This is a sample only. Every mediation is different, and agreements are tailored to the people involved. This example is meant to show the kind of clear, practical language often used.

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This Mediation Agreement (“Agreement”) is made on _____________________
between:
• Party A: __________________________________________
• Party B: __________________________________________

1. Background
The parties participated in a mediation with Mediator: ____________________
on the issues arising out of: ________________________________________________________________.

2. Agreements reached
The parties agree to the following terms:

1. ____________________________________________________________________________________

2. ____________________________________________________________________________________

3. ____________________________________________________________________________________

3. Timing and next steps
• Party A will: _________________________________________________
• Party B will: _________________________________________________
• These steps will be completed by: _______________________________.

4. Confidentiality
The parties understand that this Agreement may be shared with their attorneys or other necessary professionals, but that the discussions in mediation remain confidential except as otherwise required by law.

5. Voluntary agreement
The parties confirm that they are entering into this Agreement voluntarily and that they understand its terms.

Signatures
Party A: ___________________________ Date: ___________________
Party B: ___________________________ Date: ___________________