Form Aoc-292 - Appearance Waiver And Consent To Adoption

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AOC-292
Doc. Code: AWCA
Rev. 6-17
Case No. ____________________
Page 1 of 2
l e x
e t
Court
q District
q Family
j u s t i t i a
Commonwealth of Kentucky
Court of Justice
County
____________________
APPEARANCE WAIVER AND
KRS 625.041(3); 199.011(16); and
Division
____________________
CONSENT TO ADOPTION
199.500
IN THE INTEREST OF:
_____________________________________________, a child
Respondent
_______________________________________________
Address
_______________________________________________
_______________________________________________
WAIVER OF APPEARANCE
I, ___________________________________________________________, hereby state that I am the natural parent of
the above-named child and I hereby voluntarily, and with full knowledge and agreement, waive my right to appear in the
above-styled proceeding to terminate my parental rights.
_______________________________________________
Parent's Signature
_______________________________________________
Parent's Name (Please Print)
_______________________________________________
Counsel for Parent
_______________________________________________
Guardian ad litem for Minor Parent
_______________________________________________
Cabinet Designee
SUBSCRIBED and SWORN to before me this ___________ day of _______________________________, 2_______.
My Commission expires: ___________________________.
____________________________________________
Notary Public
q Please mail a copy of the FINAL JUDGMENT to:
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________

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