ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): FOR COURT USE ONLY TELEPHONE NO: ATTORNEY FOR (Name): FAX NO: SUPERIOR COURT OF CALIFORNIA · COUNTY OF FRESNO 1130 `O' Street Fresno, California 93724-0002 (559) 457-2100 PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: STIPULATION REGARDING PARTICIPATION IN THE ALTERNATIVE DISPUTE RESOLUTION (ADR) FAMILY LAW MEDIATION PROGRAM CASE NUMBER: Instructions: Participation in the ADR Family Law Mediation Program is voluntary. Eligible cases shall receive up to 90 minutes of mediation at a reduced fee rate. In order to be eligible for the reduced fee session, this stipulation must be filed with the Court and a filed copy must be provided to the mediator selected from the Court's ADR Family Law Mediation panel. (A list of panel mediators may be found at www.fresno.courts.ca.gov/alternative_dispute_resolution) The parties stipulate to participating in the Alternative Dispute Resolution (ADR) Family Law Mediation Program. The parties further stipulate that Family Law Mediation Panel. Mediator Info: Address: City, State, Zip: Phone Number: has been selected as the mediator from the ADR Email: Eligibility: Please note that not all cases may be suitable for the ADR Family Law Mediation Program. Cases with a history of domestic violence in the relationship may not be appropriate for participation in the program. Please indicate below if there is a history of domestic violence in this matter and/or existing restraining orders between parties in the case. YES - there is a known history of domestic violence and/or existing restraining orders in place. NO - there is no known history of domestic violence and/or existing restraining orders between parties. Date Type or Print Name Signature of Petitioner or Attorney for Petitioner Date Type or Print Name Signature of Respondent or Attorney for Respondent PADR-05 E09-16 OPTIONAL STIPULATION REGARDING PARTICIPATION IN THE ALTERNATIVE DISPUTE RESOLUTION (ADR) FAMILY LAW MEDIATION PROGRAM American LegalNet, Inc. www.FormsWorkFlow.com