Substantial revision is required before use.
Sample language may or may not be consistent with current law or rules of court. Any person involved in a legal proceeding would be wise to obtain competent local counsel with recent experience in the relevant area of law as soon as possible. I understand that I have a right to consult independent counsel in making this decision, but I decline to do so. I further understand that adoption may affect my life in a variety of respects concerning which advice by independent counsel would be advisable. Having examined this instrument carefully, and with full awareness as a competent, literate adult, I waive the right to consult independent counsel prior to consenting to my own adoption.