S.I. No. 104/1953 - Adoption Act, 1952, Rules, 1953.

1. Address of Society's headquarters............................................................ ...................................................

(Block letters).

............................................................ ............................................................ .......................................................

2. Date of establishment............................................................ ............................................................ ...............

3. Objects of the Society. [A copy of the Society's constitution or other instrument (if any) governing its activities should be attached]............................................................ ............................................................ ..........

4. Full names, addresses, occupations and/or descriptions of

(a) all members of the Committee controlling the activities of the Society and

(a)

attach separate lists.

(b) all person employed by the Society, whether voluntary or paid, on work connected with adoption.

(b)

5. Has the Society under its control any home, hostel, orphanage or other such institution in which children under the age of seven years are maintained ?

............................................................ ............................................................ ........................................................

6. If the answer to question 5 is " yes," state

(a) The address of such Institution............................................................ ..................................................

............................................................ ............................................................ ............................................

............................................................ ............................................................ .............................................

(b) Whether it is exclusively an institution for children (if not, give brief particulars) and whether it is exclusively for boys or exclusively for girls ............................................................ ........................

(c) Number of children for whom accommodation and care can be provided in the

institution ............................................................ ............................................................ .........................

(d) Approximate number of children normally in the institution............................................................ ...

(e) In what religion the children are brought up............................................................ .............................

(f) How the institution is mainly financed............................................................ ........................................

(g) Whether the Society, if registered, propose to concern themselves only with the children in this institution if not, give brief particulars.

............................................................ ............................................................ ............................................

7. If the answer to question 5 is " no," state briefly how the Society propose to function as a registered Adoption Society—in what children they propose tointerest themselves or in what circumstances do they propose to arrange adoptions............................................................ ............................................................ ......

............................................................ ............................................................ ............................................................

The Society hereby undertake, if registered, to make available to the Board, when requested, in relation to any and every child with whose proposed adoption the Society is concerned, all material facts known to the Society relating to the child, and to the proposed adopters, for the assistance and guidance of the Board prior to the making of an adoption order.

STATUTORY DECLARATION.

I,............................................................ ................ do solemnly and sincerely declare that the foregoing particulars stated in this application are true and I make this solemn declaration conscientiously believing the same to be true and by virtue of the

Statutory Declarations Act, 1938

.

Signature............................................................ ..............................................

Office held in the Society............................................................ .................

Address............................................................ ................................................

............................................................ ................................................

Date............................................................ ................................................

Declared before me(a)............................................................ ....................................by the said applicant who is personally known to me (or who is identified to me, by............................................................ ..................

who is personally known to me) at............................................................ ............................................................ ......

Signed............................................................ ............................................

Description............................................................ ....................................

This.........................................day of.....................................,19......

(a) This declaration should be made before a Notary Public or a Commissioner for Oaths or a Peace Commissioner.

Form 9.

FORM OF ENTRY IN ADOPTION SOCIETIES' REGISTER.

Serial No.

Name of Society

Address of Society's Headquarters

Name and address of Chairman/ President of Society

Name and address of Secretary of Society

Date of Application for registration

Date of registration

Remarks

Form 10.

ADOPTION ACT, 1952

.

Memorandum to be furnished by a registered Adoption Society to a mother or guardian who proposes to place a child at the disposal of a registered Adoption Society.

If an adoption order is made in respect of the child, all your rights and duties in regard to the child will be transferred permanently to the adopters. The child will be regarded as the child of the adopters and you will have no right to get it back later on, even if you can then prove that you are able to give it a better home than the adopters can. If you have an insurance policy against funeral expenses for the child, the policy will be transferred to the adopters and it will be for them to pay the premiums from then onwards. If the child is illegitimate and the natural father is making any payments for the child's benefit, either under an agreement or under an affiliation order, he will not be legally bound to continue these payments, unless the mother is the adopter.

The Board which deals with adoptions will not make an adoption order without the consent of the child's mother or guardian, unless the mother or guardian cannot be found (or is unable to give consent because of mental infirmity). In order to ensure, therefore, that you will be informed of any proposal to have the child adopted, you should notify the Society of any change in your address. If you do not do this, it may not be possible to trace you, and the adoption order may be made without your consent.

(Perforate on this line).

............................................................ ............................................................ ............................................................ .........

(Detach here).

To the Registered Adoption Society called............................................................ .....................................................

............................................................ ............................................................ ............................................................ ...

