Act of Sederunt (Child Care and Maintenance Rules) 1997

Rule 2.21(1)

FORM 11 S PETITION FOR ADOPTION ORDER UNDER SECTION 12 OF THE ADOPTION (SCOTLAND) ACT 1978

Petition of

[A.B, full name]

[and (full name of spouse)

Maiden surname

Any previous married surname]

[Address]

For authority to adopt the child

[Full name of child as shown on birth certificate], born on

[Child’s date of birth]

Child’s present address]

The petitioner(s) crave(s) the court [(1)] to make an adoption order in his/her/their favour under section 12 of the Adoption (Scotland) Act 1978, in relation to the child [; and to dispense with the agreement [or consent] of on the ground that ] and condescends as follows:

1.—a. The petitioner(s) is/are domiciled in and reside(s) at [or the male/female petitioner is domiciled in and both petitioners reside at ]. S

b. The occupation(s) of the petitioner(s) is/are.

c. The petitioner(s) is/are married [or unmarried or widow or widower]. (If married, state whether spouse resides with, or apart, from, the petitioner).

d. The petitioner(s) is/are [respectively] [and] years of age.

e. The petitioner(s) has/have resident with him/her/them the following persons, namely.

f. The child was received into the home of the petitioners on (date).

g. The child has continuously had his home with the petitioner(s) since the date shown above.

h. *Arrangements for placing the child in the care of the petitioner(s) were made by (give full name and address of agency or authority or person making such arrangements) and therefore notification in terms of section 22(1) of the Adoption (Scotland) Act 1978 is not required.

i. *The petitioner(s) notified (give name of local authority notified) of his/her/their intention to apply for an adoption order in relation to the child on (date).

(*Delete as appropriate)

j. An order freeing the child for adoption was made at Sheriff Court on (date) [or an order declaring the child free for adoption has not been made].

k. No reward or payment has been given or received by the petitioner(s) for or of in consideration of the adoption of the child or the giving of consent to the making of an adoption order.

2.—a. The child is years of age, having been born on the day of 19, at in the County of. S

b. The child is not and never has been married and is male/female.

c. The child’s natural mother is (full name and address)

d. *The child’s natural father is (full name and address)

e. *Paternity of the child has not been admitted or established by decree of any court.

(*Delete either (d) or (e) as appropriate)

f. The child is of British/or nationality.

g. The child is entitled to the following property, namely

h. The child has the following tutors, curators or guardians. (Either give full names and addresses or delete the paragraph if it does not apply).

3.   is/are liable to contribute to the support of the child. S

4.  The child has not been the subject of an adoption order or of a petition for an adoption order save that. S

5.  The petitioner(s) is/are prepared to undertake, if any order is made on this petition, to make for the said child the following provisions, namely— S

6.  There is lodged along with this application the following documents S

(i) extract birth certificate relating to the child

(ii) extract marriage certificate relating to the petitioner(s)

(Note: this need be lodged only in the case of a joint application by spouses)

(iii) medical certificate relating to the health of the male petitioner

(iv) medical certificate relating to the health of the female petitioner

(Note: medical certificate need not be produced where either the petitioner or one of the joint petitioners is a parent of the child)

(v) *agreement to the adoption by the child’s natural mother

(vi) *agreement to the adoption by the child’s natural father

(vii) *consent to the adoption by the child

(viii) *consent to the adoption by the tutor or curator

(ix) *extract of the order freeing the child for adoption

(x) *acknowledgement by local authority of letter by petitioner(s) intimating intention to apply for adoption order

(xi) *report by local authority in terms of section 22(2) of the Adoption (Scotland) Act 1978

(xii) *report by the adoption agency in terms of section 23 of the Adoption (Scotland) Act 1978

(xiii) *any other document not referred to above

(*Delete as appropriate)

7.   have taken part in the arrangements for placing the child in the care of the petitioner(s)— S

The petitioner(s) crave(s) the court to dispense with intimation and to order notice of this petition to be served on such persons, if any, as the court may think proper, and thereafter, on resuming consideration hereon, to make an adoption order in favour of the petitioner(s) under section 12 of the Adoption (Scotland) Act 1978 on such terms and conditions (if any) as the court may think fit, and to direct the Registrar General for Scotland to make an entry regarding the adoption in the Adopted Children Register in the form prescribed by him, giving as the forename(s), and the surname of the adopter(s) as the surname of in the form; and further, upon proof to the satisfaction of the court in the course of the proceedings to follow hereon, that (name of child) was born on the day of in the year Nineteen hundred and and is identical with the to whom any entry numbered and made on the day of in the year 19, in the Register of Births for the Registration District of in the relates, to direct the said Registrar General to cause such birth entry to be marked with the word “adopted" and to include the abovementioned date of birth in the entry recording the adoption in the manner indicated in the Schedule to the said Act and to pronounce such other or further orders or directions upon such matters including the expenses of this petition, as the court may think fit.

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Signature of male petitioner

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Signature of female petitioner

or

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Signature of solicitor with designation and address

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