Madera — Waiver of Right to Individual Session (MAD-FCS-012)

Source: https://www.madera.courts.ca.gov/system/files/forms-and-filings/mad-fcs-012-waiver-right-individual-session-rev-04-15-2020.pdf

STATE OF CALIFORNIA MADERA SUPERIOR COURT Family Court Services WAIVER OF RIGHT TO INDIVIDUAL SESSION 200 South G Street Madera, CA 93637 PH #: (559) 416-5560 FAX #: (559) 673-8216

CASE #:___________________ NEXT COURT DATE: __________

FCS #: ___________________

I, ,have declared I am/have been a victim of Domestic Violence,
(Print your Name)

and I have a Domestic Violence Restraining Order and/or a Criminal Protective Order

protecting me and restraining the other party. I have been informed and I understand that

Family Court Services schedules parties to meet with the Child Custody Recommending

Counselor separately from the other parent and at separate times.

I decline that option and wish to be seen together with the other parent in a conjoint

session.

SIGN

Date: _______________________ Signature: _______________________

Form Adopted for Optional Use WAIVER OF RIGHT TO INDIVIDUAL SESSION Page 1 of 1Madera Superior Court Local Form MAD-FCS-012 [Rev. 04/15/2020]