Adoption Rules 1964

FIRST SCHEDULE

Rule 1

Form 1

APPLICATION FOR ADOPTION ORDER/LICENCE UNDER SECTION 16

This form and the documents attached to it must be delivered to the Senior Magistrate. At the same time as this form is delivered to him the applicant must also supply him with two copies of this form and of the documents attached to it.

Every paragraph of this form must be completed or deleted, as the case may be.

BERMUDA ISLANDS.

To the Special Court.

PART I

Particulars of applicant(s)

1 (a) Name of (first) applicant in full

Address

Occupation

Date of birth

Sex

Relationship (if any) to infant

Religious persuasion

(b) Name of (second) applicant in full

Address

Occupation

Date of birth

Sex

Relationship (if any) to infant

Religious persuasion

2 (a) I am/We are domiciled in [blank]

(b) Application has been/will be made to the proper author ities of that country for permission for the infant, if an adoption order be made, to enter the country of my/our domicile.

3 (a) I am a widow/widower/unmarried/married to [blank] of

(b) We are married to each other and our marriage certifi cate (or other evidence of marriage) is attached.

4 (a) The consent of my husband/wife to the making of an adoption order authorising me to adopt the infant is at tached.

(b) I request the court to dispense with the consent of my husband/wife on the ground that he/she—

(i) cannot be found;

(ii) is incapable of giving his/her consent;

(iii) we have separated and are living apart and the separation is likely to be permanent.

5 I/We attach a certificate as to my health/the health of each of us signed by a registered medical practitioner.

PART II

Particulars of Infant

6 Name in full

7 Sex

8 Religious persuasion

9 The infant is not and has not been married

10 The infant is the person to whom the attached birth certificate relates.

11 The infant was born at

12 The infant was—

(a) born in Bermuda;

(b) is the child of a person possessing Bermudian status
under the provisions of the Bermuda Immigration and Protection Act 1956;

(c) is resident in Bermuda with the specific permission of the Minister responsible for immigration affairs and re lated matters.

13 I/We attach a report as to the health of the infant signed by a registered medical practitioner.

14 The infant is the child of—

Name of mother

Address

Religious persuasion

and Name of Father

Address

Religious persuasion

15 The guardian of the infant is—

Name of guardian

Address

Religious persuasion

16 (a) I/We attach a document/documents signifying the con sent of the infant's mother/father/guardian to the making of an adoption order authorising me/us to adopt the infant.

(b) I/We also attach a document/documents signifying the consent of the person who has the actual custody of the infant who is liable to contribute to the support of the infant.

17 I/We request the court to dispense with the consent of the in fant's mother/father/guardian on the ground that he/she—

(a) has abandoned/neglected/persistently ill-treated the infant;

(b) cannot be found/is incapable of giving his/her con sent/is withholding his/her consent unreasonably;

(d) is a person where consent ought, in all the circum stances of the case, to be dispensed with.

18 The following approved society/person has the rights and powers of a parent of the infant—

Name

Address

Particulars of court order or agreement—

Name of court

Date of order/agreement

19 The following person is liable by virtue of an order or agreement to contribute to the maintenance of the infant/has been adjudged by a court to be the putative father of the infant—

Name

Address

Particulars of court order or agreement—

Name of court

Date of order/agreement

20 If an adoption order is made in pursuance of this application the infant is to be known by the following names—

Surname

Other names

PART III

21 The infant was received into my/our care and possession on the [blank] day of [blank] 19 [blank] and has been continuously in my/our care and possession since that date. Before that date the infant was in the care and possession of [blank] of [blank]

22 The infant is now in the actual custody of [blank]

23 I/We registered my/our names as a person/persons who in tended to apply for an adoption order in relation to the infant in the Adopters' Register on the [blank] day of [blank] 19 [blank].

24 (a) I have not made/Neither of us has made a previous ap plication for an adoption order in respect of the infant.

