Statements of Understanding

Purpose

The purpose of this form is for 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 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 for adoption 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. A Guardian Angel Adoptions, LLC may choose to prosecute me if I have committed a fraudulent act. 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 there are Policies & Procedures of A Guardian Angel Adoptions, LLC that I must follow. If I decide not to follow these policies I understand that A Guardian Angel Adoptions, LLC has the right and responsibility to discontinue their services. Before accepting any services from A Guardian Angel Adoptions, LLC, I agree to follow those Policies and Procedures.

I accept

Alcohol and Drug Use:

I understand the use of alcohol or illegal drugs during my time as a client with A Guardian Angel Adoptions, LLC is prohibited. If I am using drugs or alcohol while I am a client through this agency, they have the option of terminating services and/or referring me to a drug or alcohol treatment facility as well as to the appropriate law enforcement.

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 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 responsibility for the choice to travel.

I accept

Statement of Liability:

I acknowledge that A Guardian Angel Adoptions, LLC is providing services 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

Living Arrangements:

I understand it is my choice to choose one person to support me through my pregnancy and the adoption process, but at any time should my support person be found using, or in possession of drugs or if they become physically or mentally abusive to me, my children, or any member of A Guardian Angel Adoptions, LLC, he/she will be IMMEDIATELY escorted to the nearest bus station to return home. There are no exceptions to this rule.

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 me 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 law enforcement officers 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 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:

If I place my child with A Guardian Angel Adoptions, LLC I may be involved in the selection of an 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 is placing my child with a family that may or may not practice religion as I do and that the adoptive parents will raise my child in the faith of their choice. A Guardian Angel Adoptions, LLC does not discriminate against adoptive families 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 who are providing me services may also be providing services to the adoptive family. I also understand that such an arrangement might create a conflict of interest between my concerns and the concerns of the adoptive family.

I accept

Irrevocable Relinquishment:

If I decide on an adoption plan for my child, I will sign the relinquishment papers. I understand that I must wait at least 24 hours following the delivery of my child to sign the relinquishment papers. I realize that when I sign the relinquishment and consent paperwork, all my rights and responsibilities to this child will end and that my consent to adoption will be final, irrevocable and legally binding.

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. A Guardian Angel Adoptions, LLC will facilitate the exchange of pictures, letters and phones 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, if applicable to the state where I deliver my baby. 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 adoptee to be reunited when the adoptee is 18 years of age. I understand that contact will be possible through this resource only if both adoptee and birth parent register. I understand it is my responsibility to initiate my desire to be listed with the registry, which is administered by Utah 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 understand A Guardian Angel Adoptions, LLC reserves the right to discontinue services if for any reason the initial birth father information I provide, is not consistent with fact.

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 understand A Guardian Angel Adoptions, LLC reserves the right to discontinue services if the information provided about any marriages I am in, or have been in are not consistent with the facts.

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 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 only 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.


Please Sign here