--- title: Jury Duty Nursing Mother Accommodation Request Form Template | Paperform description: Free jury duty lactation accommodation request form for courts. Collect pumping schedules, private space needs, and break frequency to support nursing mothers during jury service. url: "https://paperform.co/templates/jury-duty-nursing-mother-accommodation-request-form" type: static generatedAt: "2026-04-03T00:49:17.324Z" --- [← Back to free form templates](/templates/) ![Jury Duty Nursing Mother Accommodation Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/jury-duty-nursing-mother-accommodation-request-form.png) [Preview](https://_preview.paperform.co/ai-template/jury-duty-nursing-mother-accommodation-request-form) [Use this template for free](/create?ai-template=jury-duty-nursing-mother-accommodation-request-form) [Legal & Compliance Forms](/templates/category/legal/)[Government & Civic Forms](/templates/category/government-civic/) [Public Administration](/templates/industry/public-admin/) [Office Manager](/templates/role/office-manager/)[Administrative Assistant](/templates/role/admin-assistant/)[Manager](/templates/role/manager/) About this free form template 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](https://stepper.io)** 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. Built for growing businesses, trusted by bigger ones. Trusted by 500K+ business owners and creators, and hundreds of millions of respondents. ![Capterra - 4.8 out of 5](/images/capterra-st.jpg) ![Trustpilot - 4.8 out of 5](/images/trustpilot-st.jpg) ![G2 - 4.8 out of 5](/images/g2-st.jpg) [Try Paperform free now](/register) ## More templates like this [![Jury Duty Language & Hearing Accommodation Request](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/jury-duty-language-hearing-accommodation-request.png) ### Jury Duty Language & Hearing Accommodation Request Request language interpretation or hearing assistance services for jury duty with detailed accommodation needs and dialect specifications.](/templates/jury-duty-language-hearing-accommodation-request/) [![Court Disability Accommodation Effectiveness Evaluation Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/court-disability-accommodation-effectiveness-evaluation-form.png) ### Court Disability Accommodation Effectiveness Evaluation Form A comprehensive evaluation form for court users to assess the effectiveness of disability accommodations, report accessibility barriers, and recommend modifications to improve equal access to justice.](/templates/court-disability-accommodation-effectiveness-evaluation-form/) [![Court Fee Waiver Application](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/court-fee-waiver-application.png) ### Court Fee Waiver Application Apply for a waiver of court fees and costs by demonstrating financial hardship through income verification, asset declaration, and proof of public assistance eligibility.](/templates/court-fee-waiver-application/) [![Court Reporter Transcript Request Form](https://img.paperform.co/fetch/f_webp/https://d3gw2uv1ch7vdq.cloudfront.net/content/form_templates/assets/court-reporter-transcript-request-form.png) ### Court Reporter Transcript Request Form Professional form for requesting court transcripts with hearing details, page range selection, and expedited delivery options. 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