(b) I/We made an application to the [blank] court which was on the [blank] day of [blank] 19 [blank] dealt with
as fol lows—

25 I/We have not received or agreed to receive and no person has made or agreed to make or give to me/us any payment or other reward in consideration of the adoption of the infant, except as follows—

26 As far as I/We know no person or body has taken part in the ar rangements for the adoption of the infant except—

Name

Address

27 For the purposes of this application reference may be made to—

(a) Name

Address

Occupation

(b) Name

Address

Occupation

Address

Occupation

28 I/We desire that my/our identity should be kept confidential.

The serial number of this application is [blank]

I/We being desirous of adopting the infant hereby apply for an adoption order. I/We being desirous of adopting the infant abroad hereby apply for a licence authorising the care and possession of the infant to be transferred to me/us for that purpose.

Dated the [blank] day of [blank] 19 [blank]

Signature(s)

Form 2

MEDICAL CERTIFICATE AS TO HEALTH OF APPLICANT

I examined [blank] on [blank] and have formed the opinion that he is physically, mentally and emotionally suitable to adopt a child.

Signature

Date

Qualifications

Address

Form 3

MEDICAL REPORT AS TO HEALTH OF INFANT

Note: This Form is for a medical report on a child who may be adopted. The report is for the benefit of the adopters and the court. In order that the adopters may benefit fully from the report, it is important that the certifying doctor should explain to the adopters the nature and extent of any disability or abnormality disclosed by the examination which might affect their decision whether or not to adopt the child.

Child's name

Date of birth

Sex

Weight

Height

A. General condition.

Skin

Eyes (including vision)

Ears (including hearing)

Nose and throat

Speech

Cardio-vascular system

Respiratory system

Alimentary system

Genito-urinary system (including examination of urine for albu men, sugar and phenylpyruvic acid)

Skeletal and articular system (including examination for con-
genital dislocation of hip)

Nervous system (including fits)

Lymphatic system

Any other comments

Is the child physically normal having regard to his age?

B Are there any items in the child's history or examination which suggest that he may be mentally abnormal having regard to his age?

C Particulars of any illness from which the child has suffered.

D If known,

Weight at birth (if child is under one year of age)

Details of birth, including result of mother's serological tests for syphilis

Particulars, with dates, of vaccination or immunization against—

Tuberculosis (state result of Mantoux test or whether child has been successfully vaccinated with B.C.G. vaccine).

Smallpox

Diphtheria

Whooping cough

Poliomyelitis

Tetanus (active)

Any other disease

E Result of suitable serological test of the child's blood for syphilis taken six weeks or later after birth (please specify test).

F I examined the child on the [blank] day of [blank] 19 [blank], and I have informed the adopters of the state of health of the child dis closed by the examination.

Signature

Address

Qualifications

Form 4

CONSENT TO ADOPTION ORDER

1 I understand that an application for an adoption order has been or is to be made in respect of [blank] to whom the birth/adoption certifi cate now produced and shown to me marked "A" relates (hereinafter called the infant) by [blank] by a person or persons identified in the Spe cial Court under the serial number [blank] (hereinafter called the appli cant).

2 I am the mother/father/guardian of the infant.

3 I understand that the effect of an adoption order will be to de prive me permanently of my rights as a parent or guardian and to trans fer them to the applicant: in particular I understand that, if an order is made, I shall have no right to see or get in touch with the infant or to have the infant returned to me.

4 I further understand that the court cannot make an adoption or der without the consent of each parent or guardian of the infant unless the court dispenses with a consent on the ground that the person con cerned has abandoned, neglected or persistently ill-treated the infant, or cannot be found, or is incapable of giving consent, or is unreasonably withholding consent or has persistently failed without reasonable cause to discharge the obligation of a parent or guardian.

5 I further understand that, when the application for an adoption order is heard, this document may be used as evidence of my consent to the making of the order unless I inform the court that I no longer con sent.

