In the matter of 

First and last name(s), alias(es)

1. A hearing is scheduled for 

 Date and time

 

Type of hearing

 regarding

 .

2. I have received a copy of the petition for the hearing scheduled above.

3. I understand that this hearing may result in either a temporary suspension or a permanent loss of my parental rights to
 

the minor(s).

4. I understand that:

  a. In a juvenile delinquency proceeding, the juvenile has the right to remain silent and is not obligated to testify.

  b. The juvenile has a right to an appointed attorney if the juvenile and those responsible for his/her support are
 

    financially unable, or refuse, to provide an attorney.

  c.  The respondent has the right to an appointed attorney, if charged with an offense against the child and financially
 

    unable to hire an attorney.

  d. I have the right to bring witnesses on my behalf and confront and examine those testifying against me.

  e. I have the right to a jury at trial only, there is no right to a jury at a termination hearing. If I want a jury trial, I must file
    a request in writing with the court within: 1) 14 days after the court gives notice of the right to jury trial, or 2) 14 days
 
    after an appearance by an attorney, whichever is later, but no later than 21 days before trial.
 

5. I acknowledge this notice and my right to receive a summons or written notice of hearing.
 

I knowingly, voluntarily, and understandingly waive 

 service of a summons. 

 further legal notice of this hearing.

 

Date

Juvenile’s signature

Address

City, state, zip

 Father’s signature

Address

City, state, zip

Approved, SCAO
Form JC 23, Rev. 12/21
MCR 3.911, MCR 3.915, MCR 3.920(F)
Page 1 of 1

 

 

 

 

 

 

Mother’s signature

Address

City, state, zip

Address

City, state, zip

Signature                                                                                       Relationship

 

STATE OF MICHIGANJUDICIAL CIRCUIT - FAMILY DIVISIONCOUNTYWAIVER OF SUMMONS/NOTICE OF HEARINGCASE NO.PETITION NO.JUDGECourt addressCourt telephone no.JIS Code: WNH