JUVENILE COURT, _______________ COUNTY, STATE OF COLORADO

No. CASE NUMBER

The State of Colorado in the Interest of:

CHILD, et. al, Children, and Concerning:

RESPONDENT, et. al., Respondents.

COMES NOW Respondent RESPONDENT and to confess the termination motion of the Denver Department of Social Services and states and swears as follows: I have consulted with my attorney in this matter and understand I am giving up the following rights.

1. I understand this Confession affects myself and my rights to the children CHILDREN.

2. I understand I have a right to have the County Attorney's office or the Guardian ad Litem prove the elements of the termination motion in trial by clear and convincing evidence; including:

a. When the children were adjudicated.

b. If there was an appropriate treatment plan.

c. If it was unsuccessful or if I did not comply.

d. That I am an unfit parent.

e. That my condition is unlikely to change in a reasonable time.

f. That Social Services made reasonable efforts to rehabilitate me.

g. That it is in the minor children's best interest to terminate my rights.

h. There are no less-drastic alternatives.

3. I understand I have a right to cross-examine other parties' witnesses and have my witnesses subpoenaed to come to court to testify on my behalf..

4. I understand if I am indigent I have a right to have legal counsel appointed for me.

5. I understand I have the right to have one expert witness appointed for me at the State's expense.

6. I understand I have the right to testify.

7. I understand I have the right to appeal if I were to lose my trial.

8. I understand I give up the above rights if I sign this document.

9. I ACKNOWLEDGE THAT BY CONFESSING THIS TERMINATION MOTION MY PARENTAL RIGHTS TO THE CHILD OR CHILDREN WILL BE PERMANENTLY ENDED AND THE CHILD CAN BE PLACED FOR ADOPTION, AND FURTHER THAT I WILL NOT KNOW WHERE THE CHILD OR CHILDREN ARE, NOR HAVE VISITS, NOR ANY CONTACT.

10. I understand that the effect of termination includes that the children will continue to be my heirs at law unless adopted, and that I will not get to participate in any adoption proceedings.

11. My confession to the termination motion is voluntary.

12. I understand the court is not bound by any promises or representations made by anyone as to the placement of the children, and that all the above applies regardless of what the Social Worker, the Guardian ad Litem or my attorney has told me.

13. I understand the above advisement and the effects and consequences of my admission.

14. I am not under the influence of drugs, alcohol or medications so that I do not understand the consequences of this document. No one is coercing me or forcing me to sign this document.

AND THEREFORE I CONFESS THE ALLEGATIONS OF THE TERMINATION MOTION in this Dependency and Neglect matter, that the child or children are no longer legally my child or children.

_________________________
RESPONDENT

Sworn and executed by RESPONDENT before me on ____________.

My Commission expires _______________.

_____________________
Notary Public