non-Resident Indian/Overseas Citizen of India/ Foreign prospective adoptive parents. In case of Overseas Citizen of India/Foreign prospective adoptive parents living in India, a copy of No Objection Certificate from their Embassy/ High Commission for the proposed adoption.3. Inter-country Relative Adoption. - As indicated in Schedule VI of the Adoption Regulations, the prospective adoptive parents shall file the adoption application in the court concerned of the district through their power of attorney, where the child resides with biological parents or guardians.
4. In-country Relative Adoption. - As indicated in Schedule VI of the Adoption Regulations, the prospective adoptive parents shall file the adoption application in the court concerned of the district where the child resides with biological parents or guardians.
Note: Only the above mentioned list of certificates/documents as applicable are required to be filed. Infertility certificate is NOT required in any case of adoption.
X
[See regulation 16(1)]Central Adoption Resource Authority(A Statutory Body of Ministry of Women and Child Development)
| Certificate Number: |
Date: |
|
Photograph of the child and theprospective adoptiveparents
|
| Sl. No. |
Name of the Child |
Sex of Child |
Date of Birth |
Name and Address of the Prospective AdoptiveParent(s)
|
| (i) |
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|
|
2. This NOC is issued as per Adoption Regulations, 2017 and Article 17 (c) of the Hague Convention on the Protection of Children and Cooperation in respect of inter-country Adoption, 1993.
3. The Specialized Adoption Agency and the Foreign Adoption Agency/Central Authority/concerned Foreign Government department/Indian Diplomatic Mission have been authorized to process this adoption case.
4. The Specialized Adoption Agency shall file the adoption application in the competent court.
Signature and Seal ofAuthorized SignatoryTo:(1)Name and address of the Specialized Adoption Agency.(2)Name and address of the State Adoption Resource Agency/ concerned State Government department.(3)Name and address of Authorized Foreign Adoption Agency (AFAA)/concerned Foreign Government department/ Indian Diplomatic Mission.(4)Diplomatic Mission of the Receiving Country in India.(5)Central Authority of the Receiving Country.(6)Foreigners' Regional Registration Officer (FRRO).
XI
[See regulation 18(1)]Central Adoption Resource Authority
| Certificate Number: |
Date: |
|
Photograph of the child and theprospective adoptiveparents
|
1. The undersigned authority:
(Name and address of the competent authority of the State of adoption)........................................................................................................................2. Hereby certifies that the child:
Family name: ................................First name(s): ...............................Sex: Male [ ] Female [ ]Date of birth: day ....month ....year ... .Place of birth: ...............................Habitual residence: .............................3. Was adopted according to the decision of the following authority:
....................................... .Date of the decision: .............................Date at which the decision became final: ...................(If the adoption was made otherwise than by a decision of an authority, please specify the equivalent details)4. By the following person(s):
(a)Family name of the adoptive father: ................... .First name(s): ............................. .Date of birth: day ....month ....year ... .Place of birth: ............................. .Habitual residence at the time of the adoption: ............. .(b)Family name of the adoptive mother: ................... .First name(s): ............................. .Date of birth: day ....month ....year ... .Place of birth: ............................. .Habitual residence at the time of the adoption: ............. .5. The undersigned authority certifies that the adoption was made in accordance with the Convention and that the agreements under Article 17, sub-paragraph c, were given by:
(a)Name and address of the Central Authority of the State of origin:...............................................................................................................Date of the agreement: .........................(b)Name and address of the Central Authority of the receiving State:...............................................................................................................Date of the agreement: .........................6. The adoption had the effect of terminating the pre-existing legal parent-child relationship.
Done at ............, on ..........Signature and Seal ofAuthorized SignatoryTo:(1)Name and address of the Specialized Adoption Agency.(2)Name and address of the State Adoption Resource Agency/State Government concerned department.(3)Name and address of Authorized Foreign Adoption Agency (AFAA)/concerned Foreign Government department/ Indian Diplomatic Mission.(4)Diplomatic Mission of the Receiving Country in India.(5)Central Authority of the Receiving Country.(6)Foreigners' Regional Registration Officer (FRRO).
XII
[See regulations 13(1), 19(1) and 20(5)]Post-Placement Report of the Child
| Photograph of the childwith family |
1. Identifying Information:
(a)Child's Name(initial and given. if any) :(c)Child's date of birth:2. Contact Details of the Adoptive Parents:
3. Child's Adjustment:
(a)Current height and weight(b)Results of physical examinations or doctor visits(c)Eating and sleeping habits(d)Emotional, physical and social development(e)Attachment to family members(f)Child's enrolment in school (if applicable)(g)Language(s) spoken (if applicable)4. Adjustment between Adoptive Family and the Child:
5. Significant Changes in Family Structure or Dynamics, if any:
(Change of residence, employment, work responsibilities, illness, etc.)6. Observations and Recommendations of Social Worker
(Signature)Social Worker's Name:Agency Name and Date________________________________Note: Online updating of post-placement report is mandatory
XIII
[See regulations 24(1)(f) and 26(4)(h)]Standards of Child Care in Specialized Adoption Agencies1. The agencies are required to ensure that the following facilities are provided to the children in the institution:
(a)Physical facilities:(i)Physical surroundings in which the children are cared for must be clean. Sanitation and hygiene maintained at the agency must be adequate since a majority of children at the institution are small and suffer from numerous ailments. Children below the age of 1 year should be in a room with an attached bathing room and milk room. Children between the age of 1 - 3 years should be kept in a room with an attached bathing and bathroom. The older children need to be separated into two boy's room and girls room. Each room must have attached baths, and toilets.(ii)There should be a separate washing area and a large kitchen and dining hall for the older children. Good lighting, ventilation and adequate space must be mandatory.(iii)The home should be neat, clean, particularly bathrooms, toilets and kitchen. Walls and surroundings must be bright and stimulating. For visual stimulation the rooms should be well painted and decorated with toys, animal cut outs, etc(b)Medical facilities: Regular medical inspection must be done. Preferably every alternate day by a registered medical practitioner. The child specialist is best trained to diagnose and treat children who are at risk and highly vulnerable.(i)Infants and children on admission to institutions should be in quarantine and observation for a week at least.(ii)Weight, height and head circumference may be noted along with any other details available on the child at admission.(iii)A medical record should be maintained and a doctor must assess the child as soon as possible, preferably within 24 hours of his or her admission.(iv)Each child below the age of six months should be photographed every month, from six months to 3 years every three months and thereafter, every six months.(v)Immunization should be regularly given and monitored.(vi)Emergency kits should be available at all times in the Home and there should be a doctor on call.(vii)General health measures viz hygiene, dental, skin care and diet to be supervised.(viii)Stimulation is very important for the proper development of the child. This could be achieved by increasing awareness amongst the nurses, helpers by introducing simple stimulation techniques in the daily routine. It is also advised to have a physiotherapist visit the children on a regular basis.(c)Staff:(i)The agency must have adequate staff for child care, preferably in the ratio of 4:1 for children below 1 year, 5:1 for children in the age group 1 to 3 years and 8:1 for older children.(ii)Adoption Homes need personnel who are sensitized to the issues of the children. They need to be "educated" in caring for the children. It is recommended to conduct workshops for nurses, helpers, care takers and other staff to enable them to recognize the special status of these children who are under their care.(iii)As committed staff is an integral part of good child care, the motivational levels of the staff should be kept high.(iv)Staff to be immunized as well.(d)Clothing: It is important that the children in a home are dressed in clean, comfortable and well-kept clothes at all times, not just during the visit of the adoptive parents.(e)Food: The food in the institution should be hygienically cooked, nourishing and tasty. The menu should be varied. The need of children on a special diet should be attended to. This will help overcome the problems of malnutrition faced by children entering a home. Feeding charts with indication of the formulas may be displayed and followed.(f)Education: The Specialized Adoption Agency should be able to provide informal education through a qualified teacher, and a special educator, or tie up with a school that will take the child or children on a temporary basis.Note: All adoption agencies shall adhere to the standards of child care prescribed under the Juvenile Justice (Care and Protection of Children) Model Rules, 2016.2. While providing child care, the following issues are important:
(a)A child's neurological growth is complete within the first few years of his or her early childhood and determines the brain's capabilities throughout the rest of his or her life. Moreover, a child needs to have experienced positive attachment by the age of 3 in order to develop cognitively, physically, socially, and psychologically. Hence, every effort shall be made by the Specialized Adoption Agency to expeditiously find alternate family for such children so that they develop attachment and proper bonding experiences during infancy itself.(b)It is very essential to talk, hug, hold, play, tell stories and sing to the child to give it a sense of security. Though this should be done regularly by the staff, it is also advisable to encourage volunteers to take up this activity.(c)Quality child care (early childhood care) means providing adequate health care, immunization, feeding and nutrition, creating a safe environment so that infants and young children can play and socialize with their peers, promoting school readiness and preparing children for primary school and focusing on total development during early years of childhood.(d)It should be ensured that there is no instance of child abuse and neglect while the child is in the institution.
XIV
[See regulation 43]Timeline for Authorities Concerned and AgenciesA. Timeline for the processes relating to children:
| Sl. No. |
Regulation |
Action |
Time |
| 1. |
6(2) |
Specialized Adoption Agency to produce anabandoned child before the Child Welfare Committee along with areport containing his photograph and particulars.
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Within 24 hours (excluding journey period). |
| 2. |
6(5) & 7(10) |
Specialized Adoption Agency to enter the detailsof the child along with his photograph online in the ChildAdoption Resource Information and Guidance System.
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Within three working days from the time ofreceiving the child.
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| 3. |
6(6) |
District Child Protection Unit to advertise theparticulars and photograph of an abandoned child in a state levelnewspaper having wide circulation and local cable networks,wherever existing.