6 I hereby consent to the making of an adoption order authorising the adoption of the infant by the applicant [on condition that the reli gious persuasion in which the infant is proposed to be brought up is]

7 As far as I know, no person or body has taken part in arranging for the infant to be placed in the care and possession of the applicant ex cept—

Full name and address of person or body taking part in ar rangements

Signature

Address

CERTIFICATE OF ATTESTOR

I hereby certify—

(a) that I have verbally explained to [blank] (name of person giving consent) the effect of his/her signing this Form and that I am satisfied that he/she understands the ef fect of giving such consent.

(b) that, paragraphs 1, 2, 6 and 7 of this Form having been duly completed, this Form was signed by the said [blank] (name of person giving consent) before me at [blank] on the [blank] day of [blank] 19 [blank].

Signature
J.P.
Full name
Address
Qualification
(i.e. Justice of the Peace or other qualification)

Warning. It is an offence to receive or give any reward for, or in consider ation of, the adoption of an infant or for giving consent to the making of an adoption order, other than a payment to an adoption society for their expenses incurred in connection with the adoption.

Form 5

APPOINTMENT OF GUARDIAN AD LITEM

BERMUDA ISLANDS

Before the Special Court sitting at [blank]

WHEREAS an application has been made by [blank] [and [blank] (his wife)] both of [blank] for an adoption order in respect of [blank] an infant of the [blank] sex (hereinafter called the infant).

THE COURT HEREBY APPOINTS The Minister responsible for health and welfare and related matters to be guardian ad litem of the infant.

Dated the [blank] day of [blank] 19 [blank]

Senior Magistrate and
Chairman of the Special Court.

Form 6

REPORT OF GUARDIAN AD LITEM

CONFIDENTIAL

BERMUDA ISLANDS

ADOPTION OF CHILDREN ACT 1963

Report upon circumstances relevant to a
proposed adoption order.

(a) APPLICANT(S)

1 Name of applicant(s)

2 Address

3 Date of Marriage

4 Marriage certificate seen?

5 If single application by married person—

(a) whether other spouse consents;

(b) reason not a joint application.

6 Number and age of children of applicants' marriage.

Boys:

Girls:

7 How many of such children are employed and at what wages.

8 Number, age, and relationship to applicants of other children in applicants' home.

Boys:

Girls:

9 Particulars of all other members of applicants' household and their relationship to applicants.

10 Number of bedrooms

11 Number of living rooms

12 Condition of home

13 Rent

14 Means of applicant

15 Any serious illness of applicants

16 Any history in family of—

(a) Tuberculosis;

(b) Epilepsy;

17 Are Referees to application responsible persons?

18 Do they recommend without reservation?

19 Do applicants understand—

(a) adoption order is irrevocable (except under circum stances of section 20)?

(b) order renders them responsible for maintenance of in fant?

20 Whether person from whom infant received confirms that fact?

21 Is guardian ad litem satisfied that no payment has been made or is to be made in consideration of the application?

22 Is guardian ad litem satisfied that applicants have never previ ously made an adoption application? If not so satisfied give particulars of other applications.

23 Has guardian ad litem or an agent satisfactorily interviewed—

(a) each applicant;

(b) each respondent;

24 Has guardian ad litem verified dates of birth of applicants?

25 (a) Are applicants Commonwealth citizens?

(b) Were applicants born in Bermuda?

(d) Do applicants have Bermudian status?

(e) Are applicants domiciled in Bermuda?

26 Where application is made under section 10—

(a) nationality of applicants;

(b) birth-place of applicants;

(d) where will applicants reside if order is made;

(e) domicile of applicants;

(f) has guardian ad litem verified from the consular repre sentative of the applicant's country of domicile that the infant will, in the ordinary course of events, be permitted to enter that country if the infant is adopted under the Act?

27 (a) Religious persuasion of applicants.

(b) In what religious persuasion do they propose to bring up the infant?

