Co-Parenting Application

General Info

Applicant's Information

Pronouns *

Age *

Address *

Work/Daytime *

Cell

Our standard fees are $50/hour per party. Are you requesting a subsidy?

Other Party Info

Pronouns *

Age *

Address *

Work/Daytime *

Cell

Mutual Children

Relationship Information

Marriage/Cohabitation Date

Separation Date

Divorce Date

Is there a child custody agreement? *

Is there any legal restriction in communication between parties? *

Is there any legal restriction in communication or contact with children for you? *

Is there any legal restriction in communication or contact with children for the other party? *

Mediation Information

What are the issues you want to discuss in mediation? *

What do you think the other party might want to discuss in mediation? *

Do you have any concerns meeting in the same room together with the other party? *

Are there any accommodations you may need during the process of mediation? *