"NOTICE OF SAFE HAVEN RELINQUISHMENT
Be advised that on the _____ day of ______. _____, (NAME OF PARENT), the parent of an infant (FEMALE/MALE), born on the _____ day of ____________,_____, relinquished the infant for adoption by leaving (HIM/HER) at an emergency care facility.
You are alleged to be the other parent of the infant. You may oppose the adoption of this child only by filing a motion of opposition with this court within fifteen days after you are served with this notice.
If you file a motion of opposition timely, the court will then hold a hearing within twenty days of the filing of your objection, to determine whether you have established or forfeited your parental rights.
To establish your parental right to oppose the adoption, you must acknowledge that you are the parent of the child or be found to be the parent by court order as a result of blood or tissue tests. Thereafter, you must also demonstrate to the court that you are a fit parent who is willing and able to assume the legal and physical care of your child. You must also demonstrate that you have made a substantial commitment to your parental responsibilities by providing or attempting to provide substantial and consistent support during pregnancy or after the infant's birth and by frequently and consistently visiting or attempting to visit the child after birth. If you fail to file a motion of opposition, or if, after a hearing on a motion timely filed, the court finds that you have failed to establish your parental right to oppose the adoption, the court will order the termination of any and all parental rights you may have and the child may be subject to adoption."
La. Ch.C. § 1155