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Within three working days from the time ofreceiving the child.
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| 4. |
6(9) |
District Child Protection Unit to submit areport to the Child Welfare Committee on the efforts made by itfor tracing out the biological parents/ legal guardian of anabandoned child, including the outcome of the particulars andphotograph of the child in the newspapers.
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Within 30 days from the date of production ofthe child before the Child Welfare Committee for the same.
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| 5. |
6(10) |
Specialized Adoption Agency to submit a reportto the Child Welfare Committee regarding the efforts made by itto trace the biological parent(s) or legal guardian of theabandoned child.
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Immediately after 30 days from the date ofproduction of the child before the Child Welfare Committee.
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| 6. |
7(17) |
The reconsideration period/reclaiming of thesurrendered child by the biological parent/legal guardian.
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60 days of the date of surrender. |
| 7. |
7(18) |
Specialized Adoption Agency to upload the ChildStudy Report and Medical Examination Report along with latestphotograph of the child.
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Within ten days from the date of declaration ofthe child as legally free for adoption by Child WelfareCommittee.
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| 8. |
8(a) |
A normal child up to 05 years of age to beavailable for adoption by a Resident Indian (RI) and NRIprospective adoptive parents.
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For 60 days from the date the child is declaredlegally free for adoption by the Child Welfare Committee.
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| 9. |
8(b) |
An older child above 5 years of age and siblingsto be available for inter-country adoption.
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After 30 days from the date the child isdeclared legally free for adoption by the Child WelfareCommittee.
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| 10. |
8(c) |
A mentally and physically challenged child to beavailable for inter-country adoption.
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After 15 days from the date the child isdeclared legally free for adoption by the Child WelfareCommittee.
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| Sl. No. |
Regulation |
Action |
Time |
| 1. |
9(5) |
The prospective adoptive parents should uploaddocuments after their registration.
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Within a stipulated period of thirty days. |
| 2. |
9(10) |
Home Study Report of the prospective adoptiveparents to be completed by the social worker.
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Within 30 days from the date of submission ofrequired documents in Child Adoption Resource Information andGuidance System.
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| 3. |
10(3) |
Prospective adoptive parents to reserve onechild
|
Within 48 hours from the date and time ofreferral.
|
| 4. |
10(6) & 10(7) |
Process of matching of the reserved child by theSpecialized Adoption Agency and acceptance by prospectiveadoptive parents
|
Within 20 days from the date of reserving thechild.
|
| 5. |
12(1) |
Specialized Adoption Agency to file applicationin the Court for obtaining adoption order from the Court
|
Within ten working days from the date ofmatching of the child by the prospective adoptive parents.
|
| 6. |
12(6) |
Disposal of the adoption petition by the Court |
Within two months from the date of filing of thepetition.
|
| 7. |
12(8) |
Specialized Adoption Agency to obtain acertified copy of the adoption order from the Court, to forwardthe same to the prospective adoptive parents and also to post thesame in the Child Adoption Resource Information and GuidanceSystem.
|
Within ten days from the date of adoption order. |
| 8. |
12(10) |
Specialized Adoption Agency shall apply for thebirth certificate and obtain the birth certificate of the childfrom the issuing authority.
|
Specialized Adoption Agency shall apply within 3days from the date of issuance of the adoption order and it shallbe issued by the authority within five days.
|
| Sl. No. |
Regulation |
Action |
Time |
| 1. |
15(7) |
Reservation of one child by the prospectiveadoptive parents from Child Adoption Resource Information andGuidance System through the Authorized Foreign Adoption Agency/Central Authority/ Government department/ Indian Mission
|
Within 96 hours |
| 2. |
15(10) |
Acceptance of the child by the prospectiveadoptive parents
|
Within 30 days |
| 3. |
16(1) |
No Objection Certificate by CARA |
Within ten days from the date of receipt ofrequisite documents including acceptance of the child by theprospective adoptive parents and approval of the CentralAuthority (CA).
|
| 4. |
12(1) & 17(1) |
Specialized Adoption Agency to file adoptionpetition in the Court
|
Within ten days from the date of receipt of NoObjection Certificate from Central Adoption Resource Authority
|
| 5. |
12(6) |
Disposal of the adoption petition by the Court |
Within two months from the date of filing of thepetition.
|
| 6. |
12(8) |
Specialized Adoption Agency to obtain acertified copy of the adoption order from the Court, to forwardthe same to the prospective adoptive parents and also to post thesame in the Child Adoption Resource Information and GuidanceSystem.
|
Within ten days from the date of adoption order. |
| 7. |
18(1) |
CARA shall issue conformity certificate underArticle 23 of the Hague Adoption Convention.
|
Within three working days from the date ofavailability of adoption order.
|
| 8. |
18(3) |
Specialized Adoption Agency to submitapplication to the Regional Passport Officer (RPO) for thepassport to the child.
|
Within three working days from the date ofavailability of adoption order.
|
| 9. |
18(4) |
Regional Passport Officer to issue the passportto the child
|
Within ten days from the date of receipt ofapplication for the same.
|
| 10. |
18(5) |
The Specialized Adoption Agency shall approachthe birth certificate issuing authority for birth certificate ofthe adopted child
|
Within a period of three days of obtaining ofthe certified copy of the adoption order.
|
XV
[See regulation 47]Format for Quarterly Reporting of Adoption DataBy Specialized Adoption Agency (SAA)Financial Year: ____________
| Name of the Specialized Adoption Agency |
: |
| Address |
: |
| Landline |
: |
| Mobile |
: |
| Fax |
: |
| Email |
: |
| Part I |
No of children placed in In-country Adoption(pre-adoption foster care)*
|
In-country Adoptions finalized by the Court # |
| Male |
Female |
Total |
Male |
Female |
Total |
| 1st Quarter(April- June) |
|
|
|
|
|
|
| 2nd Quarter(July - Sept) |
|
|
|
|
|
|
| 3rd Quarter(Oct - Dec) |
|
|
|
|
|
|
| 4th Quarter(Jan - March) |
|
|
|
|
|
|
| Total |
|
|
|
|
|
|
| Part II |
Pre-Adoption Foster Care in case of inter-countryAdoption*
|
Inter-country Adoptions finalized by the Court # |
| Male |
Female |
Total |
Male |
Female |
Total |
| 1st Quarter(April- June) |
|
|
|
|
|
|
| 2nd Quarter(July - Sept) |
|
|
|
|
|
|
| 3rd Quarter(Oct - Dec) |
|
|
|
|
|
|
| 4th Quarter(Jan - March) |
|
|
|
|
|
|
| Total |
|
|
|
|
|
|
XVI
[See regulation 34 (12)]Monthly Report of the Child Welfare Committee (CWC)To the State Adoption Resource AgencyAnd Central Adoption Resource AuthorityName of the District: ______________________________, State __________________Reporting Month________________, Year _________ Date of Report:Part-A: Information about children declared legally free for adoption and number of cases pending for decision.
| Child Category |
No. of cases pending from previous month |
No of new cases produced during the current month |
Total number of children declared legally freefor adoption during the month
|
Break-up of pendency before CWC |
| Children below 2 yrs of age |
Children above 2 yrs of age |
| M |
F |
M |
F |
M |
F |
Pending for > 2 months |
Pending for > 4 months |
Pending for > 4 months |
Pending for > 6 Months |
| 1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
11 |
| Orphan |
|
|
|
|
|
|
|
|
|
|
| Abandoned |
|
|
|
|
|
|
|
|
|
|
| Surrendered |
|
|
|
|
|
|
|
|
|
|
| Any other (specify) |
|
|
|
|
|
|
|
|
|
|
| Total |
|
|
|
|
|
|
|
|
|
|
| Sl. No. |
Name of the Child |
Date of Birth |
Gender |
Date of production before CWC and case no |
Name and address of the Child Care Institution(CCI)/ Specialized Adoption Agency (SAA) which produced the child
|
Category (orphan/ abandoned/ surrendered) |
Date of receipt of application in CWC from CCI/SAA for declaring the child legally free for adoption
|
Date on which declared legally free for adoption |
Reasons for pending, if not cleared |
XVII
[See regulation 34(12)]Format for Reporting of Adoption CasesPart-I: Information regarding Adoption Cases in Child Adoption Resource Information and Guidance System (CARINGS) during the Month____________, Year ______Name of the Court ____________________________, District ________________, State ___________
| Sl. No. |
No. of In-country relative adoptions undersection 56(2) of Juvenile Justice Act, 2015
|
No. of In-country adoptions under section 58 ofJuvenile Justice Act, 2015
|
No. of inter-country adoptions under section 59of Juvenile Justice Act, 2015
|
No. of inter-country relative adoptions undersection 60 of Juvenile Justice Act, 2015
|
| |
1 |
2 |
3 |
4 |
| |
|
|
|
|
| Sl. No. |
Type of Adoptions done |
Name of the child with gender and date of birth |
Adoptive Parents with Child Adoption ResourceInformation and Guidance System Registration No.
