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Initial Agreement to Mediate This is an AGREEMENT between a Mediation Participant, Name



Email Address


Phone Number (daytime) AND

Expected Other Participant(s) to Mediation: who is/are hereafter referred to as “Parties” collectively; and



Mediator Name (if known) who is hereafter referred to as “Mediator.” The Parties wish to enter into mediation with Mediator with the intention of reaching a consensual settlement of their concerns regarding certain issues generally related to their dispute. The provisions of this agreement are as follows: 1. The Mediator is a neutral facilitator who will assist the parties to reach their own settlement. The Mediator will not make decisions about “right” or “wrong” or tell the parties what to do. 2. If the Mediator is an attorney, they will not offer legal advice nor will they provide legal counsel. Each party is advised to seek his/her own counsel in order to be properly counseled about his/her legal interests, rights and obligations before any party signs a written agreement. 3. It is understood that in order for mediation to work, open and honest communications are essential. Accordingly, all written and oral communications, negotiations and statements made in the course of mediation will be treated as privileged settlement discussions and are absolutely confidential. (K.S.A. 5-512). The confidentiality of this process includes: a.

The Mediator will not reveal anything discussed in mediation to third parties without the permission of both parties as well as the Mediator.


That pursuant to state law, information regarding child abuse, domestic violence, elder abuse, crimes committed or express intent to commit a crime are not subject to privilege and the Mediator may be compelled to disclose such. (K.S.A. 5-512(b)).


Consistent with state law and to ensure free and open discussions, the parties agree that they will not at any time before, during, or after mediation, call the Mediator as a witness in any legal or administrative proceeding concerning this dispute. To the extent that they may have a right to call the Mediator as a witness, that right is hereby waived. The parties also agree that statements made/documents produced in this process will not be admissible in any legal or administrative proceeding unless obtained previously or subsequently by independent means of discovery. At no point will Mediator maintain originals of documents.


The parties agree not to subpoena or demand the production of any records, notes, work product or the like of the Mediator in any legal or administrative proceeding concerning this dispute. To the extent that they may have a right to demand these documents, that right is hereby waived. Mediator has my consent to destroy personal notes or other records of the mediation not requested to be returned.


The exception to the above is that this agreement to mediate and any written agreement made and signed by the parties as a result of mediation may be used in any relevant proceeding, unless the parties make a written agreement not to do so. (K.S.A. 5-514).

4. It is understood that full disclosure of all relevant and pertinent information is essential to the mediation process. Accordingly, there will be a complete and honest disclosure by each of the parties to the other and to the Mediator of all relevant information and documents. This includes providing each other and the Mediator with all information and documentation that usually would be available through the discovery process in a legal proceeding. If either party fails to make such full disclosure, then the agreement reached in mediation may be set aside. 5. While both parties intend to continue with mediation until a settlement agreement is reached, it is understood that either or both parties may withdraw from mediation at any time. It is the agreement that if one or both parties decide to withdraw from mediation, best efforts will be made to discuss this decision in the presence of both parties and the Mediator. 6. If the Mediator determines that it is not possible to resolve the issues through mediation, the process can be terminated once this has been conveyed to the parties and confirmed in writing. 7. When an agreement is reached, the Mediator will prepare a Memorandum of Understanding. Each party is strongly advised to review this with his/her own counsel before the agreement is placed in final form and formally signed. 8. It is understood that any applicable statute of limitations is tolled (on hold) from the date the parties jointly agree in writing to participate in mediation per the

Dispute Resolution Act and tolling extends (no more than 60 days without consent of the parties) until date mediation is officially terminated by Mediator. (K.S.A. 5-515). 9. The parties agree to share expenses as a part of the settlement of the parties and if no agreement otherwise achieved the expenses will be shared equally between the parties. The parties shall, however, be jointly and severally liable for the payment of any outstanding balance due to Mediator. I have read, understand and agree to each of the provisions of this Agreement and further understand it will not be fully binding until all parties to the mediation have 1.) signed an Agreement, and 2.) the additional terms below is approved by all parties to the mediation and the Mediator. ____________________________________ Date: Sign by simply typing your name with a “#� before and after name. Save file and deliver as requested.

Additional Terms and Final Acceptance 1.) The Initial Agreement to Mediate above is again approved and ratified; additionally the following is approved: 2.) The Mediator is: (Name): ________________________________________ and it is disclosed the Mediator IS / IS NOT an attorney who will NOT provide legal advice. 3.) The parties understand and agree that Mediator’s fee for mediation is $_________ per hour with a minimum advance retainer of $________________ to be paid at beginning of the first session or as otherwise agreed; 4.) Additional terms, if any, ARE / ARE NOT attached as Attachment A. ____________________________________ Date signed: ______________________ Signed by Mediation Participant ____________________________________ Date signed: ______________________ Signed by Mediation Participant ____________________________________ Date signed: ______________________ Signed by Mediation Participant ____________________________________ Date signed: ______________________ Signed by Mediator

Agreement to Mediate Dispute  

This is an Agreement to Mediate offered by Mediators of

Agreement to Mediate Dispute  

This is an Agreement to Mediate offered by Mediators of