ADOPT-216 - Verification of Compliance with Hague Adoption Convention Attachment

Summary

Verification of Compliance with Hague Adoption Convention Attachment

Text

Form ID: ADOPT-216
Title: Verification of Compliance with Hague Adoption Convention Attachment
Effective Date: 2013-07-01
Mandatory Form: yes
Languages: español
Info Page: https://selfhelp.courts.ca.gov/jcc-form/ADOPT-216
Primary Download URL: https://www.courts.ca.gov/documents/adopt216.pdf
Alternate Download URLs: https://www.courts.ca.gov/documents/adopt216s.pdf
Form Detail Page:
Verification of Compliance with Hague Adoption Convention Attachment
(ADOPT-216)
Tells the court that the adoptive parent(s) or the child or child's birth parents may live outside of the United States and whether the adoptive parents have met all requirements under the Hague Convention.  Once completed, this form must be attached to the Adoption Order (ADOPT-215) prior to the final hearing.
Get form ADOPT-216
español
Get form ADOPT-216 in Spanish
(Spanish)
Effective: July 1, 2013
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PDF Text:
Judicial Council of California,  www.courts.ca.gov   
New July 1, 2013, Mandatory Form  
Family Code, §§ 8900, 8900.5, 8901, 8902, 8903,  
8904, 8905, 8908, 8910, 8911, 8912, 8919, 8924,  
8925; 22 Code of Federal Regulations Part 96, § 97.3; 
Hague Adoption Convention 
Verification of Compliance with 
Hague Adoption Convention Attachment
ADOPT-216, Page 1 of 2
ADOPT-216 Verification of Compliance with Hague  
Adoption Convention Attachment
Clerk stamps date here when form is filed.
Superior Court of California, County of
Court fills in case number when form is filed.
Case Number:
(Attach to Adoption Order (form ADOPT-215) in cases proceeding under 
the Hague Adoption Convention.)
1 Determination of Application of Hague Adoption Convention  
(to be completed by adopting parent(s)):
a. If applicable, please state the permanent address outside the United 
States of the adopting parent(s): 
b. Will you be moving the child to permanently reside in another  
country?  Yes No
c. If your answer to 1(b) is yes, what is the name of the other country?
d. If your answer to 1(b) is yes, when will the move occur?
e. Has the child lived in any other country since his/her birth? Yes No
f. If your answer to 1(e) is yes, please indicate the country and the length of time the child resided there. 
(country): 
(length of time resided in country): 
g. What is the child's citizenship?
h. Please state date(s) for any contact between the prospective adoptive parent(s) and the child's birth parent(s) or 
any other person who has had care of the child and describe the contact:
i. Please state the amount and purpose of any payments made by the adopting parent(s) to the birth parent(s)  
or any other person who has had care of the child:
2 Court Findings (to be completed by the judge)
The court finds as follows:
The Hague Adoption Convention applies to this adoption.
All parental rights have been terminated and the child has been declared free from the custody and control of his 
or her parents; thus, the child is adoptable. (Convention, art. 4(a).)

For your protection and privacy, please press the Clear 
button after you have printed the form.
New July 1, 2013
Verification of Compliance with  
Hague Adoption Convention Attachment
ADOPT-216, Page 2 of 2
Your name:
Case Number:
By clear and convincing evidence, an intercountry adoption is in the best interest of  the child. (Convention, art.  
4(b).)
The adoption services provider meets the requirements of 22 C.F.R. (Code of Federal Regulations) part 96.
3 Court Verifications (to be completed by the judge)
The court verifies that the agency has met the substantive regulatory requirements of 22 C.F.R. § 97.3(a)–(k) in the 
following categories:
Preparation of child background study (Convention, art. 16(1)(a); 22 C.F.R. § 97.3(a));
Transmission of child data to foreign authorized entity (Convention, art. 16(2); 22 § C.F.R. 97.3(b));
Reasonable efforts to find domestic placement (Convention, art. 4(b); 22 C.F.R. § 97.3(c));
Preparation and transmission of home study (Convention, art. 15; 22 C.F.R. § 97.3(d));
Authorization for the child to enter the receiving country (Convention, art. 5; 22 C.F.R. § 97.3(e));
Consent to the adoption/custody by foreign authorized entity (name of entity):  
(Convention, art. 17; 22 C.F.R. § 97.3(f));
Guardian/parent counseling and consent (specify):   
(Convention, art. 4(d); 22 C.F.R. § 97.3(g));
Child counseling and consent (if applicable)(specify):    
(22 C.F.R. § 97.3(h));
The agency and the Central Authority of the receiving country, as defined in Family Code section 8900.5(c),  
(name of receiving country):                                                                                                     
(name of central authority):     
have both signed Placement Adoption Papers (22 C.F.R. § 97.3(i));
The agency has taken all steps to ensure the secure transfer of the child, including obtaining permission for  
the child to leave the United States (Convention, arts. 18 & 19; 22 C.F.R. § 97.3(i));
The agency has taken all steps to keep the Central Authority of the receiving country informed about the  
adoption process, as well as the progress of the placement if a probationary period is required (Convention, art. 
20; 22 C.F.R. § 97.3(i));
Proper observance of the “no-contact” rule, if applicable (22 C.F.R. § 97.3(j));
That no improper financial or other gain was derived (22 C.F.R. § 97.3(k)).
4 Court Orders
The court grants
Final adoption order.
Final custody decree.
Date:
Judge (or Judicial Officer)

Retrieval chunks

• #1

  Form ID: ADOPT-216 Title: Verification of Compliance with Hague Adoption Convention Attachment Effective Date: 2013-07-01 Mandatory Form: yes Languages: español Info Page: https://selfhelp.courts.ca.gov/jcc-form/ADOPT-216 Primary Download URL: https://www.courts.ca.gov/documents/adopt216.pdf Alternate Download …

• #2

  any other person who has had care of the child and describe the contact: i. Please state the amount and purpose of any payments made by the adopting parent(s) to the birth parent(s) or any other person who has had care of the child: 2 Court Findings (to be completed by the judge) The court finds as follows: The H…

• #3

  The agency has taken all steps to keep the Central Authority of the receiving country informed about the adoption process, as well as the progress of the placement if a probationary period is required (Convention, art. 20; 22 C.F.R. § 97.3(i)); Proper observance of the “no-contact” rule, if applicable (22 C.F.R. § …