|
Specialized Adoption Agency/ Child CareInstitution concerned and their address (wherever applicable)
|
Court concerned |
Adoption petition Number |
Date of filing of adoption petition |
Date of adoption order |
| 1 |
In-country adoptions under Section 56(2) of Juvenile JusticeAct, 2015 (2 of 2016)
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
Total |
|
|
|
|
|
|
|
| 2. |
In-country adoptions under Section 58 of Juvenile Justice Act,2015 (2 of 2016)
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
Total |
|
|
|
|
|
|
|
| 3. |
Inter-country adoptions under Section 59 of Juvenile JusticeAct, 2015 (2 of 2016)
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
Total |
|
|
|
|
|
|
|
| 4. |
Inter-country relative (family) Adoptions under Section 60 ofJuvenile Justice Act, 2015 (2 of 2016)
|
|
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
|
|
|
|
|
|
| |
Total |
|
|
|
|
|
|
|
| |
Grand Total (1+2+3+4) |
|
|
|
|
|
|
|
XVIII
[See regulations 2 (21) and 48(3)]Classification of Special Needs Children for the Purpose of AdoptionA. Physical1. Refractory or Severe Rickets (Bones)
4. Blind or Partially Blind
5. Blood disorders (e.g., severe anaemia requiring blood transfusion)
6. Brain Lesions resulting in physical/ neurological or cognitive impairment (certified by paediatrician)
10. Chromosomal Abnormality (Genetic)
13. Cleft Lip-Cleft Palate or Cleft Lip
17. Deaf or Partially Deaf
21. Ectodermal dysplasia (no sweat glands)
23. Fetal Alcohol Syndrome
24. Fingers/ toes joined (syndactyly)
26. Growth Hormone Deficiency
29. Heart conditions of a severe nature
35. Ichthyosis (Collodion baby) (Skin)
36. Indeterminate sex (Genetic)
39. Low Birth Weight (under 1800 gms)
40. Microcephaly (Neurological)
42. Absence of one kidney- Physical
43. Urinary Tract Anomalies- Physical
47. Person with disability
48. Pierre Robin Syndrome
50. Premature Birth (less than 34 weeks)
52. Severe disfiguring birth marks
53. Severe Orthopaedic conditions
54. Speech dysfunction-dysphasia
56. Stammering (only severe cases)
57. Stuttering (only severe cases)
58. Beta thalassemia, Thalassemia Major
1. Autism certified by a paediatric neurologist or child psychologist
2. Child requiring psychiatric treatment
4. Intellectual disability (certified by a paediatric neurologist or child psychologist)
5. Severe learning disability (certified by a paediatric neurologist or child psychologist)
6. Mental illness.
C. Neurological4. Epilepsy/ Seizures/Convulsions (not excluding febrile convulsions)
5. Any other neurological disorders as certified by pediatrician.
D. Any other. Any other child with disabilities as defined in The Rights of Persons with Disabilities Act, 2016.Note: The categories of ailments listed in this Schedule (compiled with the help of panel of doctors, All India Institute of Medical Sciences) are illustrative and not exhaustive.
XIX
[See regulations 51(2) and 55(1)]Consent for the Purpose of Relative AdoptionA. I/We the undersigned have read the following statements carefully and I/we have information about the effects of my/our consent and I/we am/are making the statement without coercion or threat and without receiving any payment or compensation of any kind.
| Biological Father |
Biological Mother |
| Family name: .......................... |
Family name: .................................. |
|
First name:...................................................
|
First name:...................................................
|
| Date of birth: day .... month .... year ... |
Date of birth: day .... month .... year ... |
|
Permanent Address:..............................................
|
Permanent Address:..............................................
|
| -------------------------------------- |
--------------------------------------- |
| I/ We |
| (i) |
hereby terminate the natural relationship with the child. |
| (ii) |
understand that the adoption of this child will create apermanent and legal parent-child relationship with the adoptiveparent(s).
|
| (iii) |
certify that the child has given his/ her consent for the saidadoption and willing to accept our relative as adoptive parents(wherever applicable).
|
| (iv) |
certify that our consent has not been induced by payment orcompensation of any kind.
|
| (v) |
agree to place our child/ children in adoption with ourrelative falling under the definition of section 2 (52) of theJuvenile Justice (Care and Protection of Children) Act, 2015 (2of 2016).
|
| |
Family name of the child:.....................................................
|
| |
First name(s):...................................................
|
| |
Sex: male [ ] female [ ] |
| |
Date of birth: day .... month .... year .... |
| |
Place of birth:..................................................
|
| |
Address: .............................................. |
| |
I/ We declare that I/ we have fully understood the abovestatements.
|
| |
Signed at ................ on .............. |
| |
(Signature or Thumb Impression of the biological parent(s)) |
| Biological Father |
Biological Mother |
|
Note:-Death Certificate of the biological parent to be attached in casehe/ she is not alive.
|
|
B. Consent of the child, if hehas completed five years of age
|
|
Countersignedby Biological Parent(s)
|
| C. |
Prospective Adoptive Parent(s) Adopting the Child/ Children |
|
AdoptiveFather
|
AdoptiveMother
|
|
Family name:..........................
|
Family name:..................................
|
|
Firstname(s): ...................................................
|
Firstname(s): ...................................................
|
|
Date ofbirth: day .... month .... year ...
|
Date ofbirth: day .... month .... year ...
|
|
PermanentAddress: ..............................................
|
PermanentAddress: ..............................................
|
| -------------------------------------- |
--------------------------------------- |
|
Pre-adoptionrelationship with the child:
|
Pre-adoptionrelationship with the child:
|
| _______________________________ |
________________________________ |
|
(Signature orThumb Impression of the prospective adoptive parent(s))
|
| Adoptive Father |
AdoptiveMother
|
|
Photograph ofbiological parents
|
Photograph of child |
Photograph of prospective adoptive parents |
XX
[See regulation 52(2) and 55(2)]Consent of Biological Parent(S) along with Step-Parent to obtain the permission of Child Welfare Committee for adoption of child/ children by Biological Parent and the Step-ParentA. I/We the undersigned:
|
BiologicalFather
|
BiologicalMother
|
|
Family name:..........................
|
Family name:..................................
|
|
First name:...................................................
|
First name:...................................................
|
|
Date ofbirth: day .... month .... year ...
|
Date ofbirth: day .... month .... year ...
|
|
PermanentAddress: ..............................................
|
PermanentAddress: ..............................................
|
| -------------------------------------- |
--------------------------------------- |
| (i) |
hereby relinquish/ surrender my/ our natural right/ claim withmy/ our child/ children -----------------------------------(name, gender, date of birth).
|
| (ii) |
understand that the adoption of this child will create apermanent and legal parent-child relationship with thestep-parent & the biological parent adopting the child.
|
| (iii) |
certify that the child/ children has/ have given his/ her/their consent for the said adoption and is/ are willing to acceptthe step-parent adopting the child/ children as father/ mother(strike out which is not applicable).
|
| (iv) |
certify that my/ our consent above is given out of free willand has not been induced by payment or compensation of any kind.
|
| (v) |
declare that I/ we have fully understood the above statements. |
| Signed at ................ on.............. |
|
(Signature or Thumb Impression of thebiological parent(s))
|
| Biological Father |
Biological Mother |
|
B. Consent of the child/ children at A (i), if completedfive years of age before Child Welfare Committee.
|
| Countersigned by Biological Parent(s) |
| C. |
Step Parent & the Biological Parent Adopting the Child/Children.
|
| |
Family name: .......................... |
| |
First name(s):...................................................
|
| |
Date of birth: day .... month .... year ... |
| |
Permanent Address:..............................................
|
| |
We, the undersigned: |
| (i) |
give our consent to adopt the child/ children mentioned at A(i) above, out of our free will.
|
| (ii) |
understand that the adoption of the child/ children willcreate a permanent parent-child relationship with all the rightsand duties associated with such relationship.
|
| (iii) |
declare that we have fully understood the above statements. |
| Signed at ................ on.............. |
|
(Signature or Thumb Impression of thestep-parent & the biological parent)
|
| Step-Parent |
Biological Parent |
| Photograph of biological father/ mother |
Photograph of child |
Photograph of step parent |
| Seal of Child Welfare Committee |
Signature of three members of |
| |
Child Welfare Committee |
XXI
[See regulation 54(1)]Family Background report of the Child and the Biological Parents in cases of Inter-Country Relative AdoptionsDate of Home Visit:1. Personal particulars about the child
1.1Full name of the child:1.3Date of birth (Birth Certificate of the child to be attached):1.6Language spoken (if applicable):1.7Order of birth in the family:1.8Present educational status:1.9Whether the child is able to express any feeling/opinion regarding his/her adoption?Yes No1.10If the child is above 5 years of age, written statement/ translation of statement of consent of the child for the proposed adoption by the social worker in English to be enclosed.1.11Disability/ special needs (if any to be reflected in the Medical Examination Report)Yes No1.12Whether the child has been counseled thoroughly about the effects of adoption?Yes No NA (Not applicable in case the child is below 5 years old)1.13Whether the child knows about the legal termination of parent-child relationship due to the adoption?Yes No (Not applicable in case the child is below 5 years old)1.14Who has provided counseling to the child?Parent/s Guardian Child Welfare Committee Social Worker Teacher Uncle Aunt Sibling Grandparent/sAny other (Specify)1.15General Personality and description of the child:1.16Social and educational background of the child:2. Details about the biological parents of the child or guardian of the child, as the case may be.
| Details of the father/ guardian |
Details of the mother/ guardian |
| Date of birth and age |
|
Date of birth and age |
|
| Religion |
|
Religion |
|
| Nationality |
|
Nationality |
|
| Present and Permanent Address |
|
Present and Permanent Address |
|
| Educational Qualifications |
|
Educational Qualifications |
|
| Present Occupation |
|
Present Occupation |
|
| Total income per month (proof to be given) |
|
Total income per month (proof to be given), if applicable |
|
|
Whether suffering from any disease (if yes, details to begiven)
|
|
Whether suffering from any disease (if yes, details to begiven)
|
|
3. Details about other family members living with the biological parents/guardians (Other individuals who reside in the household or outside)
| Name in full |
Age/ Sex |
Occupation details |
Marital status |
Relationship to the child |
| |
|
|
|
|
| |
|
|
|
|
4. Opinion about the proposed adoption by each member of the family
5. Remarks of District Child Protection Unit. - (The District Child Protection Unit is required to provide counseling to the biological parents about the effects of adoption, give reasons for proposing the child in adoption to a relative. Further, the District Child Protection Unit has to mention if the adoptive parents have already interacted with the child, if yes when, reason/s or motivation/s for adoption. District Child Protection Unit may also describe about home of the biological family, whether the parents of the child/ren are in touch with the prospective adoptive parents, and description of living accommodation and photograph of the child with adoptive family, etc.
