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Private Adoption Agreement

[READ CAREFULLY. THIS IS A LEGALLY BINDING AGREEMENT TO RELEASE ALL RIGHTS IN REGARD TO THE CHILD TO BE BORN.]

[Name], the Biological Mother, and [Name], the Biological Father; referred to collectively as the Biological Parents,

and [Name, the Adoptive Mother, and [Name], the Adoptive Father, referred to collectively as the Adoptive Parents, do hereby agree:

Biological Parents are the parents of a child, which is now being carried by Biological Mother, who is approximately [--] months pregnant. Biological Parents are aware that the Adoptive Parents are specifically reliant on Biological Parents for these representations.

Biological Parents desire to allow the child to be adopted by the Adoptive Parents. Biological Parents understand that:

(a) their parental rights will be lost and terminated by this agreement;

(b) that they will have no legal rights as to the child as a result of this agreement whatsoever, including visitation of any kind;

(c) that the Adoptive Parents by this agreement will become the only legal parents of the child;

(d) that this agreement is binding and legally valid, and there will be no opportunity to change decisions made; and,

(e) that this is a final legal agreement for Biological Parents to turn over all rights as to the child to be born.

Biological Mother agrees to obtain medical advice from qualified practitioners throughout her pregnancy. Biological Mother agrees that Adoptive Parents may have full and complete access to such records.

And, in consideration of this agreement, that Biological Parents will receive the following reimbursement of expenses from Adoptive Parents: [$------]

This fund will be deposited by Adoptive Parents within [--] days of the final signature to this agreement, with (referred to as Agent); and, prior to any disbursement from the funds, Biological Parents will each be required to sign an affirmation of this agreement before any disbursements are made. The agent will pay from this fund the actual costs of the pregnancy of the Biological Mother.

Biological Parents will provide bills for all such expenses to agent. The maximum amount of such reimbursement shall be [$------]. Adoptive Parents shall upon exhaustion of the fund at any time replenish the fund to the limit agreed upon.

Biological Parents shall provide any and all reasonable cooperation required by Adoptive Parents on request including execution of any legal documents required by Adoptive Parents, and attendance at any legal hearings required.

This agreement shall be confidential, and all parties hereto agree that the existence of this agreement and adoption shall be private and confidential.

The nature of this agreement is for unique and personal services and modification of legal rights, and the parties agree that this agreement may be specifically enforced.

If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If a court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid or enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.

The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement.

Neither party has made any representations nor promises, other than those contained in this agreement or in some further writing signed by the party making the representation or promise.

This Agreement will in all events be construed as a whole, according to its fair meaning, and not strictly for or against a party merely because that party (or the party's legal counsel) drafted the Agreement. The headings, captions, and titles in this legal Agreement are merely for reference and do not define, limit, extend, or describe the scope of this Agreement or any provision herein. Unless the context requires otherwise,

(a) the gender (or lack of gender) of all words used in this Agreement includes the masculine, feminine, and neuter, and

(b) the word including means including without limitation.

Each individual party to this Agreement represents and warrants to each other party that such party has read and fully understands the terms and provisions hereof, has had an opportunity to review this Agreement with legal counsel, and has executed this Agreement based upon such party's own judgment and advice of independent legal counsel.

If any provision of this Agreement is held to be illegal, invalid, or unenforceable under any present or future law, then that provision will be fully severable. This Agreement will be construed and enforced as if the illegal, invalid, or unenforceable provision had never comprised a part of this Agreement, and the remaining provisions of this Agreement will remain in full force and effect and will not be affected by the illegal, invalid, or unenforceable provision or by its severance from this Agreement. Furthermore, in lieu of each such illegal, invalid, or unenforceable provision, there will be added automatically, as a part of this Agreement, a provision as similar in terms to such illegal, invalid, or unenforceable provision as may be possible and be legal, valid and enforceable.

The failure of a party to object to, or to take affirmative action with respect to, any conduct of the other which is in violation of the terms of this Agreement shall not be construed as a waiver of the violation or breach or of any future violation, breach, or wrongful conduct until (--) days since the wrongful act or omission to act has passed.

Any provision hereof prohibited or unenforceable under any applicable law of any jurisdiction shall as to such jurisdiction be ineffective without affecting any other provision of this Agreement. To the full extent, however, that the provisions of such applicable law may be waived, they are hereby waived to the end that this Agreement be deemed to be a valid and binding agreement enforceable in accordance with its terms.

This Agreement may be executed in several counterparts and when so executed shall constitute shall constitute one agreement binding on all the parties, notwithstanding that all the parties are not signatory to the original and same counterpart.

This Agreement supersedes any prior oral agreements between the parties.

Agreement Binding. This Agreement shall be binding upon the parties hereto and their respective heirs, administrators, successors, and assigns.

No Assignment. Neither this agreement nor any right or interest thereunder shall be assigned in any respect whatsoever.

Exclusion of Oral Statements. This instrument contains all of the agreements of the parties. No oral or other statements shall be binding on either of the parties hereto.

Applicable Law. This Agreement shall be governed by the laws of the State of [State].

Time of The Essence. Time is the essence of this agreement.

READ CAREFULLY PRIOR TO SIGNING.

Dated:

Signatures

This Section for Notary:

Acknowledgment

STATE OF -------)

) ss: [date]

COUNTY OF ------)

On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

[signature]

[Name of Notary Public]

My commission expires: [date]

(Seal)