Okla. Stat. tit. 12, app B
______________________ Case No. | ______________________ Date | ______________________ Mediator |
______________________ Referral Source | ______________________ County |
______________________ Initiating Party | ______________________ Responding Party |
______________________ Address | ______________________ Address |
______________________ Telephone | ______________________ Telephone |
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We agree to participate in the mediation process in an effort to resolve our dispute. "Mediation" means the process of resolving a dispute with the assistance of a mediator outside of a formal court proceeding.
Our rights and obligations under the Dispute Resolution Act, 12 O.S. Supp.1991, § 1801 et seq., and the Rules and Procedures for the Dispute Resolution Act include:
We understand that any information received by a mediator or a person employed to assist a mediator is privileged and confidential. However, a mediator must disclose information brought to his/her attention that an elderly person, or a person with disabilities, or a child under the age of eighteen (18) has been physically abused or neglected.
We hereby release from liability the sponsoring agency for any claimed damages arising out of any action, statement, or decision made or taken in the mediation session, except where provided for in the Dispute Resolution Act.
We acknowledge that we have read and understand this Agreement, and we hereby agree to abide by its terms.
______________________ Initiating Party | __________________ Date | ______________________ Responding Party | __________________ Date |
Okla. Stat. tit. 12, app B