6. Whether the envisaged placement is in the best interests of the child. - Signature with Stamp of the officer concerned from District Child Protection Officer
Address:Documents to be attached with the Report(a)Proof of residence of the biological family/guardian(b)Proof of income of the biological family/guardian(c)Proof of date of birth of the biological family/guardian(d)Medical certificate in case the biological parent(s) have any medical condition(e)Proof of date of birth of the child(f)Medical Examination Report of the child to be adopted
XXII
[See regulation 51(2)]Permission by child welfare committee to the consent given by the guardian of the child for adoption by his/ her relative (where biological parents are not alive/ not able to give consent)I. I/We, the undersigned give the following declaration before the Child Welfare Committee (District--------------):
|
MaleGuardian
|
FemaleGuardian
|
|
Name.........................................
|
Name........................................
|
|
Surname.....................................
|
Surname.......................................
|
|
Son of...........................................,
|
Wife/daughter of..........................,
|
|
Date ofbirth: Day ... Month ..... Year ........
|
Date ofbirth: Day ... Month .... Year ........
|
|
PermanentAddress .................................
|
PermanentAddress .................................
|
|
PresentAddress: ............................
|
PresentAddress: ..............................
|
|
Declarethat:
|
|
|
The child (name)............................ (Surname)........................................... Sex: Male [ ] Female[ ], Date of birth: Day ..... Month ..... Year......, Place ofbirth.........., daughter/ son of................................, permanent resident of............................................................................andpresently residing at......................................................................is under my/ our custody due to death of his/ her parents(both).The natural parent(s) of the above mentioned child/ children is/are my/ our ____________________ (please specify the relationand attach proof of supporting documents).
|
| I/ We |
| (i) |
give consent to the surrender of the child named -----------to my/ our relative for adoption;
|
| (ii) |
hereby terminate the legal guardian-ward relationship with thesaid child or children;
|
| (iii) |
understand that the said child shall be adopted by his/ herrelative residing in India or abroad;
|
| (iv) |
understand that the adoption of this child will create apermanent parent-child relationship with the adoptive parent(s);
|
| (v) |
shall have no claim over the child; |
| (vi) |
declare that I/we have fully understood the above statementscarefully;
|
| (vii) |
have information about the effects of my/ our consent; |
| (viii) |
Am/ are making the statement without coercion or threat andwithout receiving any payment or compensation of any kind.
|
| Signed at ................ on .............. |
|
[Signature or Thumb Impression of theGuardian(s)]
|
|
AdoptiveFather
|
AdoptiveMother
|
|
Family name:..........................
|
Family name:..................................
|
|
Firstname(s): ...................................................
|
Firstname(s): ...................................................
|
|
Date ofbirth: day .... month .... year ....
|
Date ofbirth: day .... month .... year ....
|
|
PermanentAddress: ..............................................
|
PermanentAddress: ..............................................
|
| -------------------------------------- |
--------------------------------------- |
|
[Signature orThumb Impression of the adoptive parent(s)]
|
| Adoptive Father |
Adoptive Mother |
| Photograph of the guardian |
Photograph of child |
Photograph of prospective adoptive parents |
XXIII
[See regulation 12(11)]Affidavit by the Chief Functionary/ Authorized person of the Specialized Adoption Agency to Court in support of Adoption of Child ______________________1. Affidavit of_____________________ working as __________________________ in ______________ located at _______________
2. I do hereby state of solemn affirmation as under:
(a)That details of the child ________________________ (Name, gender and DOB) have been entered into the online Child Adoption Resource Information and Guidance System (CARINGS). The unique registration number assigned to the child through Child Adoption Resource Information and Guidance System (CARINGS) is _____________________.(b)That the Child Welfare Committee ___________________ has declared the child as legally free for adoption on __________________.(c)That the child was referred to waiting Prospective adoptive parents in the online child referral system through Child Adoption Resource Information and Guidance System and the child has been accepted by the present prospective adoptive parents (Regd. No and Name) ____________________________________ following the procedure as provided in paragraph ______________ of the Adoption Regulations.(d)That the Home Study Report of the prospective adoptive parents, prepared by _____________________________ is found to be suitable.(e)That the Adoption Committee constituted under paragraph ______________ of the Adoption Regulations has taken decision in favour of the proposed adoption and accordingly the adoption application has been filed in the Court _________________________.OrThat No Objection Certificate for the proposed inter-country adoption has been issued by the Central Adoption Resource Authority (CARA) on dated ------ (strike out the one which is not applicable).(f)That the adoption procedure followed in this case complies Section ________________ of the Juvenile Justice (Care and Protection of Children)Act 2015 and paragraph ________________ of the Adoption Regulations.(g)That our organization ___________________ has been recognized by the State Government of ______________________ to run as a Specialized Adoption Agency vide no. _______________ dated __________ which is valid till __________________.(h)That the Specialized Adoption Agency has received adoption fee Rs. __________________ only as stipulated by Central Adoption Resource Authority (CARA).(i)That I commit myself not to receive any donation in any form from the adoptive parents or their relatives or through their sponsoring agency during the adoption process or after completion of the adoption process.(j)That facts stated above are genuine to the best of my knowledge and belief and I do hereby declare that in case the facts mentioned above are found non-genuine, I shall be liable for the consequences.VerificationThat I ___________________, the deponent above, do hereby verify that the contents of the above affidavit are true and correct.
Sworn and signed before meOn ______________________In my presence
XXIV
[See regulation 51(4)]Affidavit of Prospective Adoptive Parent(s)In cases of In-Country Relative AdoptionsIn support of their Relationship, Financial and Social Status as per sub-regulation 4 of regulation 51Affidavit of Mr. __________________________ and Mrs. _______________________, resident of ____________________________________, about socio-economic and financial status to adopt the child _____ from the relative family Mr. ________________________ and Mrs. _______________________, residing at ________________________.1. That I/we am/are Indian nationals residing in _________________ since __________ years.
2. That the child proposed to be adopted is my _________________ and fulfills the relationship criteria as provided in Section 2 (52) of the Juvenile Justice (Care and Protection of Children) Act 2015.
3. That my/our total annual income from all sources is _______ per annum, which is adequate to raise the child in our family in the local living standards where we reside.
VerificationThat I/we _____________________, the deponent above, do hereby verify that the contents of the above affidavit are true and correct.
Sworn and signed before me on --------------- in my presence
XXV
[See regulation 26(3)]Format for Inspection of Specialized Adoption Agencies1. Information about the Institution
Name of the Institution: ________________________________ Address of the Institution:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Telephone Number:E-mail:Name of the State:Date of inspection:Inspection Team:
| Sl. No. |
Name |
Designation |
Office |
| (a) |
|
|
|
| (b) |
|
|
|
| (c) |
|
|
|
| (d) |
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| (e) |
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2. Legal Status
| Sl. No. |
Registration/ Recognition Status |
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| (a) |
Registration No under Societies Registration Act 1860 (21 of1860) or Indian Trusts Act; 1882 (2 of 1882) or Companies Act;2013(18 of 2013) or Income Tax Act; 1961 (43 of 1961).
|
No.Date:
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| (b) |
Registration as a Child Care Institution under Section 41 (1)of the Juvenile Justice (Care and Protection of Children) Act2015 and its validity.
|
No.Validity period :
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| (c) |
Recognition as a Specialized Adoption Agency for placingchildren in adoption under Section 65(1) of the Juvenile Justice(Care and Protection of Children) Act 2015.
|
NoValidity period:
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| (d) |
Foreign Contribution Regulation Act Registration No. if anyand its validity
|
No.Validity period:
|
3. Staff
3.1Staff of the Specialized Adoption Agency if getting grants under ICPS
| Sanctioned Position |
Name of the Staff |
Date of joining |
Qualifications and Experience |
| Manager/ Coordinator (1) |
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| Social Worker cum Early Childhood Educator (1) |
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| Nurse (1) |
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| Doctor (Part time) |
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| Ayas (6) |
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| Watchman (1) |
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Any other staff in the payroll of the Specialized AdoptionAgency
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| Name of the volunteer if any |
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| Position |
Name of the Staff |
Date of joining |
Qualifications and Experience |
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4. Committees in place
| Committee |
Meetings held during last financial year |
Observations of the Inspecting Team |
| Managing Committee/ Governing Body |
|
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| Adoption Committee |
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| Home Management Committee |
|
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| Any other Committee |
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5. Documents and record keeping (Please put √ mark wherever required)
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Records/ Registers to be maintained by the SpecializedAdoption Agency as per Adoption Regulations
|
Observations |
| (a) Master admission register |
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| (b) Attendance register of the children |
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| (c) Attendance register of the staff |
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| (d) Vouchers, cashbook, ledger, journal and annual accounts |
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| (e) Grant utilization register |
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| (f) Stock register |
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| (g) Record of minutes of meetings of the Management Committee |
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| (h) Record of minutes of meetings of the Adoption Committee |
|
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Whether the case files maintained by the Specialized AdoptionAgency contain documents as stipulated inSchedule VIIIofthe Adoption Regulations and Observation of the Inspecting Team?
