2017 Western Justice Center Peer Mediation Invitational Registration

Western Justice Center cordially invites your school to attend the 2017 Western Justice Center Peer Mediation Invitational to be held March 14, 2017 (elementary and middle schools) from 8:30am to 2:00pm and March 15, 2017 (high schools) from 8:30am to 3:00pm. The event is open to all Los Angeles County schools (public, charter and private) with active peer mediation programs.
NOTE: The Association for Conflict Resolution (ACR) defines "active peer mediation program" as follows:

  1. Elementary: 12-15 hours of training AND 12 plus hours of ongoing mediator training per year
  2. Middle School: 15-18 hours of training AND 12 plus hours of ongoing mediator training per year
  3. High School: 18-20 hours of training AND 12 plus hours of ongoing mediator training per year

The Western Justice Center Invitational is an annual retreat and celebration of peer mediators in Los Angeles County. Participants have the unique opportunity to be coached by experienced mediators within the walls of a federal courthouse. The day includes mock mediations and an activity relevant to conflict resolution education and peer mediation.

Please fill out the school registration and student profile information no later than Wednesday, February 21, 2017. You can bring up to six peer mediators and you must have all the information completely filled out in order to submit your registration. Remember that all students must be current peer mediators and their acceptance must be confirmed in advance. Student substitutions will not be permitted. If you are bringing four or more mediators, please think about how best to pair them and let us know who is together in the question pertaining below.  

PLEASE NOTE: Representatives of Western Justice Center will be filming and photographing all participants of the Western Justice Center Peer Mediation Invitational for the purposes of program evaluation and publicity. By attending the Western Justice Center Peer Mediation Invitational, participants, and parents/guardians if the participant is a minor, are giving consent to having their images and speech recorded, reproduced and used for evaluation and promotional purposes. 

Participants, and parents/guardians if the participant is a minor, release and hold harmless WJC and their authorized representatives from any and all actions, claims, damages, costs, or expenses that may relate to or arise out of any use of these images.


Program Registration Form

If you are bringing students on both dates, please submit a separate form for each day.
School Address *
School Address
School Phone Number *
School Phone Number
Principal/Head of School Name *
Principal/Head of School Name
Name of the School's Peer Mediation Program Coordinator *
Name of the School's Peer Mediation Program Coordinator
Program Coordinator Phone Number *
Program Coordinator Phone Number
Choose all that apply. If not listed, please check Other.
Note: Schools must provide their own transportation to and from the invitational.
Each school may bring up to six students.

Individual Student Information Form

Please fill out the information for each student who is participating in PMI with your group.

Name *
Name
Is Student currently a peer mediator? *
If this is their first PMI, just enter 0
This student, or their parent or guardian if the student is a minor, agrees to having his/her image and speech recorded by Western Justice Center representatives for program evaluation and promotional purposes while participating in The Western Justice Center Peer Mediation Invitational. *