LAWYER REFERRAL AND INFORMATION SERVICE

Application

* Required

PART I - PARTICIPATION APPLICATION

The undersigned attorney ("Attorney") hereby

(1) applies for participation in the KAYDEN JAYCE FOUNDATION, Inc.;

(2) acknowledges acceptance of the terms and conditions of the KAYDEN JAYCE FOUNDATION, Inc., Inc., Inc. Agreement;

(3) provides the requested information; and

(4) applies for client referrals in the areas of practice and under the requirements of Part III.

Attorney will be notified of acceptance of Attorney’s KAYDEN JAYCE FOUNDATION,Inc. participation, which shall continue until terminated pursuant to this Agreement.

PART II – APPLICANT ATTORNEY INFORMATION

Applicant Attorney Name: *

Mr. / Mrs. / Ms

Business Phone Number/FAX *

Street Address *

with City / State / Zip / Country

E-Mail Address: *

Admitted to practice in Georgia (Year):

Admitted to practice before other Courts (Court/Year):

Bar admission(s) in other State(s)/year:

Are you aware of any unresolved discipline complaints filed against you? If so, explain and identify investigating agency:

Have you ever subjected to professional discipline in any jurisdiction? If so, explain:

Name of your Professional Liability Insurer:

Policy Limits:

Expiration Date of Policy:

What language are you fluent in speaking?

Please list any secondary languages you: SPEAK, READ and/or TRANSLATE

PART III – AREAS IN WHICH YOU WILL ACCEPT REFERRED CASES

(Please select area(s) of expertise.)

Attorney/Firm Hourly rate $

Attorney/Firm Retainer Fee Amount $

Agreement

INTRODUCTION

The KAYDEN JAYCE FOUNDATION, Inc. is a non-profit public organization, having its center activities at 2274 Salem Rd SE Suite 106-200 Conyers, GA 30013 dedicated not only to families dealing with abusive relationships, but also to those who have to deal with unfairness in an attempt to gain child custody. The purpose of KAYDEN JAYCE FOUNDATION, Inc. is to provide access to lawyers and legal help to for men and women dealing with false protective orders, false accusations, false allegations to the court system and/or child protective services, assistance with filling out court paperwork, abusive relationships (men and women), and counseling services for those families for the child(ren) dealing with this type of ordeal.

PARTICIPATION AGREEMENT TERMS

As a condition to KAYDEN JAYCE FOUNDATION, Inc. participation, Attorney agrees to each of the following terms and the accuracy of all representations contained therein.

1. Attorney is a member in good standing in the Georgia Bar,

2. Attorney must be engaged in the practice of law on a full time basis and must maintain a law office suitable for reception of clients during normal business hours; and,

3. Attorney must carry professional liability malpractice insurance with policy limits of at least $100,000/$300,000 and agree to maintain such coverage during the period of membership.

ACCEPTANCES OF CASES

4. Attorney has the right to refuse a client referred by KAYDEN JAYCE FOUNDATION, Inc..

ATTORNEY OBLIGATIONS

5. An initial consultation of any KAYDEN JAYCE FOUNDATION, Inc.-referred person is without charge. Such consultation is limited to identifying the person’s perceived legal needs and providing preliminary advice.

6. Attorney will not charge a KAYDEN JAYCE FOUNDATION, Inc.-referred client (hereafter "Client") fees and/or expenses in amounts greater than would have been charged if no KAYDEN JAYCE FOUNDATION, Inc. referral has been made. Whenever possible, Attorney and Client shall enter into a written fee agreement.

7. Attorney agrees that any referred client wishing to terminate his/her relationship with Attorney shall have the right to do so and Attorney agrees to refer any client terminating their relationship back to KAYDEN JAYCE FOUNDATION, Inc..

8. Attorney will not transfer responsibility for a KAYDEN JAYCE FOUNDATION,Inc.-referred person to another attorney and shall refer back to KAYDEN JAYCE FOUNDATION, Inc. any KAYDEN JAYCE FOUNDATION, Inc.-referred person that Attorney does not accept as a Client.

9. Attorney agrees to give referred clients the best possible representation consistent with the Rules of Professional Responsibility, regardless of race, color, sex, age, national origin, religion, handicap, or political preference.

10. Attorney agrees to participate and contribute between 1 to 2 hours to the Foundation’s activities per month. (if asked)

11. Attorney is qualified to competently handle matters in the areas selected in Part III hereof and in such other areas.

