Forms and Agreements
The following subsections are dedicated to providing service users access to the required forms and agreements that will/may be required to submit to their mediator.
Service users may submit copies of completed forms/agreements online, via secured email (admin@alternativedecisions.net), or via postal mail to the following:
Alternative Decision or Mediator’s Name
PO Box 61 STN MAIN
Port hope, ON
L1A 3W9
Referrals
Professional legal, health care, or other service providers may use the Referrals Guide, for referral submission instructions.
General Forms
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Click Here for our Financial Assistance Online Application.
OR
This form may also be submitted via secure email or postal mailing services:
Alternative Decisions or Service Provider’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Financial Assistance Form PDF
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People under the age of 18, commonly known as youth, are welcome to be included in mediation and negotiation services.
The following three forms must be completed before the inclusion of any child or youth (each youth will require a copy of each document).Youth Inclusion Agreement Form PDF
Consent Form - Parent Form PDF
Forms may be submitted via secure email or postal mailing services:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Addictions Mediation
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Please fill out this form to apply for addictions mediation services, including as much information as possible.
This form may be completed online
Online FormThis form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
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Once an ‘Application for Addictions Mediation’ is submitted and approved, and your intake session is complete you will be requested and required to complete an ‘Agreement to Mediate’.
Your mediator will supply all parties with access to the agreement form. Parties may take as long as they require to complete this document and submit it. If you require clarification or wish to address an aspect of the agreement, please reach out to your mediator.
This must be completed before any mediation sessions can begins
This form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
Agreement to Mediate PDF -
Your mediator will supply you with a personalized ‘Confidentiality Agreement‘ as part of your welcome package. This form must be filled out and submitted prior to any mediation sessions or other activities.
This form may be submitted with ‘Agreement to Mediate’ or afterwards, however is a required document.
This form may be submitted via secure email or postal mailing services addressed to the following:Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have attached a blank Confidentiality Agreement to view and use at your discretion.
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This form must be filled out and submitted before the involvement of any third-party in any mediation service or session.
This form may be submitted via secure email or postal mailing services:Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Any emailed submissions must be emailed via secure email to admin@alternativedecisions.net
Family Mediation
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Please fill out this form to apply for family mediation services, including as much information as possible.
This form may be completed online Online FormThis form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Once an ‘Application for Family Mediation’ is submitted and approved, and your intake session is complete you will be requested and required to complete an ‘Agreement to Mediate’.
Your mediator will supply all parties with access to the agreement form. Parties may take as long as they require to complete this document and submit it. If you require clarification or wish to address an aspect of the agreement, please reach out to your mediator.
This must be completed before any mediation sessions can begins
This form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Your mediator will supply you with a personalized ‘Confidentiality Agreement‘ as part of your welcome package. This form must be filled out and submitted prior to any mediation sessions or other activities. This form may be submitted with ‘Agreement to Mediate’ or afterwards, however is a required document.
This form may be submitted via secure email or postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have attached a blank Confidentiality Agreement to view and use at your discretion.
-
This form must be filled out and submitted before the involvement of any third-party in any mediation service or session.
Disclosure - Inclusion Agreement Form PDF
This form may be submitted via secure email or postal mailing services:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Any emailed submissions must be emailed via secure email to admin@alternativedecisions.net
Mental Health Mediation
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Please fill out this form to apply for mental health mediation services, including as much information as possible.
This form may be submitted online
Online FormThis form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Once an ‘Application for Mental Health Mediation’ is submitted and approved, and your intake session is complete you will be requested and required to complete an ‘Agreement to Mediate’.
Your mediator will supply all parties with access to the agreement form. Parties may take as long as they require to complete this document and submit it. If you require clarification or wish to address an aspect of the agreement, please reach out to your mediator.
This must be completed before any mediation sessions can begins
This form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Your mediator will supply you with a personalized ‘Confidentiality Agreement‘ as part of your welcome package. This form must be filled out and submitted prior to any mediation sessions or other activities.This form may be submitted with ‘Agreement to Mediate’ or afterwards, however is a required document.
This form may be submitted via secure email or postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have attached a blank Confidentiality Agreement to view and use at your discretion.
-
This form must be filled out and submitted before the involvement of any third-party in any mediation service or session.
Disclosure - Inclusion Agreement Form PDF
This form may be submitted via secure email or postal mailing services:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Any emailed submissions must be emailed via secure email to admin@alternativedecisions.net
Negotiation Services
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Please fill out this form to apply for negotiation services, including as much information as possible.
This form may be submitted online or via email.
Online FormThis form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Negotiator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
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Once an ‘Application for Negotiation’ is submitted and approved, and your intake session is complete you will be requested and required to complete an ‘Agreement to Negotiate’.
