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Date of Birth
 















Legal aid Information

The cost of the MIAM is £119, including VAT. However, if you are on a low income or benefits you MAY be eligible for Legal Aid. Please complete these questions as accurately as possible to help us ensure you get the support you need. 


You are able to check to see if you are eligible for Legal Aid at: www/gov.uk/check-legal-aid. 

Following the completion of this form, the Team at the Trust will contact you regarding payments and appropriate fees. 

 
 
 
 

Legal Aid Evidence

If you believe you are eligible for Legal Aid support, please could you provide further information. This information will only be used in your assessment for Legal Aid. 

Second Party Details

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Date of Birth
 

Children Involved

If you would like to address issues around children and child access, the Trust needs to understand who the children are and their ages. 

Stage in Separation and Support









Consent

Please read the information below and confirm you agree to these terms and conditions. 

Overview 


This document outlines the process for using online and video (e.g. WhatsApp, Zoom, Teams) for mediation assessments and mediation meetings in family mediation cases.

It is recognised that mediation is likely to be most effective when people speak face to face and in person. However, there are occasions when people cannot or decide not to come together in the same place to mediate. Childcare, transport, mobility, accessibility, illness and location can all be reasons why people are unable to attend mediation in person.  The Family Mediation Trust can offer mediation services online or via video link in such circumstances, however we reserve the right to decline this option if we do not feel it is practical, appropriate or necessary to do so. 

Should a mediation session or MIAM be offered online or via video link, the following terms and conditions must be abided by. 

Terms for Everyone

We agree that from this date any information shared in this meeting and in any mediation session will be confidential.

Confidential information cannot usually be used in legal proceedings. However, there are some exceptions:

      • Financial information can be disclosed;
      • The mediator cannot keep confidential information where there is serious risk of harm to someone or where there is a suggestion of a financial crime, such as benefits fraud or tax evasion; and
      • The Legal Aid Agency has the right to look at a file of anyone on legal aid. If one party is paying privately, that party can stop this.

We understand we are able to show confidential information to our professional advisors, but, subject to the exceptions, it cannot be used in legal proceedings.

To aid the development of new mediators, the Trust reserves the right for a trainee mediator to join the accredited mediator in the delivery of both MIAMs and mediation sessions.

The mediator may not be asked to be a witness, or to provide information, in any legal proceedings. If the court requires the mediator to give evidence, then the parties will both be liable to pay the mediator's costs.

Terms for Mediators 

      • We will not audio or video record any mediation session, and nor will you. We will check with you that neither you, nor anyone on your behalf, will do so. 
      • We may terminate online video mediation if there is inadequate quality of connection or a breach of this agreement may have occurred. 
      • We may suspend the mediation if there is any remote interruption and will restart the online session once satisfied that any interruption has been resolved and that it remains appropriate to continue following such interruption. 

Terms for Participants 

      • Only the people who have signed this agreement to mediate online may be present in the same rooms used by the participants during any online video mediation session. You will confirm that you are not able to be overheard from your location.  
      • You agree to do all you can to ensure that you are not interrupted during online video mediation by anyone else such as children, relatives, pets, deliveries.  
      • You agree to turn off or put to silent any phones, tablets or computers, and disable any alerts announcements or notifications of texts, emails, tweets or other social media activity, and close all or any other open application.   
      • You agree to there being no live or deferred video or audio relay of the online mediation to third participants. 
      • You agree not to video or audio record any online session. 
      • You assign all intellectual property rights in the online video mediation sessions to the mediator.  
      • If you create any video or audio recording of the online mediation, inadvertently or otherwise, you undertake to destroy any such recording as soon as you become aware of its existence.  

Minimum recommended specifications for hardware and software (mediators and participants):

      • The latest version of the chosen webcam software for your device (most software will be supported to 2 major releases prior to the current one) 
      • A high-speed broadband connection (see below) 
      • High-quality or HD webcam 
      • Microphone and speakers (built-in or external headset with microphone) 
      • A desktop/laptop with a 2 GHz dual core processor or greater 
      • The latest version of Microsoft Internet Explorer, Mozilla Firefox, Google Chrome or Safari
      • Minimum suggested broadband connection
      • Minimum download speed 2Mbps/Minimum upload speed 1Mbps
Beginning and ending the session
      • If using Skype, the participant will provide a Skype address that is unique to them. 
      • The Family Mediation Trust will initiate the session by Skype calling the account provided. 
      • At the beginning of the session the mediator will confirm that the above terms and conditions have been met, particularly that:
a) The participant will not create any electronic, video or audio record of the mediation.
b) The participant will not make or allow any live or deferred video or audio relay of the mediation to others.
c) Only the participants to the mediation and those who have signed the agreement to mediate will be present in the room used by each participant during any mediation session.
      • If at any point during the session the above ‘Terms for Participants’ are breached, the mediator reserves the right to terminate the session. In such an instance the mediation may be postponed and rescheduled. 
      • At the end of the session the mediator will terminate the call. 
      • All other correspondence aside from the specified mediation session will be made by telephone, email or letter.

Confidentiality and Data Protection

The Family Mediation Trust will handle your data and respect your privacy in accordance with data protection legislation and with the Service’s policies on Confidentiality, Data Protection and Privacy. For a copy of any of these documents please contact us on 01223 576 308 or families@thefamilymediationtrust.org 

Client agreement to mediate online / via video link

I confirm that I have read and understood the above terms and conditions and that I would like to mediate online/via video link. I confirm that I will abide by the terms and conditions above. 

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Date form was completed.
 
This form has been designed to help you book your MIAM online.

Completing the MIAM application online gives us the information we need to process your booking. But to achieve this there is quite a bit of information we need from you; the form may take about 10 minutes to complete.

When you have completed the form, you will receive a confirmation email. Following this the team will contact you to arrange the exact time of the MIAM and to take your payment. Until we take your payment and send you the booking confirmation you have not formally booked a MIAM and have no legal obligation to the Trust.