28 Date when applicant registered in Adoption Register.

(b) THE PARENTS

29 Does the mother consent to the application?

30 Does she identify the birth certificate as the birth certificate of this particular infant?

31 Does the father consent (if infant is legitimate)?

32 If infant is illegitimate—

(a) Particulars of affiliation order (if any);

(b) Particulars of agreement (if any) ;

33 Date parents parted with infant and to whom?

34 Reasons of parents for consenting to adoption.

35 Was consent given without pressure from any source?

36 Does parent (or both parents) understand that an Adoption Or der is irrevocable (except under section 20)?

37 Do parents understand that Order will deprive them of all

Form 7

NOTICE TO APPLICANT OF TIME OF HEARING/ADJOURNED HEARING

BERMUDA ISLANDS

To A.B. of [blank]

I hereby give notice that your application for an adoption order to be made in respect of [blank] (name of infant) will be heard/further heard before the Special Court sitting at [blank] on the [blank] day of [blank] 19 [blank], at [blank] o'clock and that your attendance [and that of [blank] (name of infant)] is required.

Dated the [blank] day of [blank] 19 [blank]

(Signature)
Senior Magistrate and Chairman
of the Special Court.

Form 8

NOTICE TO RESPONDENT OF APPLICATION FOR ADOPTION ORDER

BERMUDA ISLANDS.

To A.B. of [blank]

I hereby give notice that—

(1) an application has been made by (name and address of ap plicant) or under the serial number [blank] for an adoption order to be made in respect of [blank] (identify the infant);

(2) The Minister responsible for health and welfare and related matters has been appointed guardian ad litem;

(3) the application will be heard before the Special Court sitting at [blank] on the [blank] day of [blank] 19 [blank], at [blank] o'clock and you may then appear and be heard on the question whether an adoption order should be made.

^*(3) the application will be heard before the Special Court sitting at [blank] .

You may appear before the court and be heard on the question whether an adoption order should be made. If you wish to appear, write to the Senior Magistrate at [blank] on or before the [blank] day of [blank] 19 [blank] , in order that a time may be fixed for your appearance.

^**(4) While the application is pending you are not entitled, if you have signified your consent to the making of an adoption order in pursuance of the application, to remove the infant from the care and possession of the applicant except with the leave of the court.]

Dated the [blank] day of [blank] 19 [blank]

(Signature)
Senior Magistrate and Chairman
of the Special Court.

It would assist the court, if you would complete and return the attached form.

^*The second alternative should be struck out except where the applicant desires that his identity should not be disclosed to the person to whom the notice is given, in which case the first alternative should be struck out.

^**Delete except where notice is addressed to a parent or guardian.

REPLY FORM

To the Senior Magistrate,
Magistrate's Court,
Hamilton, Bermuda.

I have received notice of the hearing of the application for an adoption order in respect of [blank] an infant.

I^* do/do not wish to oppose the application. I* do/do not wish to appear and be heard on the question whether an adoption order should be made.

Date
Signature
Address

^*Delete one or other alternative.

Form 9

NOTICE TO RESPONDENT OF TIME OF FURTHER HEARING AFTER IN TERIM ORDER MADE

BERMUDA ISLANDS.

To A.B. of [blank]

I hereby give notice that the application by [blank] (state name and address of applicant)/under the serial number [blank] for an adop tion order to be made in respect of [blank] (identify the infant) will be further heard before the Special Court sitting at [blank] ^*on the [blank] day of [blank] 19 [blank], at [blank] o'clock and you may then appear and be heard on the question whether an adoption order should be made

^*and you may appear before the court and be heard on the ques tion whether an adoption order should be made. If you wish to appear, write to the Senior Magistrate, Magistrates' Court, Hamilton, on or before the [blank] day [blank] of [blank] 19 [blank], in order that a time may be fixed for your appearance.

Dated the [blank] day of [blank] 19 [blank]

(Signature)
Senior Magistrate and
Chairman of the Special Court.

