Fillable Form 20: SUPERIOR COURT OF CALIFORNIA COUNTY OF (The Superior Court of California, County of Santa Clara)

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Form 20: SUPERIOR COURT OF CALIFORNIA COUNTY OF (The Superior Court of California, County of Santa Clara)

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SUPERIOR COURT OF CALIFORNIA
COUNTY OF SANTA CLARA
Family Court Services
20
1 North First Street
San José, California 95113
(408) 534-5760
WAIVER OF MEDIATION CONFIDENTIALITY
I understand that mediation counseling is a confidential process. However, I agree to waive
confidentiality in order that the mediation counselor may conduct an assessment/evaluation
and to provide the Court with information and recommendation regarding my children.
Signature: Date:
Case Number: FCS:
FM-1073 REV 11/25/08 Page 1 of 1
SUPERIOR COURT, STATE OF CALIFORNIA
COUNTY OF SANTA CLARA
Family Court Services
20
1 North First Street
San José, California 95113
(408) 534-5760
WAIVER OF MEDIATION CONFIDENTIALITY
I understand that mediation counseling is a confidential process. However, I agree to waive
confidentiality in order that the mediation counselor may conduct an assessment/evaluation
and to provide the Court with information and recommendation regarding my children.
Signature: Date:
Case Number:
FCS:
FM-1073 REV 11/25/08 Page 1 of 1
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Form 20: SUPERIOR COURT OF CALIFORNIA COUNTY OF (The Superior Court of California, County of Santa Clara)

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Completed 29 June 2021

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