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MEDIATION AGREEMENTIlana Tamari, B.Sc., D.C.S. (Psych), Acc.FM. (OAFM)

MEDIATION RETAINER AGREEMENT

BETWEEN:

["click to insert name here" ]

- and -

["click to insert name here" ]

PRINCIPLES

  1. The parents wish to retain the services of Ilana Tamari, Accredited Family Mediator with the OAFM, to assist them in mediating a temporary Parenting Plan along with a residential schedule, that includes provisions for holiday periods.
  1. The parents agree to enter into this Agreement based on the recommendation of their counselbecause of a desire to:
  1. prioritize theirchild’s best interests
  2. promote theirchild’s optimum adjustment
  3. benefit from the direction of a qualified mental health professional
  4. improve their ability to communicate with one another as it relates to their child
  5. develop a Parenting Plan which includes a dispute resolution mechanism

ROLE AND OBJECTIVES OF THE MEDIATOR

  1. The parents agree to retain Ilana Tamariin her role as Mediator to assist them in developing a Parenting Plan.
  2. In the event that a Parenting Plan is successfully mediated with the parents, the Plan will be submitted to each parent’s counsel for ratification.
  3. In the event that the parents are unable to reach agreement on a Parenting Plan, Ilana Tamari will provide written acknowledgement to both counsel that an agreement was not reached.

TERMS AND AGREEMENT TO COOPERATE

  1. Ilana Tamari, an Accredited Family Mediator with OAFM has relevant knowledge, including that in the areas of child development, family systems theory and dynamics, the effects of separation/divorce on children, adolescents, and adults, high conflict families, and psychological functioning, from which the parents wish to benefit.
  1. At the request of Ilana Tamari, the parents shall sign all releases of information required to implement the process. The parents shall provide all records, documentation and information requested by the Mediator and pertaining to the Parenting Plan as soon as possible and upon the request of the Mediator.

CONFIDENTIALITY

  1. The counselling provided through this service as Mediator is deemed to be an ‘open’ or ‘closed’ process {Select either open or closed mediation}and each party agrees that Ilana Tamarimay be asked to provide a written report or be a witness in any future court proceeding or provide any information to any future collateral/professional.

CHILD ABUSE REPORTING AND RISK OF HARM

  1. The Mediator is required to report to the appropriate child welfare authority (i.e., Children’s Aid Society, Catholic Children’s Aid Society, Jewish Family and Child Service, or Native Child & Family Services) and/or other relevant authorities if he has a reasonable suspicion that a child(ren) may be in danger of harm and/or abuse.

FEES

  1. The fee for Mediatoris at a rate of $___ per hour plus HST. A retainer of $____ is required prior to the commencement of service. Fees are applied to all time expended in any/all professional activities, including administrative matters, associated with this process and/or arising from this process. This includes time spent in reviewing documents and correspondence, voice-mail, e-mail, travel, meetings, and telephone calls with the parents, their counsel and other professionals involved. Also included are any unpaid fees charged retroactively from the time that services are initially requested and the file is opened.
  1. Record keeping requirements make it necessary to log and make a record of each and every e-mail, telephone call and/or message. For this reason, a minimum fee (.1 or 6 minutes) may be charged for each telephone and e-mail contact. These charges shall not apply to brief contacts about scheduling.
  1. Subject to the terms of paragraph 10,["click to insert name here" ]shall provide payment of $___. They will be solely responsible to the current fee and future retainers pertaining to ongoing work. Each parent shall be advised in advance when further retainer is required. A minimum retainer (security deposit) of $___ (2 hours) per parent shall be maintained in the account at all times, to be returned to ["click to insert name here" ] at the end of the Mediator’s tenure, less any balance owing by either party. If the above terms are not satisfied, Ilana Tamari shall postpone all services until the retainer terms are met. Non-payment of fees shall be grounds for the resignation of Mediator, although Ilana Tamari shall first give notice of her intention to resign and then allow either party a reasonable period of time to obtain a court order requiring this payment before resigning. In the period after the notice is given, Ilana Tamarineed not provide any services to the parents until her retainer is fully maintained.
  1. A non-refundable administrative fee of one (1 hour) hour payable by each parent shall be applied to cover the administrative costs associated with the file, including but not limited to the time required to open the file and reasonable period of time for scheduling appointment with the mediator.
  1. Regular statements of the account detailing the date, service, time and hourly rate shall be provided. Your insurance company may not cover all of the services, although insurance company policies vary. If you require an additional statement for insurance purposes an administrative fee shall be charged for the provision of an additional statement.
  1. A client shall be billed for an appointment in which there is less than 24 (twenty-four) business hours’ notice prior to cancellation by that client, except for an appointment scheduled for 8:00 a.m. and/or after 4:00 p.m., in which case 48 (forty-eight) business hours’ notice is required prior to cancellation. A client shall be responsible for bills arising from his or his own cancellation with insufficient notice and/or failure to attend a scheduled appointment.

WAIVER OF MEDIATOR’S LIABILITY

  1. The parties waive any claim or right of action against the Mediator for any matters arising out of the in good faith functions performed by her under this Agreement.

Dated: "click to insert date here" "click here to insert name"

Mother

Dated: "click to insert date here" "click here to insert name"

Father

Dated:"click to insert date here" ______

Ilana Tamari, B.Sc., D.C.S. (Psych), Acc.FM. (OAFM)