Parenting checklist - One Stop Parenting and Visitation Program LLC

Initial Supervised Parenting Intake

Contact Information

Name

Address

Phone Number

Social Security #:

DOB:

Family Information

Child Name

Age

Emergency Contact Name

Relation

Phone

Supervised Visit Information

Copies of current Court orders required – please attach

Please describe any previous experience with supervised visitation:

Please describe the current reasons for supervised visitation:

Please list any risk factors or concerns (i.e., abduction, violence, mental illness, etc.):

Please list any restrictions during visits (i.e., photos, statements, diet/food, medication, etc.):

Details for scheduling visits:

Where:

When:

Who can visit:

Time:

Frequency:

Attorney Information

Name

Phone

Client