ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: For Court Use Only ATTORNEY FOR (NAME): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CRUZ  Santa Cruz  Watsonville Branch 701 Ocean Street, Room 110 1430 Freedom Boulevard Santa Cruz, CA 95060 Watsonville, CA 95076 Plaintiff/Petitioner: Defendant/Respondent: STIPULATION AND REFERRAL TO CONFIDENTIAL COUNSELING FAMILY LAW CASE NO. 1. PETITIONER AND RESPONDENT STIPULATE TO ATTEND CONFIDENTIAL COUNSELING REGARDING THE CUSTODY/VISITATION OF THEIR MINOR CHILD(REN). 2. FEES ARE TO BE PAID TO THE COUNSELOR AS FOLLOWS:    PETITIONER SHALL PAY $ RESPONDENT SHALL PAY $ COURT SHALL PAY $ DATED: PETITIONER DATED: RESPONDENT DATED: ATTORNEY FOR PETITIONER DATED: ATTORNEY FOR RESPONDENT REFERRAL BASED ON THE STIPULATION OF THE PARTIES, THEY ARE REFERRED TO CONFIDENTIAL COUNSELING AND SHALL PAY ALL FEES AS AGREED. (DATE) JUDGE OF THE SUPERIOR COURT SUPCV 942 (Rev. 10/05) STIPULATION AND REFERRAL TO CONFIDENTIAL COUNSELING – FAMILY LAW Local Rule 3.3.03 American LegalNet, Inc. www.USCourtForms.com