1. Each person voluntarily agrees to come to mediation and work honestly and in good faith during the process.

2. At any time before an agreement is reached, any person can withdraw his/her consent to participate in mediation. No one participating in mediation is giving up any right to take further court action if mediation fails.

3. I understand that the role of the mediator is to help others make their own decisions and not give advice or recommendations about how to resolve this dispute.

4. All information shared in this mediation with the mediator(s) or with Quabbin Mediation staff is private, privileged, and confidential as set forth in Massachusetts General Law Ch. 233, sec.23C and will not be disclosed to anyone outside of the mediation program, except under the following circumstances:

(a) Any written agreement may be presented to the court if specified by both parties.

(b) With the agreement of the participants in this mediation, when appropriate, mediation staff will inform the agency responsible the case referral that an agreement has been reached. In certain situations, the referring agency may receive a copy of the agreement and a report on whether it has been upheld.

(c) A mediator may be required to disclose information under federal and/or state law, but only if each requirement is found to supercede the mediation confidentiality privilege set forth in Massachusetts General Laws. For example: If a party to a mediation expresses an intention to harm themselves or others, or the mediator is informed of potential risk of harm to a child, the mediator may be required to disclose that information. 

5. No one may use mediation program records, notes, work product, mediators or staff in any court or administrative proceeding of any kind.

6. I understand that I am free to seek the advice of a lawyer or other professional who might assist me in understanding my options at any point before signing any agreement generated during the mediation process.

7. Other persons may attend the mediation session only if all parties to a mediation agree to it.

8. There is NO CHARGE for this service

I have read the "Agreement to Mediate" document.