I. A surrender shall state that the individual executing the surrender document acknowledges that the individual's parental rights over the child will cease upon the court's approval of the surrender.
   II. A surrender shall further state:
      (a) An acknowledgement that after the surrender is executed in substantial compliance with 170-B:9, it is final and except under a circumstance stated in 170-B:12, may not be revoked or set aside for any reason, including the failure of an adoptive parent to comply with an arrangement or understanding reached with the birth parent with respect to the post-surrender exchange of identifying or non-identifying information, communication, or contact.
      (b) An acknowledgement that the surrender will extinguish all parental obligations, except the obligation to pay any accrued unpaid child support.
      (c) That the person executing the surrender has:
         (1) Been informed of counseling services available through child placing agencies pursuant to RSA 170-E.
         (2) Been provided legal counsel, consistent with RSA 170-B:9, I and RSA 170-B:13, I, unless waived with approval of the court for good cause shown.
      (d) That the person executing the surrender has not received or been promised any money or anything of value for the surrender, except for payments permissible under 170-B:13.
      (e) Whether the person executing the surrender has been informed of the identity of the adoptive parents.
      (f) Whether the child is an Indian child as defined in the Indian Child Welfare Act, 25 U.S.C. Section 1901 et seq.
      (g) Whether the person who is surrendering wishes to be notified that a final decree of adoption has been entered.
      (h) That the person who is surrendering has read and understands the content of the document, any questions the person has asked have been answered by the court or its designee, and the person wishes the surrender to take effect.
Source. 2004, 255:1, eff. Jan. 2, 2005. 2006, 200:5, eff. July 30, 2006.