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| |
6. Carings & Status of Children
6.1Status of children in Child Adoption Resource Information and Guidance System (The Team may match actual status with the online data during the visit)
|
Name of the adoptable child in SpecializedAdoption Agency and linked Child Care Institution
|
Male/ Female |
DOB |
Legally free for adoption with date |
Adoptions in process |
Pendency in Court for more than 2 months |
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No. of Children in Specialized Adoption Agencyand the linked Child Care Institution
|
Photo uploaded |
Child Study Report uploaded |
Medical Examination Report uploaded |
Child Welfare Committee Certificate uploaded |
Remarks |
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| |
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Children in Specialized Adoption Agency and thelinked Child Care Institution
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Court order uploaded |
Post-adoption follow-up pending |
Observations |
| |
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| Year |
At the stage of pre-adoption foster care beforefiling a petition
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At the stage of pre-adoption foster-care afterthe petition has been filed in the court
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After the adoption order is issued |
Observations |
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Cases where Home Study Report is pending beyondone month from the date of completion of registration
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Reasons for the same |
Observations of the Inspection Team |
| |
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7. Infrastructure
7.1Building:(a)Rented: ------------------------- Owned: -----------------------------------------If rented, give details of rent paid per month and copy of rent agreement: .........................................................................................................................(b)CCTV cameras installed at the entrance : Yes No(c)Sufficient space to accommodate the children : Yes No7.2Space available
| No. of rooms/ dormitories |
|
| Provision of sick room/ medical unit |
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| Counseling room |
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| Recreational/ activity room for Children |
|
| (a) |
Is there a TV set available with Cable network? |
Yes No |
| (b) |
How often are children allowed to view TV? |
in the evenings or any time |
| (c) |
Are children playing games indoors? |
Yes No |
| (d) |
What games are available to them? |
Age appropriate games or not |
| (e) |
Are children playing games outdoors? |
Yes No |
| (f) |
Do they have equipments/ accessories to play? |
Yes No |
| (g) |
Do children go for picnics/ excursions? |
Yes No |
| (h) |
Do they have interactions with eminent personalities? |
Yes No |
| (i) |
Is there a recreation room available to children? |
Yes No |
| (j) |
Kitchen/ Dining Room? |
Yes No |
| (k) |
Is the cooking area and pantry separate? |
Yes No |
| (l) |
Do children get individual plates, mugs glasses? |
Yes No |
| (m) |
Are cooking utensils adequate and clean? |
Yes No |
| (n) |
Is there a fridge available for children? |
Yes No |
| (o) |
Is there an Oven available for children? |
Yes No |
| (p) |
Is there a Gas stove available in kitchen? |
Yes No |
| (q) |
Is there a chimney available? |
safe/ away from children or not |
| (r) |
What is the arrangement to keep the gas cylinders? |
Yes No |
| (s) |
Adequate water supply for washing, cooking? |
Yes No |
| (t) |
Adequate drinking water available |
Manual or mechanical |
| (u) |
(RO)? |
Yes No |
| (v) |
Is cooking done by machines or by cook? |
Yes No |
| (w) |
Number of toilets and bathrooms for Children |
Yes No |
| (x) |
Flush is working |
Yes No |
| (y) |
Taps in the wash basin are functioning |
Yes No |
| (z) |
Is the floor slippery |
Yes No |
| (aa) |
Drains clean |
Yes No |
| (bb) |
Drains are clogged |
Yes No |
| (cc) |
Fittings for hanging clothes/ towels in place |
Yes No |
| (dd) |
Cow webs are removed |
Yes No |
| (ee) |
Door has a latch |
Yes No |
| (ff) |
Door has peep holes |
Yes No |
| (gg) |
Frequency of bath a child is allowed |
once or more in a day |
| (hh) |
Water is adequately available |
Yes No |
| (ii) |
Adequate numbers of buckets and mugs |
Yes No |
| (jj) |
Personal toiletries are provided |
Yes No |
| (kk) |
Is washing powder or soap given |
Yes No |
| (ll) |
Do children wash their own clothes |
Yes No |
| (mm) |
Is there a washer man available |
Yes No |
| (nn) |
Is the washing machine in functional |
Yes No |
| Open space for outdoor activities |
Observations: |
| Class rooms |
| (a) |
Does the home have a child friendly indoors? |
Yes No |
| (b) |
How often is the sweeping, swabbing done? |
Twice a day or more |
| (c) |
Are the children involved in cleaning exercise during classhours?
|
Yes No |
| (d) |
Are the facilities of coolers/ heaters available for children? |
Yes No |
| (e) |
Are the doors and windows maintained properly? |
Yes No |
| (f) |
Are the rooms and dormitories well ventilated? |
Yes No |
| (g) |
Is there an alternate provision for lights and fans when thereis no electricity available?
|
Yes No |
| (h) |
Are the outdoors clean, pleasant and child friendly? |
Yes No |
| (a) |
Are the clothes provided as per size and season |
Yes No |
| (b) |
Provisioning of undergarments as per JJ Rule 2016 |
Yes No |
| (c) |
New clothes are stitched or bought stitched or bought |
|
| (d) |
Are the mattresses given individually |
Yes No |
| (e) |
Are pillows given individually |
Yes No |
| (f) |
Are the mattress and pillows clean |
Yes No |
| (g) |
Do children have separate cupboards |
Yes No |
| (h) |
Are bed sheets and Khes available |
Yes No |
| (i) |
Are blankets available in winters |
Yes No |
| (j) |
Number of sets provided on arrival |
one/ two/ three/ four |
| (k) |
Frequency of providing new clothes |
Monthly/ Quarterly |
| (l) |
Are these sets of same colour or different colours? |
Same/ different |
| (m) |
Are children provided with individual lockers to keep theirpersonal items?
|
Yes No |
| (n) |
Other articles provided to the children:.......................................
|
| |
................................................................................................................................................................... |
| |
................................................................................................................................................................... |
| |
...................................................................................................................... |
| (a) |
Medical facilities/ Maintenance of Health Cards:............................................
|
| |
.................................................................................................................................................................. |
| |
.................................................................................................................................................................. |
| (b) |
Nutrition/ Special Diet: |
| |
.................................................................................................................................................................. |
| |
.................................................................................................................................................................. |
| (c) |
Provision of safe drinking water :............................................
|
| |
.................................................................................................................................................................. |
| (d) |
Education (Formal Education/ NFE and Life Skill TrainingProgramme) :
|
| |
.................................................................................................................................................................. |
| |
.................................................................................................................................................................. |
| |
.................................................................................................................................................................. |
| |
.................................................................................................................................................................. |
| (e) |
Counseling/ Guidance services provided :............................................
|
| |
.................................................................................................................................................................. |
| |
.................................................................................................................................................................. |
| (f) |
Physiotherapy service available to children? |
| |
.................................................................................................................................................................. |
| (g) |
Recreational facilities available in the adoption agency forchildren :
|
| |
.................................................................................................................................................................. |
| |
.................................................................................................................................................................. |
| Time |
Activities/ Schedule |
| Morning |
|
| Day Time |
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| Afternoon |
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| Evening |
|
|
Late evening/Night
|
|
8. Linkages.
Linkages developed with other agencies/ departments :............................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................9. Connectivity and status in Child Adoption Resource Information and Guidance System and designated portal for missing child :
........................................................................................................................................................................................................................................................................................................................................................................10. Funds/ Grants received during last financial year :
|
Fees for conducting Home Study and Post-adoptionfollow-up
|
Adoption fee |
Grants from State Govt. under ICPS |
Any other donations/ grants received |
| |
|
|
|
| |
|
|
|
11. Funds/ Grants utilized during the last financial year
| Head-wise expenditure incurred |
Amount |
Observations of the Inspecting Team afterexamining vouchers, cheque or cash receipts and other relevantregisters
|
| |
|
| |
|
| |
|
12. Bank details of the Specialized Adoption Agency.
13. Any best practice followed by the Specialized Adoption Agency.
14. Issues raised by the Specialized Adoption Agency related to delays in the adoption process, funds or any other issue related to adoption.
15. Observations and Recommendations of the Inspecting Team.
Signature of the Inspecting Officer(Name and Designation)Signature of the Inspecting OfficerName and DesignationSignature of the Inspecting OfficerName and DesignationSignature of the Inspecting OfficerName and Designation
XXVI
[See regulation 23(1)]Application from a Child Care Institution for recognition as a Specialized Adoption Agency
| 1. |
About the Institution: |
| 1.1 |
Name of the Institution/ Organization |
|
| 1.2 |
Registration number and date of Registration of theInstitution/ Organization under the relevant Act (Relevantdocuments of registration and bye-laws, memorandum ofassociation to be annexed)
|
|
| 1.3 |
Registration number and date of Registration of theInstitution/ Organization as a Child Care Institution (Annexcopy of the Registration Certificate)
|
|
| 1.4 |
Period of validity to run the Child Care Institution |
|
| 1.5 |
Complete address of the Applicant/ Institution/ organization |
|
| 1.6 |
STD code/ Telephone No. |
|
| 1.7 |
STD code Fax No. |
|
| 1.8 |
E-mail address |
|
| 1.9 |
If the organization is of all India character, give addressof its branches, in other states.
|
|
| 1.10 |
If the Child Care Institution had been denied recognition/registration as a Specialized Adoption Agency earlier? Yes/ No
|
|
| |
If Yes |
|
| |
(a) |
Ref. No. of application which resulted in denial ofrecognition as Child Care Institution:
|
|
| |
(b) |
Date of denial: |
|
| |
(c) |
Which department has denied the recognition: |
|
| |
(d) |
Reason for denial of recognition as Specialized AdoptionAgency:
|
|
| 2. |
Infrastructure: |
| 2.1 |
No. of Rooms (mention with measurement) |
|
| 2.2 |
No. of toilets (mention with measurement) |
|
| 2.3 |
No. of Kitchen (mention with measurement) |
|
| 2.4 |
No. of sick room |
|
| 2.5 |
Copy of blue print of the building (authentic sketch plan ofbuilding) to be attached
|
|
| 2.6 |
Arrangement to deal with unforeseen disaster; also mentionthe kind of arrangement made:
|
|
| |
(a) |
Fire |
|
| |
(b) |
Earth quake |
|
| |
(c) |
Any other arrangement |
|
| 2.7 |
Arrangement of drinking water (certified from Public HealthEngineering department to be annexed).
