, certify that I am the adoptive parent/prospective adoptive
, on whose behalf I have filed or will file an
I-600 (petition to classify orphan as immediate relative) according said child status as an orphan as defined by Section 101(b)(1)(F).
I,
parent of a child,
Subscribed and sworn to (or affirmed) before me this
. My commission expires on (mm-dd-yyyy)
I have read the statement above and I am aware of the vaccination requirement set forth in Section 212(a)(1)(A)(ii) of the
Immigration and Nationality Act. In accordance with Section 212(a)(1)(A)(ii), I will ensure that my foreign adopted child
receives the required and medically appropriate vaccinations within 30 days after his or her admission into the U.S., or at
the earliest time that is medically appropriate.
provided that the adoptive parent or prospective adoptive parent, prior to the child's admission, executes an affidavit
stating that the parent is aware of the provisions of subparagraph (A)(ii) and will ensure that, within 30 days of the child's
admission, or at the earliest time that is medically appropriate, the child will receive the vaccinations identified in such
subparagraph.
Section 101(b)(1) defines the term "child" as an unmarried person under twenty-one years of age. Subparagraph (F)
refers to a child, under the age of sixteen at the time a petition is filed in his behalf to accord classification as an
immediate relative under section 201(b), who is an orphan because of the death or disappearance of, abandonment or
desertion by, or separation or loss from, both parents, or for whom the sole surviving parent is incapable of providing the
proper care and has in writing irrevocably released the child for emigration and adoption; who has been adopted abroad
by a United States citizen and spouse jointly, or by an unmarried United States citizen at least twenty-five years of age,
who personally saw and observed the child prior to or during the adoption proceedings; or who is coming to the United
States for adoption by a United States citizen and spouse jointly, or by an unmarried United States citizen at least
twenty-five years of age, who have or has complied with the preadoption requirements, if any, of the child's proposed
residence; Provided, that the Attorney General is satisfied that proper care will be furnished the child if admitted to the
United States; Provided further, that no natural parent or prior adoptive parent of any such child shall thereafter, by virtue
of such parentage, be accorded any right, privilege, or status under this Act.
DS-1981
01-2006
AFFIDAVIT CONCERNING EXEMPTION FROM IMMIGRANT
VACCINATION REQUIREMENTS FOR A FOREIGN ADOPTED CHILD
Statement for Parent(s): Section 212(a)(1)(A)(ii) of the Immigration and Nationality Act requires that any person who
seeks admission as an immigrant, or adjustment of status to the status of an alien lawfully admitted for permanent
residence, shall present documentation of having received vaccination against vaccine-preventable diseases,
specifically: mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, influenze type B, hepatitis B,
varicella and pneumoccocal. This section exempts from the immunization requirement a child who:
(Signature of Parent)
(i) is 10 years of age or younger;
(ii) is described in Section 101(b)(1)(F), and
(iii) is seeking an immigrant visa as an immediate relative under section 201(b),
Signed this day of ,, at
.
day of
,
at
(Signature of Notary Public or Officer Administering Oath)
U.S Department of State
Affidavit by Adoptive Parent or Prospective Adoptive Parent
