CONSENT TO VIDEOCONFERENCING Name of Defendant Type of Proceeding: Bench Warrant Hearing Emergency Protective Custody Hearing Intervention Hearing Status Review Hearing Permanency Planning Hearing Case/Docket No. FAMILY COURT FOR THE JUDICIAL CIRCUIT By my signature below, I, the defendant, consent to the use of videoconference equipment in this family court proceeding. The court will maintain the audiotape of this proceeding for a period of sixty (60) days from today's date in all proceedings, after which the audiotape may be destroyed. I have been fully informed of my right to be personally present before the court for this proceeding and, with that knowledge, I voluntarily waive that right. Attorney for Defendant Signature of Defendant Print Name and Bar Number Print Name Date SCCA/651 Revised 01/2016 American LegalNet, Inc. www.FormsWorkFlow.com