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In the Court of Common Pleas of ___ County
In the Court of Common Pleas of
___
undefined
VS.
___
Case number: _____
Case number
Interpreter Waiver Form
Name of party waiving the services of an interpreter: _____
Print name
Name of party waiving the services of an interpreter:
Relationship to case: (Check one) Defendant/Respondent Plaintiff/Petitioner (Print name) Witness Victim
Parent/Person in loco parentis
Plaintiff/Petitioner ย
Witness ย
Victim
(Print name)
Parent/Person in loco parentis Other:
Other
Parent/Person in loco parentis
Other: ______________________________
Primary language spoken: _____
Secondary language
Primary language spoken
Secondary language: _____
I, the undersigned, have been advised by the court of my right to have an interpreter present for the duration of this court proceeding to assist me in fully participating and understanding the proceeding, in order to safeguard my due process rights.
However, after consulting with my attorney, through the services of the interpreter provided by the court, (pursuant to 204 PA Code Ch.221.105 (a) or (b)), I hereby knowingly, voluntarily and intelligently choose to waive my right to have an interpreter present to assist me during these proceedings.
I understand that if at any time during the proceeding I decide that I need the services of an interpreter, one will be provided if I so petition the court.
Signature of party waiving the interpreter
Signature of Counsel for party waiving the interpreter
Signature of party waiving the interpreter
Signature of Counsel for party waiving the interpreter
Interpreter signature
Date
Date
By the court
By the court