This waiver and consent form is executed in exchange for participation by the mediator(s) int he mediation of a dispute between __________________ and __________________. It pertains only to the matters arising during mediation of that dispute.
1. I understand that the mediator is not a legal advisor and is not to provide legal advise to any party involved in mediation. I agree to hold the said mediator harmless for any observations, suggestions or implications that he/she may make in the course of mediation. I specifically agree to obtain legal advice on any issue of interest to me from my own attorney and not to rely upon the mediator for such advice.
2. I waive any right of action that I may have against the mediator for any allegation of wrongful conduct on his/her part or on the part of his/her employees, while acting in the course of the mediation herein agreed to.
3. I agree to the necessity that mediation be confidential and therefore agree that I will not call the mediators, or their agents or employees, who serve on my case to act as witnesses in any court of competent jurisdiction to testify to facts concerning or relating to the subject matter here being mediated and that neither will I subpoena documents or information about my case which may have been retained in any file of the mediator.
4. I agree to treat anything said by the opposing party as part of an offer to compromise and settle the dispute being mediated. I further agree that statements made during mediation shall be treated as offers to settle and shall not be admissible should this matter result in litigation.
5. I specifically agree, however, that a fully executed settlement agreement can be admitted to any court proceeding without my objection as evidence of such settlement.
6. I acknowledge receipt of the Rules for Mediation and agree to abide by them.
I consent to these terms and waive the rights herein specified, and I know that I have the right to consult legal counsel before executing this document.
_________________________________ ______________________ Signature of Party Date
© 1996 The Mediation Center, Inc.br>
