Application Form

Download the Application Form in Microsoft Word format

Click here to open and close the instructions for completing the Application Form.
Please check the mediator's on-line calendar. Mediations are scheduled from:

Half-Day Mediations
9:30 - 12:30 - Gary Furlong
10:00 - 1:00 - Richard Russell or Heather Swartz
1:30 - 4:30 - Richard Russell, Gary Furlong or Heather Swartz

Full-Day Mediations
10:00 - 4:00 - Richard Russell, Gary Furlong or Heather Swartz

Please don't hesitate to call Deb at 1-800-524-6967 (or 905-627-5582, Hamilton - local) if other times are necessary.

Once the parties have agreed to an available mediation date and time, complete the application form. This can be submitted electronically, or printed and faxed to 905-627-5362.

You will be contacted within 1 business day to confirm the mediation date. Once all arrangements for the mediation have been finalized, a package outlining the details of the mediation will be faxed to all parties within 5 business days.

* Indicates a field that must be populated

General Information
Mediator:	-- Select -- Richard Russell Gary Furlong Heather Swartz Shelley Stirling-Boyes	Phone #: *
Date of Application: (mm/dd/yy) *		Email: *
Mediation Date: (mm/dd/yy) *		Time:	-- Select -- 9:30 - 12:30 10:00 - 1:00 10:00 - 4:00 1:30 - 4:30
Application completed by: *
Short Style of Cause:
Mediation Details
Mediation Type:	-- Select -- Private Mandatory (Rule 78)	...if this action is Simplified Procedures (Rule 76) check here
Court File No.
Preferred venue:	-- Select -- ADR Centre, 77 Grenville St. Toronto Network Court Reporting, Toronto Atchison Denman, Toronto JPR, Toronto The Hamilton Club, Hamilton Hinkson Litigation Support, Brampton Travelodge, Burlington Other, please specify...	Other, specify:
Mediation costs to be paid by:	-- Select -- split between the parties by Defense counsel Other, please specify	Other, specify:
(Invitor) Counsel Lawyer Name: Phone: Firm Name: Fax: Address: Email: City: Assistant's Name: Prov. / Postal Code:     Client Name: Plaintiff   Defendant
Counsel Lawyer Name: Phone: Firm Name: Fax: Address: Email: City: Assistant's Name: Prov. / Postal Code:     Client Name: Plaintiff   Defendant
Counsel Lawyer Name: Phone: Firm Name: Fax: Address: Email: City: Assistant's Name: Prov. / Postal Code:     Client Name: Plaintiff   Defendant
Counsel Lawyer Name: Phone: Firm Name: Fax: Address: Email: City: Assistant's Name: Prov. / Postal Code:     Client Name: Plaintiff   Defendant