It would assist the court, if you would complete and return the attached reply form.

REPLY FORM

To the Senior Magistrate,
Magistrates' Court,
Hamilton, Bermuda.

I have received notice of the further hearing of the application for an adoption order in respect of [blank] an infant.

^**I do/do not wish to oppose the application. I do/do not wish to appear and be heard on the question whether an adoption order should be made.

Date
Signature
Address

^**Delete one or other alternative.

Form 10

ADOPTION ORDER/INTERIM ORDER/LICENCE

BERMUDA ISLANDS.

Before [blank] J.P., Senior Magistrate and [blank] Chairman and [blank] and [blank] members, sitting as a Special Court (hereinafter called the Court) sitting at [blank] in the Parish of [blank]

PART I

Nature of Application

WHEREAS an application has been made by [blank] of [blank] by occupation a [blank] (hereinafter called the male applicant) and [blank] of [blank] (hereinafter called the female applicant)—

(a) for an adoption order in respect of [blank] an infant of the [blank] sex (hereinafter called the infant) the child/adopted child of [blank] (hereinafter called the mother of the infant) and [blank] of [blank] (hereinafter called the father/natural father of the infant);

(b) for a licence authorising the care and possession of an infant of the [blank] sex (hereinafter called the infant) the child/adopted child of [blank] (hereinafter called the mother of the infant) and [blank] of [blank] (hereinafter called the father/natural father of the infant) to be transferred to the male and female applicants, being persons resident outside Bermuda, namely at for the purpose of the adoption of the infant by the male and female applicants abroad.

PART II

Facts Proved to the Satisfaction of the Court

AND WHEREAS the following facts have been proved to the sat isfaction of the Court—

A. (as to the male and female applicants)—

1 (a) That the male and female applicants are domiciled in Bermuda;

(b) That the male and female applicants are domiciled in [blank] and that the infant will, if adopted by the appli cants, be permitted to enter that country.

2 (a) That the male/female applicant—

(i) is the father/mother of the infant;

(ii) is a relative of the infant, namely the [blank] of the infant, and has attained the age of twenty-one years, having been born on the [blank] day of [blank] 19 [blank];

(iii) has attained the age of twenty-five years having been born on the [blank] day of [blank] 19 [blank].

(b) That the male/female applicant has attained the age of twenty-one years, having been born on the [blank] day of [blank] 19 [blank].

3 That the male and female applicants were registered in the Adopter's Register on [blank] day of [blank] 19 [blank], and that they have been continually so registered since that day for a period of not less than three months immediately preceding the above mentioned application.

B. (as to the infant)—

1 (a) That the infant was born in Bermuda, namely in the Parish of [blank]

(b) That the infant is the child of [blank] and that the said [blank] is a person possessing Bermudian status under the provisions of the Bermuda Immigration and Protec tion Act 1956;

(c) That the infant is now resident in Bermuda with the specific permission of the Minister responsible for immi gration affairs and related matters.

2 That the infant has been continuously in the care and posses sion of the male and female applicants for a period of at least three con secutive months (not counting any time before the date which appears to the Court to be the date on which the infant attained the age of six weeks, namely the [blank] day of [blank] 19 [blank]) immediately preced ing the date of this order. The infant has been continuously in the care and possession of the male and female applicants since the [blank] day of [blank] 19 [blank].

3 That the date/probable date of birth of the infant is the [blank] day of [blank] 19 [blank].

4 That the infant is identical with [blank] to whom an entry num bered [blank] and made on the [blank] day of [blank] 19 [blank] in the General Register of Birth relates.

5 That the infant has been previously the subject of an adoption order dated the [blank] day of [blank] 19 [blank] of which particulars are entered in the Adopted Children's Register.

C. (Miscellaneous)

1 That the male and female applicants have not received or agreed to receive, and that no person has made or agreed to make or give to the applicant/applicants, any payment or other reward in consideration of the adoption/proposed adoption abroad [other than [blank] which said payment or reward the Court doth hereby sanction].

