Adoption & Fostering Resource Center
Sample Letters
Waivers of Confidentiality

The Adoption & Fostering Resource Center is compiled and maintained by volunteers. If you would like your page to be included in this listing, please E-mail AF Resources for consideration.

Adoptee's Waiver of Confidentiality

Date:


Adoption Agency, State Adoption Department, Hospital of Birth
Address
City, State, Zip

TO ALL CONCERNED PARTIES:

      I hereby formally request that this letter and/or copies hereof be immediately placed in all records and files pertaining to my adoption as follows:

            - (give full adopted name)
            - (give date, time, and place of adoption and relinquishment if known)

      This is to be considered my legal authorization to waive the confidentiality guaranteed to me by any laws and/or organizations of the state of (give name); and includes all court records, agency records, hospital records, and anything considered to be identifying information.

      The effects of this waiver are to extend only to my birth parents, birth siblings, any other blood relatives, and/or their legal representatives. The following information may hereby be released in full to the above mentioned parties:

            - My full name (present and maiden)
            - My current address (give address)
            - My current telephone number (if desired)

      This waiver gives my full and legal permission to release my present identity; with the exclusion of any reference to my adoptive parents, and/or adoptive relatives. Please respond to this request, and should you refuse it denote the state law that supports such an action. This letter is to remain in full effect until otherwise revoked by myself in writing.

Sincerely,



(your signature)
Address
City, State, Zip

(Note: This letter must be notarized. It should be typed in a formal fashion, and sent certified mail - return receipt requested. Keep the receipt in your correspondence file attached to a copy of this letter. You may wish to have an attorney review this, as it is a legal document.)

Adoptive Parent's Waiver of Confidentiality

Date:


Adoption Agency, State Adoption Department
Address
City, State, Zip

TO ALL CONCERNED PARTIES:

      We hereby formally request that this letter and/or copies hereof be immediately placed in all records and files pertaining to the child we legally adopted as shown below:

            - (give child's full adopted name)
            - (give date, time, and place of birth and relinquishment)

      This is to be considered my legal authorization to waive the confidentiality guaranteed to ourselves and our adopted child by any laws and/or organizations of the state of (give name); and includes all court records, agency records, hospital records, and anything considered to be identifying information.

      The effects of this waiver are to extend only to our adopted child's birth relatives and/or their legal representatives. The following information may hereby be released in full to the above mentioned parties:

            - Our full names (present and maiden)
            - Our current address (give address)
            - Our current telephone number (if desired)

      This waiver gives our full and legal permission to release our present identity as described above. Please respond to this request, and should you refuse it denote the state law that supports such an action. This letter is to remain in full effect until otherwise revoked by us both in writing.

Sincerely,



(Both husband & wife's signature)
Address
City, State, Zip

(Note: This letter must be notarized. It should be typed in a formal fashion, and sent certified mail - return receipt requested. Keep the receipt in your correspondence file attached to a copy of this letter. You may wish to have an attorney review this, as it is a legal document.)

Birth Parent's Waiver of Confidentiality

Date:


Adoption Agency, State Adoption Department, Hospital of Birth
Address
City, State, Zip

TO ALL CONCERNED PARTIES:

      I hereby formally request that this letter and/or copies hereof be immediately placed in all records and files pertaining to my child which was surrendered for adoption as follows:

            - (give full birth name of child)
            - (give date, time, and place of birth and relinquishment)
            - (give your full name at the time of birth and relinquishment)

      This is to be considered my legal authorization to waive the confidentiality guaranteed to me by any laws and/or organizations of the state of (give name); and includes all court records, agency records, hospital records, and anything considered to be identifying information.

      The effects of this waiver are to extend only to my relinquished child, and any of their adoptive relatives or legal representatives. The following information may hereby be released in full to the above mentioned parties:

            - My full name (present and maiden)
            - My current address (give address)
            - My current telephone number (if desired)
            - All medical records in your files; including those enclosed with this waiver.

      This waiver gives my full and legal permission to release my present identity as described above. Please respond to this request, and should you refuse it denote the state law that supports such an action. This letter is to remain in full effect until otherwise revoked by myself in writing.

Sincerely,



(your signature)
Address
City, State, Zip

(Note: This letter must be notarized. It should be typed in a formal fashion, and sent certified mail - return receipt requested. Keep the receipt in your correspondence file attached to a copy of this letter. You may wish to have an attorney review this, as it is a legal document.)

The Adoption & Fostering Resource Center is compiled and maintained by volunteers. The resources here are offered for informational purposes only.

Some information in this collection may be available only to AOL members. Please direct questions or comments to AFResources.

Revised March 23, 2001