|
|
| 2.8 |
Arrangement to maintain sanitation and hygiene: |
|
| |
(a) |
Pest Control |
|
| |
(b) |
Waste disposal |
|
| |
(c) |
Storage area |
|
| |
(d) |
Any other arrangement |
|
| 2.9 |
Rent agreement/buildingmaintenance estimate (whichever is applicable)(Annex: copy of Rent agreement)
|
|
| 3. |
Capacity of the Institution/ Organization |
| |
No. of children (0-5, 5-11 and 11-18 years) present in thehome
|
|
| 4. |
Facilities Available for children |
| 4.1 |
Educational facility |
|
| 4.2 |
Health Check-up arrangement, frequency of check-up, type ofcheck-ups proposed to be done
|
|
| 4.3 |
Any other facility having impact on the overall developmentof the child
|
|
| 5. |
Staffing |
| 5.1 |
Detailed staff list(to be annexed) |
|
| 5.2 |
Name of partner organizations |
|
| 6. |
Background information about the Child Care Institution |
| 6.1 |
Major activities of theorganization in last two years(Annex copy of Annual Report for last two years)
|
|
| 6.2 |
An updated list of members of the management committee/governing body (Please annex resolution of the executive body ofthe institution supporting decision to run an adoption agency)
|
|
| 6.3 |
List of assets/ infrastructure of the organization (to beAnnexed)
|
|
| 6.4 |
If the organization registeredunder the Foreign Contribution (Regulation) Act, 1976 (49 of1976)(Certificate to be annexed)
|
|
| 6.5 |
Details of foreign contributionreceived last two years(Annex: relevant documents)
|
|
| 6.6 |
List of other sources of grant-in-aid funding (if any) withthe name of the scheme/ project, purpose amount, etc.
|
|
| 6.7 |
Details of existing bank account of the agency indicatingbranch code account number.
|
|
| 6.8 |
Whether the institution agrees to open a separate bankaccount for the grant proposed
|
|
XXVII
[See regulation 10(4)]Format of Minutes of the Adoption CommitteeIn case of In-Country AdoptionName and Address of the Specialized Adoption Agency:1. Following are the members of the Adoption Committee as per sub-regulation 4 of regulation 10 of the Adoption Regulations notified by Central Government.
| Sl. No. |
Name |
Designation |
| (1) |
|
|
| (2) |
|
|
| (3) |
|
|
2. The undersigned members of the Committee have scrutinised all requisite documents (attested/notarised) required for filing adoption application in the Court as mentioned below:
(1)Current family photograph/Photograph of person adopting a child.(2)PAN Card of the parents.(3)Birth certificate/Proof date of birth of the parents (In case of married couple, upload Birth Certificate of both the applicants).(4)Proof of residence (aadhar card/ voter card/ passport/current electricity bill/telephone bill) .(5)Proof of income of last year (salary slip/income certificate issued by Govt. department/income tax return).(6)Certificate from a medical practitioner certifying that the prospective adoptive parents do not suffer from any chronic, contagious or fatal disease and they are fit to adopt (In case of married couple, upload Medical Certificate of both the applicants).(7)Marriage certificate/Divorce Decree/Declaration from the competent court or affidavit on oath pertaining to divorce in case of divorce governed by personal law where decree of divorce is not mandatory/Death certificate of spouse whichever is applicable.(8)Two reference letters from acquaintances or relatives in support of adoption.(9)Copy of divorce decree/Declaration from the competent court or affidavit on oath pertaining to divorce in case of divorce governed by personal law where decree of divorce is not mandatory/death certificate of the spouse (if applicable).(10)Copy of consent of the older child/children in the family (if more than 5 years).3. Decision of the Adoption Committee.
(1)It has been decided by the Committee that the Prospective Adoptive Parents.................................................... ............................................................................................................... having Registration No .................... have been considered suitable to adopt the child ......................................... (Date of Birth........................) having Registration No ....................(2)In case the prospective adoptive parents are not considered suitable, reasons for the same:
| (.........................) |
(........................) |
(..........................) |
| Member 1 |
Member 2 |
Member 3 |
| (Name and Designation) |
(Name and Designation) |
(Name and Designation) |
XXVIII
[See regulation 12(2)]Model Application in case of Orphan or Abandoned or Surrendered Child(ren) to court for In-Country AdoptionIn the Court of ____________ Ld. District Judge/ Addl. District Judge, District Court/ Principal Judge/ Judge, Family Court or Civil Judge/ Addl. Civil Judge (Senior Division), as the case may be, at _____________________.Misc. Civil Application (MCA) No. ____________/ YearChild Adoption Resource Information and Guidance System Regd. Number of prospective adoptive parents:Name of the Specialized Adoption Agency concerned:Registered Office at:Through its Adoption In-charge/Social Worker (name and age)Applicant(Note: In case the child is from a Child Care Institution, the particulars of such Child Care Institution may be mentioned here as co-applicant)And1. Mr. ______________________ S/o ___________________ Aged about _____ years, Citizen of _______________, Occupation: ____________ Permanent Residential address: _____________________________________________.
2. Mrs. ______________________ W/o ___________________ Aged about _____ years, Citizen of _________, Occupation: _________________ Permanent Residential Address: ___________________________________.
Prospective Adoptive ParentsApplication in the matter of adoption of the child: _____________ (male/female, DOB: _____________) under section 58 (3) of the Juvenile Justice (Care and Protection of Children) Act, 2015 (2 of 2016) read with regulation 12 (2) of the Adoption Regulations.The Applicant most respectfully submits before this Hon'ble Court as under:-1. That the Applicant is a recognized Specialized Adoption Agency under Section 65 of the Juvenile Justice (Care and Protection of Children), 2015 (hereinafter referred to as "Juvenile Justice Act") by the State Government of __________________________, for rehabilitating orphan, abandoned and surrendered children through adoption in accordance with the provisions of the Juvenile Justice Act and Adoption Regulations.
2. That the Co-Applicant is a registered Child Care Institution, which is having the care and custody of the child: (male/female; DOB: ........) intends to give this child in adoption to the above named prospective adoptive parents through the applicant Specialized Adoption Agency as per the provision of Section 66 of the Juvenile Justice Act.
[Note: This paragraph would be mentioned in case the Adoption Application is being filed in a linkage case.]3. The child/children......... (male/female, DOB:............) has/have been declared legally free for adoption by the Child Welfare Committee (Child Welfare Committee), ............ District (copy of order annexed), as per the provisions of section 38 of the Juvenile Justice Act and the said child is registered in the Child Adoption Resource Information and Guidance System with the Registration No........, for the purpose of adoption as envisaged in section 56 (1) of the Juvenile Justice Act.
4. That, the above named prospective adoptive parents are resident Indians, presently living at ............................. (complete address). The prospective adoptive parents are registered in the Child Adoption Resource Information and Guidance System with the Registration No. ................. They have been found eligible and suitable to adopt the above named child/children as per the criteria mentioned in section 57 of the Juvenile Justice Act and regulation 5 of the Adoption Regulations, based upon their Home Study Report annexed. They have been found suitable by the Adoption Committee to adopt the above named child. A true copy of the decision of the Adoption Committee is also annexed.
5. That the above named child/children has/have been referred to the said prospective adoptive parents online through Child Adoption Resource Information and Guidance System and has been accepted by the said prospective adoptive parents by signing the Child Study Report and Medical Examination Report on ........ The child/children has/have been given in pre-adoption foster care to the said prospective adoptive parents on ........, after obtaining a Pre-adoption Foster Care Affidavit (true copy annexed), as per the provisions of Section 58 (3) of Juvenile Justice Act and regulation 11 (1) of the Adoption Regulations.
6. That the prospective adoptive parents have undertaken in the said Pre-adoption Foster Care Affidavit that they will allow the authorized social worker/functionary of the Specialized Adoption Agency/District Child Protection Unit/State Adoption Resource Agency to visit their home for undertaking post-adoption follow up to ascertain the progress and well-being of the child in the adoptive family [as envisaged under Section 58 (5) of Juvenile Justice Act].
7. That the prospective adoptive parents have further undertaken to inform that any change in the place of their residence (other than as stated in this application), to the Applicant(s), State Adoption Resource Agency concerned and to this Court for the purpose of post adoption follow-up.
8. That the prospective adoptive parents have also undertaken to up-bring the said child/children as their own and to accord the same status/rights/privileges to the child/children at par with the natural born child as provided in pre-adoption foster care affidavit annexed with the Application.
9. That the Applicant/Co-applicant have decided to place the child/children in adoption as per decision of the Adoption Committee vide its meeting dated................................ (copy Annexed).
10. That the conditions laid down in section 61 (1) of the Juvenile Justice Act have been complied with in this adoption case.
11. That the giver (s) and taker (s) have no interest directly or indirectly adverse to that of the child/children.
12. The applicant (s) are within the jurisdiction of this Hon'ble Court and hence this Hon'ble Court has jurisdiction to pass Adoption Order as per the provisions of section 2 (23), 58 (3) and 61 of the Juvenile Justice Act.
13. That the Applicants understand that the adopted child shall become the lawful child of the applicants with all the rights, privileges and responsibilities that are attached to a biological child.
14. That the Applicant(s) have not filed any other Application for the adoption of the said child in any other Court of Law.