2 The sole applicant being of the male sex and the infant being of the female sex that special circumstances exist which justify as an ex ceptional measure the making of an adoption order, namely [blank]

PART III

Consents

A. AND WHEREAS the Court is satisfied—

1 That [blank] of [blank] the mother of the infant and [blank] of [blank] the father of the infant, and [blank] of [blank] the guardian of the infant have consented to and understand the nature and effect of an
adoption order and the said [blank] being the parent(s) of the infant un derstand(s) that the effect of the adoption order will be permanently to deprive him/her/them of his/her/their parental rights; and that the consent of no other person is necessary under the Adoption of Children Act 1963, except [blank]

2 That [blank] of [blank] the mother of the infant and [blank] the father of the infant, and [blank] of [blank] the guardian of the infant and [blank] of [blank] a person having the actual custody of the infant and [blank] a person who is liable to contribute to the support of the infant have consented to the making by the male and female applicants of this application for a licence in respect of the infant under section 16 of the Adoption of Children Act and the consent of no other person is necessary under that Act except [blank]

3 That [blank] of [blank] the wife/husband of the applicant, not being an applicant himself/herself, has/has not consented to the making of the adoption order/the granting of the licence in respect of the infant for which application has been made by the applicant.

B. AND WHEREAS THE Court has dispensed—

1 With the consent of the said [blank] on the ground that he/she—

(i) has abandoned/neglected/persistently ill-treated the infant;

(ii) cannot be found/is incapable of giving his/her consent/is withholding his/her consent unrea sonably;

(iii) has persistently failed without reasonable cause to discharge the obligations of a par ent/guardian of the infant;

(iv) is a person whose consent ought, in the opinion of the Court and in all the circumstances of the case, to be dispensed with.

2 With the consent of the said [blank], the husband/wife of the applicant, on the ground that he/she—

(i) cannot be found;

(ii) is incapable of giving his/her consent;

(iii) is living separate and apart from the applicant and that the separation is likely to be perma nent.

PART IV

Interests of Infant

AND WHEREAS

1 The Court is satisfied that the adoption order, if made, will be for the welfare of the infant.

2 The Court is satisfied by a report of [blank] a British Con sular Official/a person appearing to the Court to be trustworthy that the applicant(s) is/are suitable person(s) to be entrusted with the care and possession of the infant for the purpose of the adoption of the infant abroad and that the transfer of such care and possession to the appli cant(s) is likely to be for the welfare of the infant and the applicant(s) in tend(s) such transfer to be for the purpose of the adoption of the infant by him/her/them.

PART V

Terms of Order

A. IT IS ORDERED that the determination of the application be postponed and that the applicant(s) do have the custody of the infant until the [blank] day of [blank] 19 [blank] by way of a probationary period on the following terms, namely [blank] and, as regards costs, it is ordered that [blank] and that the application shall be further heard on [blank]

B. IT IS ORDERED—

1 That the applicant (s) be authorised to adopt the infant;

2 That the following terms and conditions be hereby imposed upon the applicant(s) namely [blank]

3 That the Registrar-General shall make in the Adopted Children Register an entry recording the particulars set out in the Schedule to this order; and shall mark the said entry in the General Register of Births with the word "Adopted"/the Adopted Children Register with the word "Re-adopted";

4 As regards costs [blank]

C. THIS LICENCE IS HEREBY GRANTED by the Court and autho rises the care and possession of the infant to be transferred to the appli cant(s) being proposed adopter(s) abroad, within the meaning of section 10(1) of the Adoption of Children Act 1963, for the purpose of the adop tion of the infant, SUBJECT to the following conditions and restrictions, namely [blank]

Dated the [blank] day of [blank] 19 [blank]

Bermuda Consolidated Legislation

Adoption Rules 1964