Contract between child placement agency and prospective adoption parents.

This agreement, made and entered into _________, 19__, between B, a licensed child placement agency of _________, referred to as the agency, and H and W, husband and wife, of _________, subject to the approval of the department of social welfare, division of child welfare of _________.

The agency at the request of H and W has placed in the care, custody and control of H and W at their home in _________ for a probationary period of one year, the child, _________, who was born on the _________ day of _________, 19__, and who is an inmate, and under the care, custody and control of the agency. H and W covenant and agree: To receive the child into their home for a trial period of one year; to treat the child as a member of the family and to give the child proper care, and to love, cherish, nurture and educate the child in a suitable manner, as H and W would be required to do were it their own child; to send the child to school at least nine months of each year, or in accordance with the laws of the state of _________; to notify the agency promptly of any change of address of the second parties, and in no case leave with, or surrender the child to, a third party, or to remove him [her] from the state without the written consent of the agency.

It is agreed that the agency shall have at all reasonable times access to the child placed in the home of H and W and to the home in which the child is living, and H and W agree to relinquish and surrender the child whenever, in the opinion of the agency or of the state board of control, relinquishment is to the best interest of the child.

It is further agreed that H and W reserve the right to return the child to the agency any time within one year from the date of this agreement, for due and just cause. H and W agree that after the expiration of a one-year period, and before the expiration of two years from the date of this instrument, H and W will make application for the adoption of the child in accordance with the rules and practice of the agency, and in accordance with the statutes of _________ then in force and effect. H and W agree to pay the costs incident to the adoption proceedings.