WAIVER OF MEDIATION COMMUNICATION PRIVILEGE I understand that the Child Custody Mediator will make a report of the Mediation proceedings to the Court. The Mediator's Report will be filed with the Prothonotary of Indiana County. The Report may also be made available to professionals requested to perform evaluations or provide treatment to the parties and/or children. The Report may contain information about settlement discussions, including the final positions of the parties if agreement is not reached. I waive the privilege of 42 Pa. Con. Stat. Ann Section 5949 in regard to mediation communications occuring during the Child Custody Mediation Conference in respect to the Mediator's Report. __________________ Date ________________________________ Signature American LegalNet, Inc. www.USCourtForms.com