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SAMPLE ONLY --- SAMPLE ONLY --- SAMPLE ONLY �� WEST SUBURBAN MEDIATION CENTER , , 1011 First St.S,Ste.200,Hopkins,MN 55343 (612)933-0005 Fax: (612)933-6046 � �� MEETING GROUND RULES: The parties agree to participate in the meeting in an attempt to discuss the following issue(s): The parties also agree to abide by the following ground rules: 1. ISSUES TO BE DiSCUSSED. The�iscussion at the meeting will be limited to the problems described above. 2. TIME CONSTRAINTS. Specific time constraints will be proposed and agreed upon before the meeting begins. 3. MEETING IN`'GOOD FAITH". All parties agree to meet in"good faith", which means they will be forthcotning in providing truthful information. In addition, all parties will treat each other with mutual respect, meaning: • No interrupting • No abusive behavior, e.g. name calling,put-downs • Speak far yourself, using"I" statements, not for any other person �. ROLE OF FACILITATOR(S). The facilitator(s)are neutral parties and thus do not represent either pariy nor are they advocating for any specific outcome to the meeting. The role of the facilitator is to: • assist parties with clarifying issues • ensure that all parties have an equal and fair chance to state their concenls, ask questious and/or share pertinent information • ensure respectful communication bv all parties. 5. CONFIDENTIALITY. The meeting proceedings are considered confidential. No part of these proceedings can be used in any lawsuit related to the problem(s)identified above. The parties will not subpoena the facilitator(s). an_y Board members, staff of the West Suburban Mediation Center(WSMC), or any records or docwnents of the facilitators or WST7C. As these proeeedings arc not a formal mediation process and one goal of this meeting is to share information, notes may be taken and retained by all participaring parties. However. no recording of this proceeding shall be made unless all parties previously agree to it. EXCEPTIONS TO CONFIDENTIALITY. Where information regarding possible abuse or neglect of children and/or domestic abuse is stated by any participating party, statute requires that such information be reported to the appropriate authorities. Date: (Party) (Additional Parly) (Pariy) (Additional Party) (Facilitator) (Facilitator) rev 7/9( SAMPLE ONLY --- SAMPLE ONLY --- SAMPLE ONLY