Statements of Understanding

Purpose

The purpose of this form is for an expectant mother to understand all her rights and the rights of A Guardian Angels Adoptions, LLC

    If you have read the following statements click I accept. If you have questions or concerns, please call us at 877-742-6435.

    Statements

    Application for Services:

    I, at my own desire and discretion, have decided to apply with A Guardian Angel Adoptions, LLC for assistance with my adoption plans. All information I have supplied throughout the application process is true and correct to the best of my knowledge.

    I accept

    Fraud Statement:

    I understand that misrepresenting my pregnancy or my desire to place my child for adoption is considered fraud. I understand that receiving assistance from A Guardian Angel Adoptions without the intention of placing my baby is considered fraud. I also understand that receiving assistance and support from more than one adoption agency at the same time may also be considered fraud. I also understand that adoption agencies may share information about me with other agencies in an effort to prevent fraud.

    I accept

    Policies and Procedures:

    I understand that A Guardian Angel Adoptions, LLC has policies and procedures and I agree to follow those Policies and Procedures.

    I accept

    Alcohol and Drug Use:

    I understand the use of alcohol or illegal drugs or the misuse of prescription drugs will harm my baby and I agree to not use drugs or alcohol while under the care of A Guardian Angel Adoptions, LLC. I also agree that I will share if I have or have had a drug or alcohol problem with A Guardian Angel Adoptions, LLC in order for them to give me and my baby the best care possible.

    I accept

    Drug/HIV Testing:

    I understand that A Guardian Angel Adoptions, LLC will request that I participate in drug and HIV testing. These tests are done automatically for all birth parents working with A Guardian Angel Adoptions, LLC.

    I accept

    Jurisdiction:

    If I chose to travel to Utah, I expressly submit to the jurisdiction of the courts of the state of Utah and agree to be bound by the laws of Utah.

    I accept

    Choice to Travel:

    I understand that A Guardian Angel Adoptions, LLC neither encourages nor recommends long-distance travel by any means within two weeks of my due date. If I choose to travel to Utah, I take full responsibility for my decision to travel and for any consequences resulting from the trip, be they physical, financial, emotional, or otherwise, for myself and for any of my children traveling with me. I willingly and knowingly choose to leave the state in which I have been residing and release A Guardian Angel Adoptions, LLC from and responsibility for my choice to travel.

    I accept

    Statement of Liability:

    I acknowledge that A Guardian Angel Adoptions, LLC is providing the best services possible to me in good faith and I do not hold them responsible or liable in any way for any harm or accident that may come to me during my association with them.

    I accept

    Living Expenses:

    I understand that A Guardian Angel Adoptions, LLC may assist me with necessary living expenses during my pregnancy including rent, food, and utility payments if allowable in the state of services. A Guardian Angel Adoptions, LLC will also assist me in accessing any local resources that may be available to me during my pregnancy or following the delivery of my child. I understand the agency is limited by law regarding the assistance offered. I understand A Guardian Angel Adoptions, LLC is unable to pay for past bills or deposits.

    I accept

    Release of Information:

    I understand that in signing the "Release of Information" form that I am authorizing any and all psychological, psychiatric, and health information or birth certificate records pertaining to me or any child of mine to be released to A Guardian Angel Adoptions, LLC.

    I accept

    Counseling:

    I understand that A Guardian Angel Adoptions, LLC will provide me with counseling and support to help me in making decisions concerning my pregnancy. A licensed adoption counselor or a professional counselor will be assigned as my counselor to assist me throughout the adoption process.

    I accept

    Permission:

    I give permission for my caseworker and social worker to discuss my case with other staff members of the agency, health care workers, other adoption agencies, and legal counsel as needed.

    I accept

    Other Services:

    I understand that services are rendered on a case-by-case basis and that services provided to another birth mother or expectant mom may not be the same as those provided to me.

    I accept

    Privacy Statement:

    I understand that A Guardian Angel Adoptions, LLC will not disclose my last name, address, phone number or any other identifying information to the adoptive family without my permission; however, they cannot guarantee privacy in any adoption.

    I accept

    Selection and Information Sharing:

    I understand that If I desire I may be involved in the selection of my adoptive family. I understand that non-identifying information about the other birth parent, the pregnancy, and myself will be shared with any family I may be considering as potential parents for my child. I have signed or will sign a release of information, allowing information specifically for this purpose.

