Consent Release Or Refusal {WYCAI-8}

WYCAI-8 (REV. 1/27/11) ) ) SS COUNTY OF __________________) IN RE: PETITIONS TO OPEN ADOPTION AND RELINQUISHMENT FILES ) ) ) ) ) __________________________________________) STATE OF WYOMING IN THE DISTRICT COURT ____________ JUDICIAL DISTRICT CONSENT RELEASE OR REFUSAL CASE # ________________________ I HEREBY CONSENT to contact with my ____________________________________________ (relationship) I agree to the following form of contact: _____ exchange of correspondence _____ personal meeting _____ other (specify) _________________________ _____ telephone call _____ e-mail I hereby release the intermediary and the Court from any liability resulting from this contact. ____________________________________ (Signed) ______________________________________ (Intermediary) ________________________________________________________________________________ (Address) DATED this _____ day of ____________________________, 20____. -----------------------------------------------------------------------------------------------------------------------I HEREBY REFUSE CONTACT with my ____________________________________________ (Relationship) I acknowledge receipt of an application from the State of Wyoming Adoption Intermediary Commission for my use in the event I should ever desire to have contact with this individual. It is my present desire that the records remain sealed and my anonymity preserved. _______________________________________ (Signed) ______________________________________ (Intermediary) ________________________________________________________________________________ (Address) DATED this ________day of _______________________________________, 20________. Additional comments: ________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com