Form AOC-MED-ADR-13 "Agreement to Mediate for Criminal Cases" - Kentucky

What Is Form AOC-MED-ADR-13?

This is a legal form that was released by the Kentucky Court of Justice - a government authority operating within Kentucky. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on March 1, 2021;
  • The latest edition provided by the Kentucky Court of Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form AOC-MED-ADR-13 by clicking the link below or browse more documents and templates provided by the Kentucky Court of Justice.

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AOC-MED-ADR-13 Doc. Code: FMP
Case No. ____________________
Rev. 3-21
Court
____________________
Page 1 of 1
County
____________________
Commonwealth of Kentucky
Court of Justice
www.kycourts.gov
Division
____________________
AGREEMENT TO MEDIATE
FOR
Mediation Date ________________
CRIMINAL CASES
This agreement refl ects the commitment of each party to negotiate fairly and honestly throughout the mediation process.
1.
The mediator will direct the mediation process in an impartial and neutral manner. The mediator has no authority to
force a settlement on the participants and does not provide legal, fi nancial, therapeutic or other professional advice.
2.
All information disclosed during the mediation, either written or verbal, shall be confi dential. The privilege resides in
the mediator and may not be waived by the parties. However, nothing prohibits a mediator from reporting abuse
according to KRS 209.030, KRS 209A.100 or 209A.110 (if mediator is a professional as defi ned by KRS 209A.020),
KRS 620.030, or other applicable law.
3.
Participants agree to not video or voice record any part of the mediation session or allow anyone else to record
any part of it. This includes, but is not limited to, the use of desktop or mobile phone recording apps.
4.
Participants may choose another means to resolve their confl ict at any time before mediation is completed,
including, but not limited to, the court system.
5.
Any agreement signed as a result of the mediation will be presented to the Circuit Judge for fi nal approval.
I understand and agree to abide by the terms of this agreement.
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Mediator
Date
Mediator
Date
AOC-MED-ADR-13 Doc. Code: FMP
Case No. ____________________
Rev. 3-21
Court
____________________
Page 1 of 1
County
____________________
Commonwealth of Kentucky
Court of Justice
www.kycourts.gov
Division
____________________
AGREEMENT TO MEDIATE
FOR
Mediation Date ________________
CRIMINAL CASES
This agreement refl ects the commitment of each party to negotiate fairly and honestly throughout the mediation process.
1.
The mediator will direct the mediation process in an impartial and neutral manner. The mediator has no authority to
force a settlement on the participants and does not provide legal, fi nancial, therapeutic or other professional advice.
2.
All information disclosed during the mediation, either written or verbal, shall be confi dential. The privilege resides in
the mediator and may not be waived by the parties. However, nothing prohibits a mediator from reporting abuse
according to KRS 209.030, KRS 209A.100 or 209A.110 (if mediator is a professional as defi ned by KRS 209A.020),
KRS 620.030, or other applicable law.
3.
Participants agree to not video or voice record any part of the mediation session or allow anyone else to record
any part of it. This includes, but is not limited to, the use of desktop or mobile phone recording apps.
4.
Participants may choose another means to resolve their confl ict at any time before mediation is completed,
including, but not limited to, the court system.
5.
Any agreement signed as a result of the mediation will be presented to the Circuit Judge for fi nal approval.
I understand and agree to abide by the terms of this agreement.
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Participant
Date
Participant
Date
_____________________________________________
____________________________________________
Mediator
Date
Mediator
Date