Agreement to Mediate | Common Ground Mediation

Instructions: Complete all required fields marked *. Submit this form online or print and bring a signed copy to your session. You may also return it by email to LN@CommonGround-Mediation.com.

Mediation Details

Scheduled Date *

Type of Dispute *

Brief Description of Issues to Be Mediated *

Party 1 (Petitioner)

First Name *

Last Name *

Phone *

Email *

Attorney Name (if any)

Attorney Phone

Party 2 (Respondent)

First Name

Last Name

Phone

Attorney Name (if any)

Attorney Phone

Terms of Agreement to Mediate

The parties identified above agree to participate in mediation facilitated by Lynnette Nadeau, Common Ground Mediation. By signing, each party acknowledges and agrees to the following:

1. Voluntary Participation. Mediation is voluntary. Each party may withdraw at any time.

2. Confidentiality. All communications and documents produced in mediation are confidential and not admissible in any court proceeding, per the Texas Civil Practice and Remedies Code, Chapter 154.

3. Role of the Mediator. The mediator is a neutral facilitator who does not provide legal advice and does not represent any party. Parties are encouraged to consult independent legal counsel before signing any settlement agreement.

4. No Guarantee of Resolution. Mediation does not guarantee settlement. If no agreement is reached, all legal rights and remedies are preserved.

5. Fees. Fees are based on the sliding scale agreed during the initial consultation ($225–$1,200 per party for a standard 4-hour session) and are due before or at the start of the session.

6. Good Faith. All parties agree to participate in good faith with a genuine intent to reach resolution.

7. Governing Law. This agreement is governed by the laws of the State of Texas.

Acknowledgment & Signature

Party 1 — Type Full Name as Signature *

Date *

Party 2 — Type Full Name as Signature

Date

Submission confirms you have read and agreed to all terms above · Encrypted & confidential