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Alternative Decisions

Alternative Decisions

Youth Conflict Services - Mediation

Youth Conflict Services - Mediation

Service users may use our online application services with confidence, knowing it is safe, secure and confidential.

Online Application - Addiction Mediation

Please submit as much information as possible, when possible, and ensure the accuracy of the information provided.

Terms and Conditions

Youth 1 *

(Applicant)

First Name

Last Name

Youth 1 - Email *

Youth 1 - Address

Most recent

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Youth 1 - Phone

(###)

###

####

Youth 1 - Parent/Guardian *

First Name

Last Name

Youth 1 - Parent/Guardian *

Youth 1 - Parent/Guardian Address *

Most recent/current address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Youth 1 - Parent/Guardian Phone

(###)

###

####

Person 2 *

Responding Party

First Name

Last Name

Person 2 - Email *

Person 2 - Address

Most recent

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Person 2 - Phone

(###)

###

####

Person 2 - Parent/Guardian

Only required if Person 2 is under 18.

First Name

Last Name

Person 2 - Parent/Guardian Email

Only required if Person 2 is under 18.

Person 2 - Parent/Guardian Address

Most recent/current address. Only required if Person 2 is under 18.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Person 2 - Parent/Guardian Phone

Only required if Person 2 is under 18.

(###)

###

####

Dispute *

Please describe your dispute.

What is the desired outcome of mediation? *

Is there any current legal representation for either party? *

What is the nature of the addiction? *

has the individual(s) received treatment before? if so, please describe. *

1. We are looking to be provided *

2.a Are the any legal proceedings involving person 1 and person 2 *

Yes

No

Unsure

2.b If Yes or Unsure, please explain.

3.a Does this dispute have an active case with the Child's Aid Society (CAS) *

Yes

No

3.b If Yes or Unsure, please explain.

4. What additional services are you interested in?

Youth / Child Inclusion

Inclusion of Family Member(s) [non-child]

Inclusion of Community Member(s)

Interpreter services

5. What is your budget?

Total and/or hourly

6. Is there any additional information?

7. Consent to Apply *

I have read and agree to the 'Terms of Service'

I have not and do not agree to the "Terms of Service"

Thank you!

Terms and Conditions

Exceptions to Service

Terms and Conditions