The petition shall include:
(a) the pseudonym or initials of the minor;
(b) the age of the minor;
(c) a statement that the minor is pregnant and notice and consent or consent only has not been waived;
(d) a statement that the minor desires to terminate her pregnancy without notice to and consent or consent only from a parent or legal guardian; and
(e) a short and plain statement of facts to establish any of the following:
(1) The minor is sufficiently mature to decide whether to terminate her pregnancy.
(2) The minor is a victim of child abuse or sexual abuse by one or both of her parents or a legal guardian.
(3) Notice to and consent or consent only from the parent or legal guardian is not in the best interests of the minor.