State of Alabama Unified Judicial System Form JU- 26A Rev. 1/09 NOTIFICATION OF RIGHT TO ATTORNEY IN WAIVER OF PARENTAL CONSENT TO AN ABORTION PROCEEDING/ APPOINTMENT OF GUARDIAN AD LITEM Case Number IN THE JUVENILE COURT OF _____________________________________________________ COUNTY, ALABAMA (Name of County) In the Matter of __________, a minor (Initials Only) THIS IS TO INFORM YOU THAT: 1. You have the right to an attorney. 2. If you are unable to pay for the services of an attorney, one will be appointed to represent you at no charge at this time. Ala. Code 1975, §26-21-4(b). ______________________ Date _________________________ Time ____________________________________ Initials of Minor I DO NOT WANT AN ATTORNEY APPOINTED TO REPRESENT ME AT THIS TIME. I UNDERSTAND THAT ANYTIME PRIOR TO THE HEARING IN THIS MATTER, I MAY CHANGE MY MIND AND REQUEST THAT AN ATTORNEY BE APPOINTED TO REPRESENT ME. ______________________ Date _________________________ Time ____________________________________ Initials of Minor I HEREBY REQUEST THAT AN ATTORNEY BE APPOINTED TO REPRESENT ME IN THIS MATTER. ______________________ Date _________________________ Time ____________________________________ Initials of Minor ORDER The court appoints _________________________________________________as guardian ad litem for the above party. See Ex parte Anonymous, 531 So. 2d 901 (Ala. 1988). ___________________________________ Date ____________________________________________ Judge Ala. Code 1975, §26-21-4(h) American LegalNet, Inc. www.FormsWorkFlow.com