Riverdale Mediation Services

Consent to Third Party Screening with Elizabeth Hyde

IN THE MATTER OF THE ARBITRATION ACT S.O. 1991, c. 17, as amended,
and the FAMILY LAW ACT, R.S.O. 1990, c.F3, as amended

B E T W E E N:


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I , agree to meet confidentially with (“the Screener”) as required by the Regulation under the Arbitration Act, and as requested by the Arbitrator or Mediator-Arbitrator, for the purpose of assessing suitability for participation in an

 before (the Arbitrator). The other party shall also meet with the Screener for the same purpose.

The parties will sign any applicable terms for Online Screening in the event that the parties and the Third Party Screener choose to conduct their process using online technology, in whole or in part, and those terms shall form part of this Agreement.

The Screener’s relevant training and experience is set out in Schedule A. The Screener will, in their discretion, also provide appropriate information to the parties. The Screener is independent of the parties and their lawyers. The Screener will meet separately and confidentially with each party. Based on the information provided by both parties, and applying their skills and experience, the Screener will make a confidential recommendation to the Arbitrator using some of all of the form attached (Schedule B).

I agree to provide full information and documents, as requested, to the Screener. My failure to do so may result in the withdrawal of the Screener. The information that I provide will be used only to enable the Screener to make informed recommendations that are intended to help the Arbitrator
assess and monitor the suitability of this case for arbitration and to determine procedures for the Arbitration. My information will not be used by the Arbitrator as evidence for making any decisions.


I agree to hold the Screener harmless and waive any claim or right of action against the Screener.


All information and documents provided by me shall remain confidential between me and the Screener. All information and documents provided by the other party shall remain confidential between the other party and the Screener. All information arising from the screening process,
including the Screener’s notes, opinions and recommendations, shall be used only for the purpose of providing an informed and confidential recommendation to the Arbitrator.

The Screener may, solely at their discretion, release some of my screening information, as she deems necessary to fulfill their role, to a lawyer or other professional retained by me. No information arising from the screening process shall be otherwise disclosed to any person for any purpose
except as required by law.  Such exceptions may include:

  • Reporting a child in need of protection in accordance with section 125 of the Child, Youth and Family Services Act; or
  • Where the Screener believes on reasonable grounds that there is an imminent risk to an identifiable person or group of death or serious bodily or psychological harm, he or she may disclose such confidential information that is required in the circumstances to prevent such death or harm.

I will not summons the Screener to provide evidence with respect to the Screening Process in any proceeding, nor will I seek production of any documents that were provided for or prepared in connection with the Screening Process (unless they are otherwise discoverable).


I have the right to withdraw from the Screening Process. The Screener has the right to terminate the Screening Process in their discretion


I will pay the Screener’s fees in full at the time of my meeting with the Screener. I have read this agreement; I understand it and I agree to its terms.





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Riverdale Mediation Services https://www.riverdalemediation.com
Signature Certificate
Document name: Consent to Third Party Screening with Elizabeth Hyde
lock iconUnique Document ID: 0b1aac9d2b18a3987ae434f08c8179f972f32589
Timestamp Audit
June 19, 2020 2:00 pm EDTConsent to Third Party Screening with Elizabeth Hyde Uploaded by Rhodes Thompson-Chase - [email protected] IP