11. Briefly describe the issue or dispute: Please provide information as factually & neutrally as possible.
12. Have you taken any steps to try to resolve? Please provide any information on steps already taken to resolve the problem or dispute, if applicable.
13. What additional information, may be helpful to know? Please provide any background information that may be useful for the mediator.
14. Are there any court orders that apply in this matter? --Select an Option--
Yes
No
15. If any court orders, please describe:
16. Is there any pending litigation on the matter? --Select an Option--
Yes
No
17. If pending litigation, please describe:
18. Other party has consented to the mediation process: --Select an Option--
Yes
No
UNDERSTANDING & CONSENT TO MEDIATION PROCEDURES
By completing this application, I Consent to the following: I hereby consent and agree to participate in the WSCAI mediation program, in good faith, with the intent to work in a respectful and courteous manner toward a resolution to the issue or dispute as I have outlined it on the WSCAI Mediation Program Intake Form. I have read the Mediation Procedures (attached) and I agree to follow the Procedures.
AGREEMENT TO WAIVER OF LIABILITY
I agree that neither WSCAI nor any mediator shall be liable in to any party and my association, for any claim of any nature including but not limited to any alleged error, act, or omission in connection with any mediation. To the extent that any claim may exist, including any future claim, which is unknown to me at the present time, I agree to waive any and all such claims, of any nature whatsoever, and covenant not to sue the mediator or WSCAI and agree to hold them both harmless.
