SURR-5-aNew York

Affidavit of Provider of Supportive Counseling- Extra-Judicial Surrender of Child in Foster Care

New York Family Court · Juvenile & Dependency

Copy of the court's form from nycourts.gov, taken October 21, 2026. See it on the court's site ↗

Affidavit of the provider of supportive counseling in a proceeding to approve an extra-judicial surrender of a child in foster care. The counselor may not also be the employee-witness to the surrender.

This form must be printed and filled by hand, or opened in Adobe Acrobat.
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