In the Matter of:
Case No. _____________
Division No. __________
The Court finds that domestic conciliation is appropriate for this case. Domestic
conciliation is a non-confidential process in which a neutral person assists the parties in
reconciliation efforts by improving communication, reconciling differences, and helping the
parties develop solutions to a dispute, complaint, or conflict. The best interests of the parties and
their minor child(ren) are served by an amicable settlement of the custody, residency and
parenting time issues.
The Court therefore orders;
1. The parties will participate in domestic conciliation.
2. The Court appoints the following as domestic conciliator:
Name: __________________________________
Address: ________________________________
Phone: __________________________________
Email: __________________________________
The domestic conciliator serves and functions under the direction and control of the Court, and
shall have qualified quasi-judicial immunity. If the domestic conciliator is also a licensed
attorney, he or she is not representing either party or offering legal advice to the parties
concerning their rights in this case.
3. The domestic conciliator will meet with the parties to assist them in reaching
agreements as to the issues identified below. The parties will meet with the domestic conciliator
at such times, places and appointments which are set and will promptly provide such information
as the domestic conciliator requests.
4. The issues to be considered in conciliation are:
Residential Placement (“home base”, school attendance, main address)
Parenting time / Schedule
Legal Custody/Decision Making
Other Co-parenting Issues that may arise during the domestic conciliation
process, to be considered at the discretion of the domestic conciliator; and
Other: ______________________________________________________
5. The fee for the domestic conciliator will be ____________.
6. The domestic conciliator must file a written report with the Court at the
conclusion of the conciliation process. Yes _____ No _____
7. If a report is filed, the domestic conciliator must include in the report:_________
8. The domestic conciliator may communicate individually with each party. Yes
_____ No _____
9. The domestic conciliator may communicate with non-parties. Yes _____ No
_____. If yes, the parties are ordered to execute all releases or written consents authorizing the
communication requested by the domestic conciliator.
10. Conciliation is a non-confidential process and the parties waive confidentiality
under K.S.A. 5-512 and Rule 908(c)(1).
11. The parties are advised that the domestic conciliator is a mandated reporter for
child abuse pursuant to KSA 38-2223(a)(1)(D).
12. The domestic conciliator must screen and continually monitor each dispute for
domestic violence.
13. Failure to participate in domestic conciliation may be considered contempt of
Counsel for Petitioner: __________________________________________________________
Petitioner: ____________________________________________________________________
Petitioner’s Address: ____________________________________________________________
Petitioner’s Phone #s: Work _____________Home _______________Cell_________________
Petitioner’s E-mail Address: _____________________________________________________
Counsel for Respondent: _________________________________________________________
Respondent: ___________________________________________________________________
Respondent’s Address: ___________________________________________________________
Respondent’s Phone #s: Work _____________Home ______________Cell_________________
Respondent’s E-Mail Address: ____________________________________________________
Counsel for Third Party: _________________________________________________________
Third Party: ___________________________________________________________________
Third Party’s Address: ___________________________________________________________
Third Party’s Phone #s: Work _____________Home ______________Cell_________________
Third Party’s E-Mail Address: ____________________________________________________
Guardian ad Litem/Other: ________________________________________________________
GAL/Other’s Address: ___________________________________________________________
GAL/Other’s Phone #s: Work ___________Home _____________Cell____________________
GAL/Other’s E-Mail Address: _____________________________________________________