§ 48‑3‑606.  Content of consent; mandatory provisions.
A consent required from a minor to be adopted, a parent, or a guardian under G.S. 48‑3‑601 must be in writing and state each of the following:
(1)	The date and place of the execution of the consent.
(2)	The name, date of birth, and permanent address, if any, and if none, the current mailing address, of the individual executing the consent.
(3)	The date of birth or the expected delivery date, the sex, and the name of the minor to be adopted, if known. A consent to adoption of a newborn minor may give the minor's name as "Baby [Last Name of Biological Mother]" or a similar designation.
(4)	That the individual executing the document is voluntarily consenting to the transfer of legal and physical custody to, and the adoption of the minor to be adopted by, the identified prospective adoptive parent.
(5)	The name of a person and an address where any notice of revocation may be sent.
(6)	That the individual executing the document understands that after the consent is signed and acknowledged in accord with the procedures set forth in G.S. 48‑3‑605, it may be revoked in accord with G.S. 48‑3‑608, but that it is otherwise final and irrevocable and may not be withdrawn or set aside except under a circumstance set forth in G.S. 48‑3‑609.
(7)	That the consent shall be valid and binding and is not affected by any oral or separate written agreement between the individual executing the consent and the adoptive parent.
(8)	That the individual executing the consent has not received or been promised any money or anything of value for the consent, and has not received or been promised any money or anything of value in relation to the adoption of the child except for lawful payments that are itemized on a schedule attached to the consent.
(9)	That the individual executing the consent understands that when the adoption is final, all rights and obligations of the adoptee's former parents or guardian with respect to the adoptee will be extinguished, and every aspect of the legal relationship between the adoptee and the former parent or guardian will be terminated.
(10)	The name and address of the court, if known, in which the petition for adoption has been or will be filed.
(11)	That the individual executing the consent waives notice of any proceeding for adoption.
(12)	If the individual executing the document is the minor to be adopted or the person placing the minor for adoption, a statement that the adoption shall be by a specific named adoptive parent.
(13)	If the individual executing the document is the person placing the minor for adoption, that the individual executing the consent has provided the prospective adoptive parent, or the prospective adoptive parent's attorney, with the written document required by G.S. 48‑3‑205.
(14)	That the person executing the consent has:
a.	Repealed by Session Laws 2013‑236, s. 9, effective July 3, 2013.
b.	Been advised that counseling services may be available through county departments of social services or licensed child‑placing agencies; and
c.	Been advised of the right to seek the advice of legal counsel.  (1995, c. 457, s. 2; 2013‑236, s. 9; 2015‑54, s. 10; 2018‑68, s. 2.1; 2019‑172, s. 7(b).)