MEDIATION PROTECTION REQUEST UNIFIED FAMILY COURT OF YOLO CHILD CUSTODY MEDIATION When there has been a history of domestic violence between the parties: YOU HAVE A RIGHT TO SEPARATE SESSIONS. The victim of the violence has the right to have separate sessions with the mediator, that is, to meet with the mediator without having the person who did the violence in the room at the same time.    Have you been the victim of domestic violence done by any of the other adults in this case? [ ] YES [ ] NO Do you wish to be seen together with that person in mediation? [ ] YES [ ] NO Do you wish to be seen separately? [ ] YES [ ] NO YOU HAVE A RIGHT TO HAVE A SUPPORT PERSON. When a party has been issued a current domestic violence protective order against the other party, a support person may accompany the person protected by the order during the mediation where she/he wishes to be seen separately or together with the other party. It is the function of the support person to provide moral and emotional support for a person alleging she/he is a victim of domestic violence. The party may select any individual to act as a support person. The support person’s role is to assist the person in feeling more confident that she/he will not be injured or threatened during a proceeding when the victim of domestic violence and the other party must be present in close proximity. The support person is not present as a legal advisor and shall not give legal advice. The support person shall be bound by the confidentiality of the mediation in the same manner as are the other participants. The mediator has the authority to exclude a support person from mediation if their presence is disruptive.   Do you have a current domestic violence protective order against the other party? [ ] YES [ ] NO If you have such a current protective order, do you wish to have a support person with you in mediation? [ ] YES [ ] NO Signature Date Relationship to Child kl 08-06 American LegalNet, Inc. www.FormsWorkflow.com