15. That the prescribed court fees have been paid and affixed on this Application.
16. The Applicant(s), therefore, pray that :
(a)That the above named Prospective Adoption Parents may please be given the said child/children in adoption and be declared as the parents of the said minor for all purposes allowed by the law.(b)The Birth Certificate Issuing Authority (name and place) may please be directed to issue Birth Certificate for the said child/children within five working days from the date of application, as per the provisions of regulation 36 of the Adoption Regulations.
| Place: |
Applicant No. 1 |
| Date: |
Applicant No. 2 |
| Photograph of the child |
Photograph of the adoptive parent (s) |
| Sl. No. |
Documents to be annexed as provided in ScheduleIX of the Adoption Regulations
|
Reference |
Page No. |
| |
|
|
|
XXIX
[See regulation 12(2)]Model Application in case of Orphan or Abandoned or Surrendered Child(ren) to court for Inter-Country AdoptionIn the Court of Mr/ Ms. ____________, Ld. District Judge/ Addl. District Judge, District Court/ Principal Judge/ Judge, Family Court or Civil Judge/Addl. Civil Judge(Senior Division),as the case may be, at ____________________.Misc. Civil Application (MCA) No. ______________________/ 2016Child Adoption Resource Information and Guidance System Regd. Number of prospective adoptive parents:Name of the Specialized Adoption Agency concerned:Registered Office at:Through its Adoption In-charge/ Social Worker (name and age)Applicant(Note: In case the child is from a Child Care Institution, the particulars of such Child Care Institution may be mentioned here as co-applicant)And1. Mr. ___________________ S/o ____________________ Aged about _____ years, Citizen of ______________, Occupation: ________________ Permanent Residential Address: ____________________________________.
2. Mrs. _________________ W/o ____________________ Aged about _____ years, Citizen of _______________, Occupation: ________________ Permanent Residential Address _____________________________________.
Prospective Adoptive ParentsApplication in the matter of adoption of the child:....... (male/female, DOB:.......) under section 59(7) of the Juvenile Justice Act(2 of 2016) and regulations 12(2) and 17(1) of Adoption Regulations.The Applicant most respectfully submits before this Hon'ble Court as under:1. That the Applicant is a recognized Specialized Adoption Agency under Section 65 of the Juvenile Justice (Care and Protection of Children), 2015(2 of 2016) (hereinafter referred to as "Juvenile Justice Act") by the State Government of _____, for rehabilitating orphan, abandoned and surrendered children through adoption in accordance with the provisions of the Juvenile Justice Act and Adoption Regulations.
2. That the Co-Applicant is a registered Child Care Institution, which is having the care and custody of the child: (male/female; DOB:......) intends to give this child in adoption to the above named Prospective Adoption Parents through the applicant Specialized Adoption Agency as per the provision of section 66 of the Juvenile Justice Act.
[Note: This paragraph would be mentioned in case the Adoption Application is being filed in a linkage case.]3. The child/children..... (male/female, DOB:......) has/have been declared legally free for adoption by the Child Welfare Committee, ............District (copy of order annexed), as per the provisions of section 38 of the Juvenile Justice Act and the said child is registered in the Child Adoption Resource Information and Guidance System with the Registration No........, for the purpose of adoption as envisaged in section 56 (1) of the Juvenile Justice Act.
4. That, the above named prospective adoptive parents (PAPs) are Non-Resident Indians (NRI)/Overseas Citizens of India (OCI)/Foreigner, presently living at ............................. (complete address).
5. That the prospective adoptive parents have been found eligible and suitable to adopt by the Authorized Foreign Adoption Agency (AFFA)/Central Authority (CA) (name and address), based upon their Home Study Report annexed and as per the law of the country of their residence. The proposal of prospective adoptive parents to adopt a child from India has been recommended by the said Authorized Foreign Adoption Agency and has been approved by the Central Authority concerned.
6. The prospective adoptive parents have been registered in the Child Adoption Resource Information and Guidance System with the Registration No ....................... by said Authorized Foreign Adoption Agency/Central Authority. They have been found eligible by the Central Adoption Resource Authority (CARA) as per the criteria mentioned in section 57 of the Juvenile Justice Act and regulation 5 of the Adoption Regulations.
7. That the above named child/children has been referred to the said prospective adoptive parents online in Child Adoption Resource Information and Guidance System through the Authorized Foreign Adoption Agency /CA concerned and has been accepted by the said prospective adoptive parents by signing the Child Study Report and Medical Examination Report on ........................
8. That Central Adoption Resource Authority has issued No Objection Certificate on ................... in favour of the proposed adoption.
9. That the prospective adoptive parent(s) have undertaken through the Authorized Foreign Adoption Agency/Central Authority concerned that they will allow the authorized social worker/functionary of the Authorized Foreign Adoption Agency/Central Authority/concerned Government department to visit their home for undertaking post-adoption follow up to ascertain the progress and well-being of the child in the adoptive family, as envisaged under section 59 (11) of the Juvenile Justice Act.
10. That the prospective adoptive parents have also undertaken to up-bring the said child/children as their own and to accord the same status/rights/privileges to the child/children at par with the natural born child.
11. That the Applicant/Co-applicant want(s) to give the above named child/children and the said prospective adoptive parents have given their consent to take the child/children in adoption.
12. That the conditions laid down in section 61 (1) of the Juvenile Justice Act have been complied with in this adoption case.
13. That the giver(s) and taker(s) have no interest directly or indirectly adverse to that of the child/children.
14. The above named child is within the legal jurisdiction of this Hon'ble Court and hence this Hon'ble Court has jurisdiction to pass Adoption Order as per the provisions of sections 2 (23), 59 (7) and 61 of the Juvenile Justice Act.
15. That Central Adoption resource Authority (CARA) has issued No Objection Certificate (NOC) for the proposed adoption as provided in regulation 16 of the Adoption Regulations.
16. That the Applicants understand that the adopted child shall become the lawful child of the applicants with all the rights, privileges and responsibilities that are attached to a biological child.
17. That the Applicant(s) have not filed any other Application for the adoption of the said child in any other Court of Law.
18. That the prescribed court fees have been paid and affixed on this Application.
19. The Applicant(s), therefore, pray that:
(a)The above named prospective adoption parents may please be declared as parents of the said child/children for all purposes allowed by the law and may be allowed to be taken to the country of their residence for upbringing the child/children as their own child.(b)The Birth Certificate Issuing Authority (name and place) may please be directed to issue Birth Certificate for the said child/children within five working days from the date of application, as per the provisions of sub-regulation (5) of regulations 18 and regulation 36.(c)The Regional Passport Office (RPO) concerned may be directed to issue Passport for the said child/children within ten days from the date of application, as per sub-regulation (4) of regulation 18 and regulation 38.
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XXX
[See regulation 51 (5)]Model Application to Court for In-Country Relative AdoptionIn the Court of ____________ Ld. District and Sessions Judge/ Addl. District and Sessions Judge, District Court/Principal District Judge, Family Court or Civil Judge/Addl. Civil Judge(Senior Division), as the case may be, at _________________________________.Misc. Civil Application (MCA) No.____________________/ Year.Child Adoption Resource Information and Guidance System Regd. Number of prospective adoptive parents:1. Mr. __________________ S/o ________________ Aged about _____ years, Citizen of ______________________, Occupation: ____________ Permanent Residential address: _______________ P.S._________, Dist. _______ State ______________;
2. Mrs. __________________ W/o ________________ Aged about _____ years, Citizen of _________, Occupation: _________________ Permanent Residential Address: _______________ P.S. _________, Dist._______ State ______________.
ApplicantsProspective Adoptive Parent(s)And3. Mr. ____________________ S/o _____________________ Aged about _____ years, Citizen of _______________, Occupation: ____________ Permanent Residential address: ____________________________________;
4. Mrs. _____________________ W/o _________________ Aged about _____ years, Citizen of _________________, Occupation: _________________ Permanent Residential Address: ____________________.
Natural/ biological ParentsApplication in the matter of adoption of the child:....... (male/female, DoB:..........) under section 56 (2) of the Juvenile Justice (Care and Protection of Children) Act, 2015 (2 of 2016) read with regulation 51 and 55 of the Adoption Regulations.The Applicants most respectfully submit before this Hon'ble Court as under:-1. That the Applicants are prospective adoptive parents and relative to natural /biological parents of the child ___________________ (male/female) under section 2 (52) of the Juvenile Justice (Care and Protection of Children) Act, 2015 (2 of 2016) (hereinafter referred to as "Juvenile Justice Act").
2. That the Applicants are paternal uncle or aunt, or a maternal uncle or aunt, or paternal grandparent or maternal grandparents of the child ___________________________.
3. That the Applicants are resident of _________________________________.
4. That the child ________________________ was born to the natural parents on ________________________ and they are resident of __________________________________________________________________.
5. That the natural parents are desirous of placing the child in adoption for the reason_______________________.
6. That prospective adoptive parents are desirous of adopting the child for the reason __________________.
7. That the Applicants and the natural parents have given consent to the proposed adoption which is annexed with the Application. (In case the natural parents are not alive, document related to permission for adoption from the Child Welfare Committee would be annexed as provided in the Adoption Regulations.
8. That the child proposed to be adopted is a minor (below five years) who is not able to express his/her views.
OrThat the child proposed to be adopted has also given his /her consent for the said adoption and is willing to accept the Applicants as parents.9. That the adoption of the child by the applicants from the natural parents would be in the paramount welfare of the child and the applicant(s) would treat the child as their own with all rights and responsibilities.
10. That neither the applicants have given or agreed to give, nor have the natural parents or guardians of the child received or agreed to receive any payment or reward in consideration of the adoption.
11. That the conditions laid down in section 61 (1) of the Juvenile Justice Act have been complied with in the case of proposed adoption.
