I declare that I am the natural mother of a minor child with the MRN specified above. I hereby surrender all parental rights and consent to the treatment of the child at Halimatu Musa Hospital and the adoption of said child, in proceedings for such adoption which have been, or will hereafter be instituted in a Court having jurisdiction over adoption proceedings.

Believing it to be in the best interests of my child, I do hereby give my consent freely and voluntarily to said adoption, relinquish all my rights, if any, and claims to said child, and agree that from the date of the Decree of Adoption said child shall, to all legal intents and purposes, be the child of the Petitioners, therein.

I am aware of the rights and responsibilities between a parent and a child, and I understand that this Consent to Adoption and Relinquishment of Parental Rights cannot be withdrawn and is irrevocable.

I acknowledge that I am entitled to consult a lawyer regarding my parental rights, and in spite of this knowledge, I voluntarily and unequivocally consent to the adoption of the child born to me, and vest in the Petitioners the exclusive custody, care, control and treatment of the child.

I give this consent freely, voluntarily and without duress, and I have not been given or promised anything of value in exchange for this consent. I am not under the influence of any drugs and/or alcohol. I acknowledge that I am mentally competent to consent to adoption and to relinquish my parental rights to the child.

I understand that this document terminates all parental rights that I may have with this child.

I hereby waive any further process or notice of any adoption proceedings concerning the minor child and consent to be voluntarily joined as a co-petitioner in a termination of parental rights proceeding, and I will not interfere with the custody of the child from this date forward.

I hereby make this Affidavit of my own free will and accord, without coercion, and that all provisions of this written voluntary release were entered into knowingly, intelligently, and voluntarily.

And I execute this consent and relinquishment of parental rights, and for the purpose of assisting in procuring the adoption of said minor child.