State of Alabama Unified Judicial System Form JU- 26B Rev. 1/09 Case Number ORDER WAIVER OF CONSENT FOR ABORTION IN THE JUVENILE COURT OF ________________________________________________ COUNTY, ALABAMA (Name of County) In the Matter of ________, a minor (Initials Only) This matter coming to be heard by the court on __________________________, and the petitioner represented by counsel, ______________________________________________, OR being having waived counsel, and this cause being submitted upon the pleadings and evidence presented, the court is of the opinion and finds that the petitioner is _________years of age; is unmarried and unemancipitated; is approximately _______weeks/ _______ days/ ________ months pregnant; is a resident of __________________________________(County); and desires to have the abortion procedure performed in _________________________________ County, Alabama; and that: the minor is mature and well informed enough to make the abortion decision OR the performance of the abortion would be in the best interests of the minor. The court further finds that: THE COURT HEREBY GRANTS the minor’s Petition for a Waiver of Consent to have an abortion performed, and the consent of either of the parents or legal guardian for the petitioner in this cause is hereby waived. This order allows performance of the abortion procedure in _________________________________ County. The physician performing this abortion and/or his agents are hereby ordered not to release any information regarding this order and/or the abortion procedure to the parent(s) or legal guardian(s) or third persons except to the Center for Health Statistics as is required by law unless further ordered by this court. THE COURT ORDERS that the record of the evidence presented and order rendered is confidential and shall be maintained for at least four years from the date of this order. Any person who shall disclose any records or information made confidential shall be guilty of a Class C misdemeanor. THE COURT FURTHER ORDERS that the clerk of the court prepare a certified copy of this order and deliver this copy forthwith to the petitioner for delivery to the physician performing the procedure. __________________________________ Date ___________________________________________________ Judge I, _____________________________________________, clerk of this court, do hereby certify that this is a true copy of the original order on file in this office. __________________________________ Date ____________________________By: _________________ Clerk Ala. Code 1975, §§ 26-21-4, 26-21-8 American LegalNet, Inc. www.FormsWorkFlow.com