12. That the giver(s) and taker(s) have no interest directly or indirectly adverse to that of the child/children.
13. The child ordinarily resides within the jurisdiction of this Hon'ble Court and hence this Hon'ble Court has jurisdiction to pass Adoption Order as per the provisions of section 61 of the Juvenile Justice Act.
14. That the Applicant(s) have not filed any other Application for the adoption of the said child in any other Court of Law.
15. That the Applicants understand that the adopted child shall become the lawful child of the applicants with all the rights, privileges and responsibilities that are attached to a biological child.
16. That the prescribed court fees have been paid and affixed on this Application.
17. The Applicant(s), therefore, pray that:
(a)That the above named child may please be given in adoption to them and be declared as the parents of the said minor for all purposes allowed by the law.(b)The Birth Certificate Issuing Authority (name and place) may please be directed to issue Birth Certificate for the said child/children within five working days from the date of application, as provided in regulation 36 of the Adoption Regulations.
| Photograph of the biological parent(s) |
Photograph of the child |
Photograph of the adoptive parent(s) |
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XXXI
[See regulation 55(3)]Model Application to Court for Inter-Country Relative AdoptionIn the Court of ____________ Ld. District and Sessions Judge/Addl. District and Sessions Judge, District Court/Principal District Judge, Family Court or Civil Judge/Addl. Civil Judge (Senior Division), as the case may be, at ______________________________.Misc. Civil Application (MCA) No. ___________________/Year.Child Adoption Resource Information and Guidance System Regd. Number of prospective adoptive parents:1. Mr. ___________________S/o _______________ Aged about _____ years, Citizen of ________, Occupation: ____________ Permanent Residential address: _______________ P.S. _________, Dist. _______ State_______;
2. Mrs. _____________________ W/o _____________ Aged about _____ years, Citizen of _________, Occupation: _____________ Permanent Residential Address: _______________ P.S. _________, Dist. _______ State_______
Applicant(s)Prospective Adoptive Parent(s)And3. Mr. _____________ S/o ___________________ Aged about _____ years, Citizen of ________, Occupation: ____________ Permanent Residential address: ______________________________;
4. Mrs. ___________________ W/o _______________ Aged about _____ years, Citizen of _________, Occupation: _____________ Permanent Residential Address: _______________________________.
Natural/ biological ParentsApplication in the matter of adoption of the child:....... (male/female, DoB:..........) under section 60 (1) of the Juvenile Justice (Care and Protection of Children) Act, 2015 (2 of 2016) read with regulations 53, 54 and 55 of the Adoption Regulations.The Applicants most respectfully submit before this Hon'ble Court as under:-1. That the Applicants are prospective adoptive parents and relative to natural /biological parents of the child ________________ (male/female) under section 2(52) of the Juvenile Justice (Care and Protection of Children Act, 2015 (2 of 2016) (hereinafter referred to as "Juvenile Justice Act").
2. That the Applicants are paternal uncle or aunt, or a maternal uncle or aunt, or paternal grandparent or maternal grandparents of the child _________________________________.
3. That the Applicants are resident of _________________________________.
4. That the child ______________________ was born to the natural parents on _______________ and they are resident of _________________________.
5. That the natural parents are desirous of placing the child in adoption for the reason ___________________.
6. That prospective adoptive parents are desirous of adopting the child for the reason ____________________.
7. That the Applicants and the natural parents have given consent to the proposed adoption which is annexed with the Application.(In case the natural parents are not alive, document related to permission for adoption from the Child Welfare Committee would be annexed as provided in the Adoption Regulations.
8. That the child proposed to be adopted is a minor (below five years) who is not able to express his/her views.
OrThat the child proposed to be adopted has also given his /her consent for the said adoption and is willing to accept the Applicants as parents.9. That the adoption of the child by the Applicants from the natural parents would be in the paramount welfare of the child and the Applicant(s) would treat the child as their own with all rights and responsibilities.
10. That neither the Applicants have given or agreed to given, nor have the natural parents or guardians of the child received or agreed to receive any payment or reward in consideration of the adoption.
11. That the Applicants have been found eligible and suitable to adopt the relative's child as provided in section 2 (52) of the Juvenile Justice (Care and Protection of Children Act, 2015 (2 of 2016).
12. That the family background report of the child has been conducted by the District Child Protection Unit (DCPU) where the child ordinarily resides with the natural family and the District Child Protection Unit has furnished its report as per regulation 54 (2) and (3) of the Adoption Regulations which is annexed hereto this application.
13. That the receiving country of the child where the Applicants ordinarily reside have issued necessary certificate or permission in accordance with Article 5/17 of the Hague inter-country Adoption for the adoption to proceed as per sub-regulation 5 of the regulation 54 which is annexed here to this application.
14. That the conditions laid down in section 61 (1) of the Juvenile Justice Act (2 of 2016) have been complied with in the case of proposed adoption.
15. That the giver(s) and taker(s) have no interest directly or indirectly adverse to that of the child/children.
16. The child ordinarily resides within the jurisdiction of this Hon'ble Court and hence this Hon'ble Court has jurisdiction to pass Adoption Order as per the provisions of section 61 of the Juvenile Justice Act (2 of 2016).
17. That the Applicant(s) have not filed any other Application for the adoption of the said child in any other Court of Law.
18. That the Applicants understand that the adopted child shall become the lawful child of the applicants with all the rights, privileges and responsibilities that are attached to a biological child.
19. That the prescribed court fees have been paid and affixed on this Application.
20. The Applicant (s), therefore, pray that:
(a)The above named prospective adoptive parents may be declared as the parents of the said minor for all purposes allowed by the law.(b)The Birth Certificate Issuing Authority (name and place) may please be directed to issue Birth Certificate for the said child/children within five working days from the date of application, as per the provisions of regulation 36 of Adoption Regulations.(c)The Regional Passport Office (RPO) concerned may be directed to issue Passport for the said child/children within ten days from the date of application, as per the provisions of sub regulation 4 of regulations 18 and regulations 38 of Adoption Regulations.
| Photograph of the biological parent(s) |
Photograph of the child |
Photograph of the adoptive parent(s) |
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XXXII
[See regulation 52(4), 55(2)]Model Application to court for Adoption of Child/ Children by Step & Biological ParentIn the Court of ____________ Ld. District and Sessions Judge/Addl. District and Sessions Judge, District Court/Principal District Judge, Family Court or Civil Judge/Addl. Civil Judge (Senior Division), at _______ (strikeout whichever is not applicable).Misc. Civil Application (MCA) No.____________________/Year.Child Adoption Resource Information and Guidance System Regd. Number of prospective adoptive parents:1. Mr. __________________ S/o _____________ Aged about _____ years, Citizen of ___________, Occupation: _______________ Permanent Residential Address: _______________ P.S. _________, Dist._______ State______________.
ApplicantBiological Father/Father Adopting the Child(ren)And2. Mrs. _________________ W/o ______________ Aged about _____ years, Citizen of _________, Occupation: _________________ Permanent Residential Address ____________________.
ApplicantBiological Mother/Mother Adopting the Child(ren)Application in the matter of adoption of the child:....... (male/female, DOB:..........) under section 56 of the Juvenile Justice (Care and Protection of Children) Act, 2015 (2 of 2016) (hereinafter referred to as "Juvenile Justice Act") read with regulations 52 (4) and 55 (2) of the Adoption Regulations.The Applicants most respectfully submit before this Hon'ble Court as under:-1. That the Applicants are biological parent and step-parent (legally wedded spouse of the biological parent) of the child/ children with details as given in Schedule XX.
2. That the Applicants are resident of _________________________________.
3. That the child/children ________________________ with sex ___________ (Male/Female) and Date of Birth(s) _______________ was/were born to the natural parents (biological parent) _______________________ and ___________________________ on ___________________________ and they are resident of _____________________________________________________.
4. That the biological parent (applicant) is desirous of sharing the legal relationship of the child/children with the spouse adopting the child/children(applicant), being legally married him/her and he/she is wanting to adopt the child(ren).
5. That the consent of the other biological parent has been obtained /the other biological parent is deceased. (Strike out whatever is not applicable)
6. That the biological parent and step-parent adopting the child/children (applicants) understand that the adoption of the child/children will create a permanent parent-child relationship with them.
7. That the consent(s) as required for adoption in Schedule XX of the Adoption Regulations are annexed with the Application.
8. That the child(ren) proposed to be adopted is a/are minor(s) (below five years) who is/are not able to express his/her/their views.
9. That the conditions laid down in Section 61 (1) of the Juvenile Justice Act (2 of 2016) have been complied with in the case of proposed adoption.
10. That the child ordinarily resides within the jurisdiction of this Hon'ble Court and hence this Hon'ble Court has jurisdiction to pass Adoption Order as per the provisions of sub-section 2 of section 56 read with subsection (1) of section 112 of the Juvenile Justice Act (2 of 2016).
11. That there is no litigation for custody of the said child/children in any Court of Law within the country or overseas.
12. That the Applicants have not filed any other Application for the adoption of the said child/children in any other Court of Law within the country or overseas.
13. That the Applicants understand that the adopted child/children shall become the lawful child/children of the applicants with all the rights, privileges and responsibilities that are attached to a biological child/children.
14. That the prescribed court fees have been paid and affixed on this Application.
15. The Applicant(s), therefore, pray that:
(a)That the legal relationship of father/mother of above named child/children may please be transferred to the step-parent adopting the child/children (applicant) along with the biological mother/father (applicant) and they be declared as the parents of the said minor for all purposes allowed by the law.(b)The Birth Certificate Issuing Authority (name and place) may please be directed to issue/modify the Birth Certificate for the said child/children within five working days from the date of application, as provided in regulation 36 of Adoption Regulations.
| Photograph of the biological parent(s) |
Photograph of the child |
Photograph of the adoptive parent(s) |
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