Clear Form
THE STATE OF NEW HAMPSHIRE
JUDICIAL BRANCH
http://www.courts.state.nh.us
Court Name: Case Name: Case Number:
(if known)
AGREEMENT TO PARTICIPATE IN MEDIATION
Abuse/Neglect Minor guardianship Termination of Parental Rights
NOW COMES THE DIVISION FOR CHILDREN, YOUTH AND FAMILIES ("DCYF") AND THE PROSPECTIVE ADOPTIVE PARENT(S) OF THE MINOR CHILD(REN) IN THE ABOVE CAPTIONED MATTER, BY AND THROUGH DCYF, AND HEREBY STATE AS FOLLOWS: 1. DCYF is a party in the above captioned matter involving: and/or
Birth or Legal parent Birth or Legal Parent
2. DCYF and the prospective adoptive parents agree to participate as parties in the mediation session requested by the birth parent(s)/legal parent(s). 3. DCYF acknowledges that it has notified the child (if 14 years old or older) of the date of the mediation session, and has notified the child that he or she may participate in the mediation process. 4. The child does does not wish to participate in the mediation process.
Date
Division of Children Youth and Families
Date
Prospective Adoptive Parent
Date
Prospective Adoptive Parent
Date
Child (14 years old or older)
Date
Signature of Judge
NHJB-2543-F (10/15/2008)
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