Petition For Waiver Of Parental Notification Requirements {JDF 11} | | Colorado

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Petition For Waiver Of Parental Notification Requirements {JDF 11} |  | Colorado

Petition For Waiver Of Parental Notification Requirements {JDF 11}

This is a Colorado form that can be used for Abortions For Minors within Statewide.

Alternate TextLast updated: 3/30/2007

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District Court Denver Juvenile Court __________________________________________County, Colorado Court Address: IN THE MATTER OF THE PETITION OF: ___________________________________ [Name of Minor] For a Waiver of Parental Notification Requirements Concerning COURT USE ONLY an Abortion Attorney, if Minor Represented (Name and Address): Case Number: Phone Number: E-mail: FAX Number: Atty. Reg. #: Division Courtroom PETITION FOR WAIVER OF PARENTAL NOTIFICA TION REQUIREMENTS OF 12-37.5-104, C.R.S.The Petitioner, a minor, states: 1. I am ___ years old. 2. I am approximately ____ weeks pregnant and desire to terminate the pregnancy by abortion. 3. I want to have the abortion without telling my parent(s), guardian or foster parent. 4. I am am not married. 5. I do do not financially support myself. 6. I live with my: parent(s) guardian foster parent(s) relative: ____________ (state relationship) other: ______________(state relationship) 7. I have have not been informed about the risks and consequences of having the abortion.8. (Check one or both): I believe I am mature enough to decide on my own to have an abortion without telling my parent(s), guardian or foster parent. It would not be in my best interest to tell my parent(s), guardian or foster parent of the abortion.9. The name, business address and telephone number of the clinic or doctor who would perform the abortion are (this information is optional if you want to have the courts decision sent directly to the clinic or doctor): _______________________________________________________________________________________ ______________________________________________________________________________________. 10. I ask the Court to appoint a lawyer to represent me at no cost to me. JDF 11 09/03 PETITION FOR WAIVER OF PARENTAL NOTIFICATION Page 1 of 2 REQUIREMENTS OF 12-37.5-104, C.R.S. <<<<<<<<<********>>>>>>>>>>>>> 2 I have a lawyer and ask the Court to appoint that person to continue to represent me. My lawyers name, business address, telephone and fax numbers are: ___________________________________ _________________________________________________________________________________ I do not want to be represented by a lawyer. 11. I understand that the court proceedings and my court file are confidential and cannot be disclosed to anyone, including my parent(s), guardian or foster parent. 12. The Court can let me know of any Court proceedings or decisions in the following way: Via Fax: #___________________________; Attn:_______________________________ Via Telephone: #____________________________; Attn:_______________________________ Via E-mail: ____________________________________________________________ Via Beeper or Pager #______________________________________ Via First Class Mail: _________________________________________________________________ _________________________________________________________________________________ Via My Attorney 13. I ask that the Court provide me with a certified copy of the courts order in the following way (check one): Via First Class Mail: _________________________________________________________________ _________________________________________________________________________________ Via My Attorney Via the Court File for pickup by me or ___________________________ who has my permission to pick up the certified copy on my behalf from the court file at the courthouse 14. The best days and times for me to come to court are: _______________________________________________________________________________________ _______________________________________________________________________________________ WHEREFORE, I request to the Court enter an order allowing me to have the abortion without telling myparent(s), guardian or foster parent. Respectfully submitted this ____ day of ___________, 20___. _____________________________________ Signature of Minor _____________________________________ Signature of Attorney, if Petitioner is representedJDF 11 09/03 PETITION FOR WAIVER OF PARENTAL NOTIFICATION Page 2 of 2 REQUIREMENTS OF 12-37.5-104, C.R.S.

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