I, the mother/guardian* of the child, have received from you a statement explaining the effects of an adoption order. That statement was attached to this receipt and I have myself torn it off. I understand that statement.

Name (in block letters)............................................................ ...........................................................

Signature............................................................ ............................................................ .....................

Address............................................................ ............................................................ ........................

............................................................ ............................................................ ........................

Signature of Witness............................................................ ............................................................ .

Address............................................................ ............................................................ .......................

............................................................ ............................................................ .......................

Occupation or Description............................................................ ...................................................

*Strike out words which do not apply.

Form 11.

NOTICE OF MAKING OF ADOPTION ORDER.

(To be published by the Board in Iris Oifigiúil).

In pursuance of the powers vested in it by the

Adoption Act, 1952

(No. 25 of 1952), An Bord Uchtala has made an order for the adoption of a child............... (here insert Christian name of child) by........................................... (here insert name(s) and address of adopter(s).

Form No. 12.

NOTICE OF REGISTRATION OF ADOPTION SOCIETY.

(To be published by the Board in Iris Oifigiúil).

An Bord Uchtála has registered....................................................in the Adoption Societies Register.

Form No. 13.

NOTICE OF CANCELLATION OF REGISTRATION OF ADOPTION SOCIETY.

(To be published by the Board in Iris Oifigiúil).

An Bord Uchtála has cancelled the registration of.....................................................the Adoption Societies Register.

Form 14.

AN BORD UCHTÁLA

It has been represented to An Bord Uchtála that you can give evidence in the matter of an application for an Adoption Order by............................................................ ............................................................ ..................

You are hereby required to attend as a Witness on the hearing of the said application to be held at....................................on the..............................day of..............................19........., at.....................o'clock and on any day to which the hearing of the said application shall be ordered, and to bring with you the following documents............................................................ ............................................................ .............................................

............................................................ ............................................................ ............................................................ .....

............................................................ ............................................................ ............................................................ .....

GIVEN under the Official Seal of the Board this........................................................ day of........................................................, 19..........

Chairman/Registrar/ a person authorised by the Board to attest the Seal of the Board.

To: ...............................................

...............................................

...............................................

Note : If you do not obey this Summons you are liable on summary conviction to a fine not exceeding Twenty-five Pounds.

Form 15.

MEDICAL REPORT* ON HEALTH OF APPLICANT.

(This form is to be completed where the adoption order has been applied for by one person only).

Name of Applicant............................................................ ...................................................Age....................................

Address............................................................ ............................................................ .....................................................

How long have you known him/her?............................................................ ............................................................ ....

Do you consider that the general health of the applicant is such that he/she would be suitable as an adopter? If not, please state why............................................................ ............................................................ ...........

Signed............................................................ ..............................................

Address............................................................ ...........................................

............................................................ ...........................................

*The Applicant shall arrange to have this report completed by a registered medical practitioner.

Form 16.

MEDICAL REPORT* ON HEALTH OF APPLICANT.

(This form is to be completed in respect of the wife where the adoption order has been applied for by a married couple).

Name of Applicant............................................................ ............................................................ ........... Age...............

Address............................................................ ............................................................ .....................................................

How long have you known her ?............................................................ ............................................................ ...........

Do you consider that the general health of the applicant is such that she would be suitable as an adopter? If not, please state why............................................................ ............................................................ ....................

Signed............................................................ ........................................................

Address............................................................ .....................................................

............................................................ .......................................................

*The Applicant shall arrange to have this report completed by a registered medical practitioner.

Form 17.

MEDICAL REPORT* ON HEALTH OF APPLICANT.

(This form is to be completed in respect of the husband where the adoption order has been applied for by a married couple).

Name of Applicant............................................................ ............................................................ ........... Age...............

Address............................................................ ............................................................ .....................................................

How long have you known him ?............................................................ ............................................................ ..........

Do you consider that the general health of the applicant is such that he would be suitable as an adopter? If not, please state why............................................................ ............................................................ .......................

............................................................ ............................................................ ............................................................ .........

Signed............................................................ ............................................................ .......

Address............................................................ ............................................................ .......

*The Applicant shall arrange to have this report completed by a registered medical practitioner.

GIVEN under the Official Seal of the Board, this 6th day of March, 1953.

(Signed) D. Ua DONNCHADHA.

Chairman.

I consent to the foregoing rules

GIVEN under my Official Seal, this 11th day of March, 1953.

