This is an official form from the New Hampshire Judicial Branch that is used in adoptions involving a child who is under either the legal custody or guardianship of the department of health and human services, a voluntary mediation may be held to reach a voluntarily mediated agreement regarding the permanent placement of the child. This form will be used for that purpose. It complies with all applicable laws and statutes. USLF amends and updates the forms as is required by New Hampshire statutes and law.