S.I. No. 19/1965 - Adoption Rules, 1965.

1. Is the applicant suffering from any functional disorder or organic disease?

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2. If so, please give particulars

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3. Do you consider that the applicant is, as far as health is concerned, suitable to adopt a child?

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

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

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

GIVEN under the Official Seal of the Board this 2nd day of February, 1965.

ALFRED A. ROCHFORD,

Chairman.

I consent to the foregoing rules.

GIVEN under my Official Seal, this 2nd day of February, 1965.

BRIAN LENIHAN,

Minister for Justice.

EXPLANATORY NOTE.

These Rules prescribe the forms to be used for the purposes of the Adoption Acts, 1952 and 1964. They replace similar Rules made in 1953.

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 persons 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) ............................................................ ......................................

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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 to interest themselves or in what circumstances do they propose to arrange adoptions ............................................................ ............................................................ ..........................................................

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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 ACTS, 1952 AND 1964

Memorandum to be furnished by a registered adoption society to a mother, father 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

(a) the mother of the child,

(b) the father of the child (in the case of any child who has been legitimated by the marriage of its parents), and

(c) any person appointed by will or deed or by Court Order to be the child's guardian,

unless the mother, father or guardian, as the case may be, 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).

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(Detach here).

To the registered adoption society called............................................................ .....................................................

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I 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............................................................ ............................................................ ...............

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

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

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 Acts, 1952 and 1964, An Bord Uchtála 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 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 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 .......................................................... in 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............................................................ ............................................................ .........................

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

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

............................................................ ................................................... *Delete words which do not apply.

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 APPLICANT

(This form to be completed by a registered medical practitioner)

I HEREBY CERTIFY that I have examined

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

(SURNAME FIRST IN BLOCK LETTERS)

of ............................................................ ............................................................ ...........................

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

on this date and on the basis of my examination I give the following answers to the questions set out below:—

8. If the child is illegitimate, state

(a) Mother's name............................................................ ............................................................ ...................

(b) Is the mother alive or dead............................................................ ..........................................................

(c) If alive, state

(i) her address............................................................ ............................................................ .............

(ii) occupation............................................................ ............................................................ ................

(iii) date of birth, or if date unknown, her approximate age............................................................ .

(iv) religious denomination ............................................................ ....................................................

(v) whether the mother changed her religion at any time, if so, in what way, and give date of change............................................................ ............................................................ ......................

(d) If the mother is dead, state

(i) approximate date of death............................................................ .........................................

(ii) ordinary place of residence before her death............................................................ ...............

(Block letters)

(iii) place of death

(Block letters)

(iv) religious denomination at death............................................................ .......................................

(v) whether she had changed her religion at any time and, if so, particulars and date of change............................................................ ............................................................ .......................

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9. 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 ............................................................ .....................................................

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(Block letters)

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

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(Block letters)

11. If the child is or has been under the control of a Health Authority or Registered Adoption Society state name and address of Health Authority or Registered Adoption Society and date on which such body acquired control over the child.

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

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

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

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

FORM 3A

CONSENT TO ADOPTION

(For use by mother where the identity of the applicant is known to her)

In the matter of an application for the adoption of

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

13. Religious denomination ............................................................ ............................................................ ...............

PART II—

SECTION C

(To be completed in every application)

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

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

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

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16. Christian name of child to whom this application refers............................................................ ................

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(Block letters.)

17. Sex............................................................ ............................................................ ................................................

18. Date of birth ............................................................ ............................................................ ...............................

19. Name and address of person or body from whom you got the child.........................................................

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

20. Date on which you took the child under your care............................................................ ...........................

21. Please give the names and addresses of two or more persons (either men or women) to whom reference may be made by the Board............................................................ ........................................................

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(Block letters.)

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. 19 of 1965.

ADOPTION RULES, 1965.

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

section 5

of the

Adoption Act, 1952

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