FORM 8.987. PETITION FOR JUDICIAL WAIVER OF PARENTAL
NOTICE AND CONSENT OR CONSENT ONLY TO
TERMINATION OF PREGNANCY

IN THE CIRCUIT COURT OF THE ………. JUDICIAL CIRCUIT
IN AND FOR …………… COUNTY, FLORIDA
In the Interest of …………… (pseudonym or initials of minor)

Case No.: ……….
Division: ……….
PETITION FOR JUDICIAL WAIVER OF PARENTAL NOTICE AND
CONSENT OR CONSENT ONLY TO TERMINATION OF PREGNANCY
I certify that the following information is true and correct:
(1) The pseudonym or initials of the minor (is/are)
.................................., and the minor has filed a Sworn Statement
of True Name and Pseudonym with the clerk.

(2) The minor is ..... years old.

(3) The minor is pregnant and parental notice or consent has not
been waived.

(4) The minor requests that the court enter an order authorizing
her to terminate her pregnancy without

[check which applies]

………. notice to and consent from her parents or legal guardian

………. consent only from her parents or legal guardian



for one or more of the following reasons:

[check all that apply]
..... a. The minor is sufficiently mature to decide whether
to terminate her pregnancy, for the following reason(s):
…………………………………………………................
........................................................................................................
....................................................

..... b. The minor is a victim of child abuse or sexual abuse
inflicted by one or both of her parents or a legal guardian.

..... c. Notice and consent or consent only from a parent or
legal guardian is not in the best interests of the minor, for the
following reason(s):
………………………………………………….............................................
........................................................................................................
.......................................................................................
(5) The minor requests the appointment of an attorney to
represent her in this matter; and the attorney is appointed at no
costs to the minor at least 24 hours prior to hearing.

[check one]
..... Yes, I want an attorney to represent me during the
judicial waiver proceedings at no cost to me.

..... No, I do not wish to be represented by an attorney.

(6) The minor elects the following method or methods for receiving
notices of hearings or other court actions in this case (you may
choose more than one option):

[check all that apply]


..... Through a third party whose name is .................... and whose
address and phone number for purposes of notice are ....................,
.....................

..... The minor will contact the office of the clerk of court at the
following phone number .......................................

I understand that by signing this form I am swearing to or
affirming the truthfulness of the claims made in this petition and
that the punishment for knowingly making a false statement
includes fines, imprisonment, or both.

Signature:

Date: ..........

(You may sign a name other than your true name, such as
Jane Doe or other pseudonym under which your petition is being
filed.)