1. First, state the basic identity information of the adopter;
2, indicating the intention of voluntary adoption;
3. Declare that after adoption, he will voluntarily assume the responsibility of raising the adopted children and apply for adoption of XXX；;
4. Signature and date.
legal ground
Article 1098 of the Civil Code of People's Republic of China (PRC)
The adopter shall also meet the following conditions:
(a) no children or only one child;
(2) Having the ability to support, educate and protect the adoptee;
(3) Not suffering from diseases that are medically considered unsuitable for adopting children;
(4) All criminal records that are not conducive to the healthy growth of the adoptee;
(five) at least thirty years of age.
Article 1097
If the biological parents adopt their children, both parties shall adopt them together. If one parent is unknown or can't be found, it can be adopted unilaterally.