Free Mediation Participation Agreement - New Hampshire

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THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us

Court Name: Case Name: Case Number:
(if known)

MEDIATION PARTICIPATION AGREEMENT
1. 2. 3. 4. 5. 6. 7. 8. Mediation is a private process where we will work to explore options for resolving the matter that brought us here today. The mediator is an impartial person whose job is to help us reach an agreement that is fair to all, without making the decisions for us. The mediator will not provide marital counseling or legal advice. We may seek legal advice from an attorney of our own choosing at any time. We are encouraged to have an attorney review the final agreement before we sign it. We will honestly disclose all information essential to bringing this matter to an agreement. Everything said or written during the mediation is confidential, except as provided by New Hampshire law or court rules. We will not subpoena the mediator or his/her records about anything said or agreed upon during the mediation. The mediator is paid for his/her services at $60 an hour as follows (please check and initial the appropriate letter choice): A. paying % and will pay the entire fee. paying %. B. The fee will be proportionally shared with

a. Provided we financially qualify, the fee will be paid by the State of New Hampshire initially. We will arrange with the State of New Hampshire Office of Cost Containment to pay back our respective share of the total fee. b. Other:

Date

Petitioner

Attorney for Petitioner

Date

Respondent

Attorney for Respondent

Date

Mediator

NHJB-2052-F (12/07/2006)

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