(Signed) GERALD BOLAND,

Minister for Justice.

8. Name of person or persons, if any, who has or have been appointed by will or deed or by Court Order to be the guardian(s) of the child............................................................ ............................................................ .......

............................................................ ............................................................ ............................................................

(Block letters)

9. Address(es) of guardian(s) named in answer to question 8............................................................ ......................

............................................................ ............................................................ ............................................................ .

............................................................ ............................................................ ............................................................ .

(Block letters)

10. If the child is under the control of a Public Assistance Authority or Registered Adoption Society state name and address of Public Assistance Authority or Registered Adoption Society, and date on which such body acquired control over the child............................................................ ..............................................

............................................................ ............................................................ ............................................................ .

............................................................ ............................................................ ............................................................ .

11. Religion in which the child is being brought up............................................................ ........................................

Signature............................................................ ........................................................

Address............................................................ ..........................................................

............................................................ ..........................................................

Date............................................................ ............................................................ ......

Form 3.

CONSENT TO ADOPTION.

(For use where the identity of the applicant is known to the consenting party).

In the matter of an application for the adoption of............................................................ ................................

I,.....................(name and description) of................., aged, twenty-one years and upwards (or, if under age, aged............years) make oath and say as follows :—

12. Date of birth............................................................ ............................................................ ......................................

13. Date and place of marriage............................................................ ............................................................ .............

14. Religious denomination............................................................ ............................................................ ..................

PART II

SECTION C.

(To be completed in every application).

15. Have you previously applied for an adoption order in respect of this or any other child and, if so, with what result?............................................................ ............................................................ .......................................

............................................................ ............................................................ ............................................................ .

............................................................ ............................................................ ............................................................ .

16. (a) Have you any children of your own; if so, please give names, dates of birth and present addresses?............................................................ ............................................................ .........................................

............................................................ ............................................................ ............................................................ .

............................................................ ............................................................ ............................................................ .

(b) Have you any other children in your care; if so, please give names and dates of birth?............................................................ ............................................................ ..........................................

............................................................ ............................................................ .....................................................

............................................................ ............................................................ .....................................................

17. Name of child............................................................ ............................................................ ......................................

(Block letters).

18. Sex............................................................ ............................................................ ......................................................

19. Date of birth............................................................ ............................................................ ......................................

20. Is the child an orphan (both parents dead)?............................................................ ...........................................

21. Is the child illegitimate?............................................................ ............................................................ .................

22. If the child is already under your care please state—

(a) Name and address of person or body from whom you got it..........................................................

............................................................ ............................................................ .................................................

(b) Appropriate date on which you took it under your care............................................................ .......

23. If the child is not living with you, please state name and address of person or body having charge of it............................................................ ............................................................ ......................................................

............................................................ ............................................................ ........................................................

24. (a) Have you obtained the mother's consent to the adoption?............................................................ ..........

(b) Have you obtained the consent of the guardian(s) and of any other person or body having charge of or control over the child?............................................................ ...........................................................

............................................................ ............................................................ .........................................................

25. If the consents referred to at 24 (a) and (b) have not been obtained, do you ask the Board to dispense with them and, if so, on what grounds?............................................................ .................................................

26. If you are arranging to have the consents referred to in Questions 24 (a) and/or 24 (b) submitted to the Board by a person other than yourself, please state name and address of such person.............................

............................................................ ............................................................ ............................................................

............................................................ ............................................................ ............................................................ .

27. Please give the names and addresses (block letters) of two or more persons (either men or women) to whom reference may be made by the Board. Where the name of a woman is given as a reference it is preferable that she should be a mother or a woman with experience in the care of children...................

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............................................................ ............................................................ ........................................................

Note:—The Board may require you to submit a medical certificate on your state of health before coming to a decision on your application.

Form 2.

PARTICULARS CONCERNING CHILD.

Note to Applicant: If you got the child from the mother or guardian you should fill this Form yourself. If you got the child from any other source you may fill this Form yourself or you may send it to the person or body who gave you the child and ask him to fill it and return it direct to the Registrar, An Bord Uchtála.

S.I. No. 104 of 1953.

ADOPTION ACT, 1952, RULES, 1953.

An Bord Uchtála, with the consent of the Minister for Justice and in exercise of the powers conferred on it by the

Adoption Act, 1952

(No. 25 of 1952), hereby makes the following rules:—