    I accept

    Adoptive Placement:

    A Guardian Angel Adoptions, LLC will assist me in selecting the adoptive parents who match my request, though they cannot guarantee all my preferences will be met. All adoptive parents have been thoroughly screened by A Guardian Angel Adoptions, LLC, and found appropriate for the placement of my child.

    I accept

    Religion Statement:

    I understand and agree that A Guardian Angel Adoptions, LLC will look for families that meet my criteria however may place my child with a family that may or may not practice religion as I do. A Guardian Angel Adoptions, LLC does not discriminate against adoptive families or expectant parents because of religious affiliation.

    I accept

    Elective Post Operative Surgery:

    I understand that if I choose to have an elective post-operative surgery, I will be responsible for all associated charges incurred. Elective post-operative surgery is not considered an adoption related expense, and therefore, CANNOT be reimbursed.

    I accept

    Services Provided:

    I understand that staff members of A Guardian Angel Adoptions, LLC usually are employed supporting the expectant parents or the adoptive parents however, if because of unforeseen circumstances the same worker is providing me services and also is providing services to the adoptive family I understand that such an arrangement might create a conflict of interest between my concerns and the concerns of the adoptive family and I understand that A Guardian Angel Adoptions, LLC will carefully oversee the process if this occurs.

    I accept

    Irrevocable Relinquishment:

    I understand that if I place my child for adoption I am subject to state laws and will be required to sign relinquishment documents as outlined by the laws of the state I am placing in. I further understand that when I sign the relinquishment and consent paperwork, all my rights and responsibilities to my child will end and that my consent to adoption will be final, irrevocable, and legally binding from the time appointed by the state in which the adoption is taking place.

    I accept

    Openness Agreement:

    I understand that A Guardian Angel Adoptions, LLC will assist in working with the adoptive family in regards to the openness agreement by setting up a post-placement plan that meets my specific needs and desires. A Guardian Angel Adoptions, LLC will facilitate the exchange of pictures, letters, and phone calls for the birth mothers and adoptive families. I understand that in Utah, openness agreements are not legally binding.

    I accept

    Post-Placement Arrangements:

    I understand A Guardian Angel Adoptions, LLC will provide housing for up to ten days in Utah after I place my child for adoption. I will also be given a reasonable amount of financial assistance to help me for up to six weeks following my placement, according to the laws and allowances in the state where I deliver and place my baby for adoption. Additionally, I understand that A Guardian Angel Adoptions, LLC will provide me with transportation back to my home. Other post-placement services include facilitation of openness agreement and up to three post-placement counseling visits and/or appropriate counseling and community referrals.

    I accept

    Statement of Promises:

    There have been no promises made to me that would influence my decision to place my baby for adoption. I have not been offered gifts or promises for placing my child for adoption. I understand that gifts or allowances beyond the guidelines set by A Guardian Angel Adoptions, LLC cannot be accepted.

    I accept

    Utah Mutual Consent Registry:

    I understand the Utah Mutual Consent Registry makes it possible for the birth parents and adoptees to be reunited when the adoptee is 18 years of age. I understand that contact will be possible through this resource only if both the adoptee and birth parent register. I understand it is my responsibility to contact the office and register my desire to participate with the registry. These services are administered by the Utah State Department of Vital Records.

    YesNo

    Legal Advice:

    I understand that I have the legal right to consult with an attorney of my own choice and to seek independent legal counsel prior to making the decision to place my child for adoption.

    I accept

    Birth Father Information:

    I agree to give A Guardian Angel Adoptions, LLC thorough and accurate information regarding the father of my child.

    I accept

    Information Provided:

    I understand A Guardian Angel Adoptions, LLC reserves the right to discontinue services if for any reason the information provided, is not consistent with fact or actions.

    I accept

    Information on Marriage:

    I agree to give A Guardian Angel Adoptions, LLC thorough and accurate information regarding my marital status.

    I accept

    Medical Expenses:

    I understand that if I decide not to place my child for adoption, I will be responsible for all medical expenses incurred for me and my child.

    I accept

    Other Expenses:

    If for any reason, I choose to parent my baby, I will be responsible for all expenses from that day forward related to caring for myself, my baby, and any other individual that accompanied me to Utah. This includes, but is not limited to, housing and living expenses, baby necessities, and previous, current, and future medical care. I agree to find housing/hotel until I leave Utah. Transportation to the city I came from will be provided by Greyhound Bus service after I have been medically cleared to travel. No exception to this policy is permitted.

    I accept

    I, am not under the influence of any drugs, alcohol, or medication that may influence my reasoning or judgment and am signing this document of my own free will and choice.


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