ATTORNEY- CLIENT RELATIONSHIP

12. Attorney agrees that acceptance of a referral from KAYDEN JAYCE FOUNDATION, Inc. will create an association that involves the following relationships:

❖ Client/Attorney: The attorney-client relationship exists between the Client and Attorney and the client shall be informed of it. For that purpose the client communication is protected by the attorney-client privilege.

❖ KAYDEN JAYCE FOUNDATION,Inc./Attorney: The Attorney has full authority to act for the referred client in the same way he/she would for any other client.

PARTICIPATION FEES

13. There is no fee for the first year of participation. There shall be $200 fee for the subsequent years. KAYDEN JAYCE FOUNDATION, Inc. participation fees shall be paid annually a year from the this date or before date of this submission. Attorney’s KAYDEN JAYCE FOUNDATION, Inc. payments shall not be refundable or tolled for Attorney’s suspension from KAYDEN JAYCE FOUNDATION, Inc..

14. Attorney agrees to give a 10-20% discount to KAYDEN JAYCE FOUNDATION,Inc.-referred person, which will be determined by KAYDEN JAYCE FOUNDATION,Inc. The combined fees and expenses charged to a KAYDEN JAYCE FOUNDATION,Inc.-referred person for the service and the attorney to whom the client is referred does not exceed the combined fees and expenses the client would have incurred if no referral service were employed.

LIMITED LIABILITIES/INDEMNITIES

15. Attorney and KAYDEN JAYCE FOUNDATION,Inc. agree to not hold each other responsible for any damages, loss or legal liabilities.

16. Attorney agrees to pay for any loss or damages that has been or might be incurred during or after the representation.

CHOICE OF LAW

17. The Law governing this agreement shall be within the State of Georgia.

TERM

18. The term of this contract shall be from this date of submission unless otherwise terminated; and, the contract is subject to amendment(s) upon notification by KAYDEN JAYCE FOUNDATION,Inc. or its funding sources.

TERMINATION

19. This Agreement is for the term stipulated in paragraph (15). In the event that either party believes that the other party materially breached any obligations under this Agreement, such party shall so notify the breaching party in writing. The breaching party shall have sixty (60) days from the receipt of notice to cure the alleged breach and to notify the non-breaching party in writing that cure has been effected. If the breach is not cured within this time period, the non-breaching party shall have the right to terminate the Agreement without further notice.

GENERAL PROVISIONS

20. Notification. Except as may be otherwise provided, all notices and other communications required or permitted to be given pursuant hereto shall be in writing and shall be valid and sufficient if dispatched by Registered or Certified Mail, postage prepaid, and addressed to the party at the address set forth above, or at such new address as may be hereafter provided.

21. Modification. This Agreement constitutes the entire understanding between the parties, and no modification, alteration, amendment or waiver thereof shall be effective unless in writing and duly executed by both parties.

22. This Agreement shall be binding upon and inure to the benefit of the successors, assigns and legal representatives of the parties hereto.

Attorney Referral Participation Benefits:

Participating in the KAYDEN JAYCE FOUNDATION, Inc., Inc., Inc.’s Attorney Referral Networking program offers a myriad of opportunities for personal and professional growth as a practicing attorney. By devoting time to the KAYDEN JAYCE FOUNDATION, Inc., Inc., Inc., you are providing more than just legal advocacy:

- The chance to work with a well-established organization dedicated to diminishing the negative outcomes of abusive relationships and domestic violence generally;

- An opportunity to serve the community and represent indigent clients who desperately need legal assistance but lack the funds to protect themselves and their loved ones;

- Networking opportunities with other attorneys who are volunteering with the KAYDEN JAYCE FOUNDATION, Inc., Inc., Inc.;

- The opportunity to develop your professional skill set with an organization who has already established a loyal following of contributors, including award-winning broadcast journalist Dave Straub.

IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first written above. For KAYDEN JAYCE FOUNDATION, Inc.

I hereby agree that all the above is true to the best of my ability. By submitting this form I am agreeing to the terms and conditions. Submission of this agreement serves as my signiture. I agree to keep all information that I learn about the client confidential. I understand that I may not discuss or disclose any information related to any client to anyone outside the client &attorney setting. I further understand that I may learn personal information about a client and/or his or her family that is private. I understand that it is my duty and responsibility to preserve and protect this privacy and confidentiality. I understand that this duty will extend after I am no longer working with the Kayden Jayce Foundation unless otherwise stated by client.