CASE NAME: CASE NUMBER: HEARING DATE & TIME: DEPARTMENT: ATTORNEY FOR PARTY: ATTACHMENT TO ORDER FOR PRISONER'S APPEARANCE AT HEARING REQUEST FOR TELEPHONIC PARTICIPATION If you have waived your right to be physically present at this hearing, you may request to participate in the hearing by telephone. Participation by telephone can happen only if the prison or jail where you are located can provide you telephonic participation that will maintain your child's and any sibling's confidentiality. I understand that I have the right to be physically present at the hearing scheduled to affect my parental rights. I hereby request to participate in the hearing by telephone. Date: Type or print name Signature of Parent DECLARATION OF INTERPRETER (To be completed if prisoner does not understand English sufficiently to read this form.) a. The prisoner's primary language is Spanish other (specify): b. I certify that I interpreted this form for the prisoner in the prisoner's primary language to the best of my ability. Date: Type or print name Signature of Interpreter DECLARATION THAT PRISONER DOES NOT WISH TO PHYSICALLY ATTEND HEARING The prisoner (name): he or she wishes to attend the hearing by telephone. has stated to me, or by conduct indicated to me, that The court is to call the prison at (____)_________________ at the time of the hearing. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Type or print name Signature of Prison Official Title of Prison Official TO PRISON OFFICIAL: Fax the signed forms to the submitting court at (____)_________________. SDSC JUV-235 (New 6/11) ATTACHMENT TO ORDER FOR PRISONER'S APPEARANCE AT HEARING American LegalNet, Inc. www.FormsWorkFlow.com