Jury Summons Response Form

For assistance completing the following Jury Summons Response form, please refer to the following links:

Juror Summons Form - front of page
Juror Summons Form - back of page

If you have been summonsed to attend jury selection, you may apply for an exemption to the requirement to attend jury selection if:
  • You have health concerns that make you more vulnerable to COVID-19; or
  • You live with or are required to provide care for an individual who has health concerns that make them more vulnerable to COVID-19

An exemption may be applied for by EITHER
   a) completing and returning the jury summons which was mailed to you to by the Clerk's Office or
   b) using the form below. 
Please do not submit the form both ways.

Jury Selection Date:
Select Month
Report Time

Section A - Qualifications of Jurors

Are you a resident of Alberta?
Are you 18 years of age or older?
Are you a Canadian citizen?

Section B - Exclusion From Jury Service

Are you asking to be excluded from jury service?
If Yes















Section C - Exemption From Jury Service

Are you asking to be exempted from service based?
If Yes







By submitting this form, you certify that you are the person named in the Juror Summons, or you are authorized to respond on their behalf, and that the information submitted is true and correct to the best of your knowledge.