Authorizations and Confidentiality

By signing below I am agreeing that it is my intention to place my child expected to be born on or about the below listed date with International Family Services / Adoption Planners or an adopting couple yet to be selected.

I agree to sign all necessary and required documents for adoption and to otherwise cooperate in the completion of the adoption.

I agree that I am working exclusively with International Family Services / Adoption Planners.

Birth Mother's First Name

Birth Mother's Last Name

Expected Date My Child Is To Be Born

Birth Mother's Signature

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