Certificate of Adoption

I, (adoptor SN), by the affixing of my signature below, do hereby take responsibility of the one known as (adoptee SN). Any and all requirements, including but not limited to, food, clothing, and protection will be provided by me from this day forward.

(adoptee SN) will have all rights and priviledges granted to any holding my name.

The child's name, after adoption, shall be ___________________.

_______________________________(Adoptor SN)

Date:

_______________________________(Scribe SN)

Date: