Jury Duty Nursing Mother Accommodation Request Form

Balancing civic duty with the needs of nursing mothers requires thoughtful accommodation—and this Jury Duty Nursing Mother Accommodation Request Form ensures courts can provide the support required by law while helping mothers participate fully in the justice system.

Why courts need dedicated lactation accommodation requests

Under federal and state laws, nursing mothers are entitled to reasonable break time and private space (not a bathroom) to express breast milk. For jury duty service—which can involve long days and unpredictable schedules—these accommodations are essential for health, comfort, and equal access to civic participation.

This form template helps court administrators, jury coordinators, and civic offices collect the information needed to arrange appropriate lactation facilities, break schedules, and storage options before a nursing mother reports for service.

What this template includes

The form gathers:

• Juror identification and case details to link the request to the correct summons
• Infant age and feeding schedule to understand frequency and duration of breaks needed
• Pumping schedule and break frequency to coordinate with court proceedings
• Private space requirements including accessibility, proximity, and amenities
• Storage needs for expressed milk (refrigeration, cooler space)
• Equipment needs such as access to electrical outlets or seating
• Duration of accommodation based on expected length of service
• Contact information for follow-up and confirmation

By collecting this information in advance, courts can proactively arrange suitable spaces, schedule appropriate breaks, and communicate plans to the juror—reducing stress and ensuring compliance with workplace lactation laws that extend to jury service.

How Paperform makes court accommodation requests seamless

With Paperform, you can embed this form directly on your court's website, link it from jury summons emails, or provide it as a QR code on physical summons. Conditional logic can adapt questions based on the type of service (grand jury vs. trial jury) or length of duty, and confirmation emails can provide immediate acknowledgment and next steps.

Use Stepper to automate the workflow after submission: notify the jury coordinator, create a task for facilities staff to prepare a lactation room, send a confirmation to the juror with room location and schedule details, and flag the case in your jury management system.

For courts managing multiple requests across different cases and dates, Paperform's secure submissions and integration with Google Sheets, Airtable, or case management tools ensure no request falls through the cracks—and that every nursing mother receives the accommodations she's entitled to.

Building an inclusive, accessible jury system

This form is part of a broader commitment to removing barriers to jury service. By proactively addressing the needs of nursing mothers, courts demonstrate respect for caregivers, comply with legal obligations, and ensure a more representative jury pool.

Paperform is SOC 2 Type II compliant and offers data residency controls, making it a trusted solution for government and civic organizations handling sensitive personal information. With secure submissions, role-based access, and audit trails, you can manage accommodation requests with confidence and professionalism.