Name Address City, State, Zip Code Telephone Number ~ Attorney for ~ Petitioner IN THE FAMILY COURT OF THE FIRST CIRCUIT STATE OF HAWAI221I In the Matter of the Guardianship of037 ) FC-G No. )) WAIVER OF NOTICE AND CONSENT , ) TO GUARDIANSHIP (Full Legal Name) ) An Incapacitated Person. )036)036 WAIVER OF NOTICE AND CONSENT TO GUARDIANSHIP I acknowledge receipt of a filed copy of the Petition requesting the appointment of , as guardian of the above-named Incapacitated Person and the Notice of Hearing in this action. I consent to the guardianship, appointment of the proposed guardian, and waive the requirement that I receive notice of the hearing at least fourteen days before the hearing on the Petition. Also, ~ I do not want to be notified of any further hearings and understand that the Court may grant the petition without further notice to me. ~ I want to be notified of all future hearings, but do not require that I be given at least fourteen days advance notice. DATED: Kapolei, Hawai221i, . Signature Print *Name: *This document may be037 Address:037 signed by the person or037 his/her attorney.037 In accordance with the Americans with Disabilities Act, as amended, and other applicable state and federal laws, if you require a reasonable accommodation for a disability, please contact the ADA Coordinator at the First Circuit Family Court office by telephone at 954-8200, fax 954-8308, or via email at adarequest@courts.hawaii.gov at least ten (10) working days prior to your hearing or appointment date. Please call the Family Court Service Center at 954-8290 if you have any questions regarding forms or procedures. FC Adm 2/27/14036 Waiver of Notice and Consent to Guardianship