SURR-5New York

Affirmation of Authorized Agency Employee Responsible for Arranging 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 ↗

Affirmation of the authorized agency employee responsible for arranging supportive counseling for a parent signing an extra-judicial surrender of a child in foster care.

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