Release for Custody and Property Mediation

I have read the data sheets or website on custody and property mediation.
I understand the policies and procedures as stated.
I am willing to respect the rules for appropriate behavior.
I am willing to sign necessary releases.
I understand that I am financially responsible for my portion of the mediation process.
I understand that I may ask questions at any time about the process or my case.
I give my permission for Susan Kraus and/or Frank Barthell and/or Verdell Taylor to discuss case issues and the mediation process with all parties involved and respective attorneys, to seek supervision or consultation when needed regarding specific issues of my case, and to consult with the court regarding statutes and policies.
I give my permission for a mediator-in-training to observe and/or participate at the discretion of my mediator as all three of the mediators listed are supervising mediators. I understand that there will be no additional charge for this service.
My signature reflects my understanding of the procedures utilized by Susan J. Kraus, Frank Barthell and Verdell Taylor for mediation, and my willingness to respect and abide by them.

Signature________________________________ Date ____________

Name (Print) ______________________________________________

Address__________________________________________________

_____________________________________Zip_________________

Home Phone ______________________________________________

Cell__________________Can we call at work?____________________

Referred by _______________________________________________

Attorney __________________________________________________

Attorney Phone # ___________________________________________