Whether you are a birthparent or an adoptee, file waivers of confidentiality! This document will reassure record keepers that if the persons you specify come looking for you, you WANT them to get your identifying info. You want to file these with the agency, attorneys, but especially with the county court in which the adoption was finalized, which is usually the home county of the adoptive parents at the time of the adoption. If you are a birth parent and do not know what county your child was adopted to, you want to find this out so you file your waiver in the right court. You may be able to get this through the agency that facilitated the adoption if you tell them why you need it- to file the waiver. If not, you should be able to ask for it from the Bureau of Vital Statistics. To clarify: where an adoptee was relinquished and where the adoption was finalized are not the same thing necessarily. I was born in Allegheny County but my adoption was finalized in Westmoreland County, the county my parents lived in at the time of the adoption.

I have attached three sample waivers of confidentiality. You can choose the letter that fits your situation depending on whether you are a birth parent or an adoptee. The letter should be tailored to suit your own needs and situation. This letter must be notarized. Remember to send the letter return-receipt requested; this way you will have a record of when and by whom the letter was received at your adoption agency. Also keep a copy of the notarized letter for your personal files.
I also would like to say that I am not a lawyer and therefore can not give legal advise. This is the waiver form has been used by others, including myself. If you have a better sample or suggestions for improving this form, please let me know.

SAMPLE #1

WAIVER OF CONFIDENTIALITY

NO CONFIDENTIALITY NEEDED

This Waiver of Confidentiality Applies to the Following:
Name: ________________________ Concerning: __________________
Present Name: ________________________Date of Birth: ___________

Relationship to Relinquished Child: __________ Hospital: ____________

To Whom it May Concern:

Please place this letter in both the adoption file of the above-mentioned birth mother and mine, and use it as authorization to waive confidentiality. This includes the release of any and all agency records, hospital records, doctor records, court records, and records surrounding the birth and relinquishment, including "identifying information"
Further, upon request from any birth family member, I request that a photocopy of this letter be sent or given to her/them and recognize this letter to be my consent and authorization thereto. I request notification from you should the birthmother, birth father or any birth family member make a request for this information.

Please send a letter informing me of your agency's intent to recognize this waiver and, if I am refused, please cite the state law that prohibits such recognition.

Very truly yours,
Signature
Printed Name
Address
City, State Zip
Phone Number


SAMPLE #2

Your address and phone number

Date

Adoption agency name and address

To All Concerned Parties:

I hereby formally request that this letter and/or copies of it immediately be placed in all records and files you have pertaining to my adoption as handled through (your adoption agency's full name) and finalized (date of your adoption's finalization), in (the court which finalized your adoption). My adopted name is (your name) and I was born on (your birthday).

Please consider this letter and/or copies of it to be my legal authorization to waive the confidentiality due me by any law(s) and/or organizations of the (state in which your adoption was finalized) regarding anything considered to be identifying information.
I want the effects of this letter to extend to any member of my birth family that relinquished me for adoption: mother, father, any and all grandparents, any and all siblings, any and all uncles or aunts. It is my desire that the following information be released in full: My full name, (your name); my current address and telephone number as found above; and all records in my files, including any updated information I may give you in the future.

By this waiver I give you full and legal permission to release my present identity and whereabouts as given above. This waiver shall remain in full effect until revoked by myself in writing. I would like you to respond to my request in writing forthwith.

Sincerely,

(your signature)
(your name)
(Name, date, and seal of notary)

SAMPLE #3

Waiver of Confidentiality for Birth Parents

TO WHOM IT MAY CONCERN:

I, (Present Identity), also.known.as. (name used to sign consent) of (address), including city, county, & state) do state that:

I did on (day, month, year) at (hospital of birth) (place of birth, address) give birth to a (male/female) which I named (or did not name) (first, middle, surname). That I, under the name of (Name used by birth parent), consented to relinquish, by signature to: (name of placing agency/intermediary) of (city, county, state) and did grant the legal right to said parties to place my child, (name of child) for adoption.

I (present name), hereby state that I waive ALL RIGHTS OF CONFIDENTIALITY extended to self under past and present identity, granted to me by the Statues of the State of (name of State), known court of jurisdiction thereof, and the (placing agency) or person (intermediary) and to my child (name at birth) in (his/her) present adoptive identity. That access to these confidential records is to include all court and placing agency records, all social-biological-medical history and heritage, pertaining to self, together with my past and present identity and the identity of my child by birth. This waiver of confidentiality and right to privacy is extended solely to my child and none other. Permission is granted to the holder of this waiver to furnish a photocopy of this transcript to my child, and this to be regarded as full consent, for the release of the original certificate of birth by full transcript.

(Month, day, year)
(Signature, using present identity)

(Signature, using name signed on consent to surrender)

(Notary stamp, seal, and signature)