Your negotiator will supply all parties with access to the agreement form. Parties may take as long as they require to complete this document and submit it. If you require clarification or wish to address an aspect of the agreement, please reach out to your negotiator.
This must be completed before any negotiation sessions can begins
This form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Negotiator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Your negotiator will supply you with a personalized ‘Confidentiality Agreement‘ as part of your welcome package. This form must be filled out and submitted prior to any negotiation sessions or other activities. This form may be submitted with ‘Agreement to Negotiate’ or afterwards, however is a required document.
This form may be submitted via secure email or postal mailing services addressed to the following:
Alternative Decisions or Negotiator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have attached a blank Confidentiality Agreement to view and use at your discretion.
-
This form must be filled out and submitted before the involvement of any third-party in any negotiation service or session.
Disclosure - Inclusion Agreement Form PDF
This form may be submitted via secure email or postal mailing services:
Alternative Decisions or Negotiator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Any emailed submissions must be emailed via secure email to admin@alternativedecisions.net
Prenuptial Mediation
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Please fill out this form to apply for prenuptial mediation services, including as much information as possible.
This form may be submitted online or via email.
Online FormThis form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Once an ‘Application for Prenuptial Mediation’ is submitted and approved, and your intake session is complete you will be requested and required to complete an ‘Agreement to Mediate’.
Your mediator will supply all parties with access to the agreement form. Parties may take as long as they require to complete this document and submit it. If you require clarification or wish to address an aspect of the agreement, please reach out to your mediator.
This must be completed before any mediation sessions can begins
This form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Your mediator will supply you with a personalized ‘Confidentiality Agreement‘ as part of your welcome package. This form must be filled out and submitted prior to any mediation sessions or other activities.This form may be submitted with ‘Agreement to Mediate’ or afterwards, however is a required document.
This form may be submitted via secure email or postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have attached a blank Confidentiality Agreement to view and use at your discretion.
-
This form must be filled out and submitted before the involvement of any third-party in any mediation service or session.
Disclosure - Inclusion Agreement Form PDF
This form may be submitted via secure email or postal mailing services:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Any emailed submissions must be emailed via secure email to admin@alternativedecisions.net
Separation Mediation
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Please fill out this form to apply for separation mediation services, including as much information as possible.
This form may be submitted online or via email.
Online FormThis form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Once an ‘Application for Separation Mediation’ is submitted and approved, and your intake session is complete you will be requested and required to complete an ‘Agreement to Mediate’.
Your mediator will supply all parties with access to the agreement form. Parties may take as long as they require to complete this document and submit it. If you require clarification or wish to address an aspect of the agreement, please reach out to your mediator.
This must be completed before any mediation sessions can begins
This form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Your mediator will supply you with a personalized ‘Confidentiality Agreement‘ as part of your welcome package. This form must be filled out and submitted prior to any mediation sessions or other activities. This form may be submitted with ‘Agreement to Mediate’ or afterwards, however is a required document.
This form may be submitted via secure email or postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have attached a blank Confidentiality Agreement to view and use at your discretion.
-
This form must be filled out and submitted before the involvement of any third-party in any mediation service or session.
Disclosure - Inclusion Agreement Form PDF
This form may be submitted via secure email or postal mailing services:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Any emailed submissions must be emailed via secure email to admin@alternativedecisions.net
Youth Conflict Mediation
-
Please fill out this form to apply for youth conflict mediation services, including as much information as possible.
This form may be submitted online or via email.
Online FormThis form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
Application for Youth Conflict Mediation PDF
-
Once an ‘Application for Youth Conflict Mediation’ is submitted and approved, and your intake session is complete you will be requested and required to complete an ‘Agreement to Mediate’.
Your mediator will supply all parties with access to the agreement form. Parties may take as long as they require to complete this document and submit it. If you require clarification or wish to address an aspect of the agreement, please reach out to your mediator.
This must be completed before any mediation sessions can begins
This form may be submitted by secure email or by postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have also supplied a blank PDF for to use at your discretion.
-
Your mediator will supply you with a personalized ‘Confidentiality Agreement‘ as part of your welcome package. This form must be filled out and submitted prior to any mediation sessions or other activities.This form may be submitted with ‘Agreement to Mediate’ or afterwards, however is a required document.
This form may be submitted via secure email or postal mailing services addressed to the following:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
For your convenience we have attached a blank Confidentiality Agreement to view and use at your discretion.
-
This form must be filled out and submitted before the involvement of any third-party in any mediation service or session.
Disclosure - Inclusion Agreement Form PDF
This form may be submitted via secure email or postal mailing services:
Alternative Decisions or Mediator’s Name
PO Box 61 STN Main
Port Hope, Ontario
L1A 3V9
Any emailed submissions must be emailed via secure email to admin@alternativedecisions.net