Fill and Sign the Supervised Visitation Form

FL-341a PETITIONER/PLAINTIFF: ––––– ––––– RESPONDENT/DEFENDANT: ––––– CASE NUMBER: ––––– SUPERVISED VISITATION ORDER Attachment to Child Custody and Visitation Order (form FL-341) 1. Evidence has been presented in support of a request that the contact of Petitioner Respondent with the child(ren) be supervised based upon allegations of abduction of child(ren) physical abuse drug abuse neglect sexual abuse domestic violence alcohol abuse other (specify) : ––––– Petitioner Respondent disputes these allegations and the court reserves the findings on these issues pending further investigation and hearing or trial. 2. The court finds, pursuant to Family Code section 3100, that the best interest of the child(ren) requires that visitation by Petitioner Respondent shall, until further order of the court, be limited to contact supervised by the person(s) set forth in item 6 below pending further investigation and hearing or trial. THE COURT MAKES THE FOLLOWING ORDERS 3. CHILD(REN) TO BE SUPERVISED Child's name Birth date Age Sex ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– 4. TYPE a. Supervised visitation b. Supervised exchange only c. Therapeutic visitation 5 SUPERVISED VISITATION PROVIDER a. Professional (individual provider or supervised visitation center) b. Nonprofessional 6. AUTHORIZED PROVIDER Name Address Telephone ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– ––––– Any other mutually agreed-upon third party as arranged. 7. DURATION AND FREQUENCY OF VISITS (see form 1296.31A for specifics of visitation): ––––– ––––– 8. PAYMENT RESPONSIBILITY Petitioner: ––––– %, Respondent: ––––– % 9. Petitioner will contact professional provider or supervised visitation center no later than (date) : ––––– Respondent will contact professional provider or supervised visitation center no later than (date) : ––––– 10. THE COURT FURTHER ORDERS ––––– ––––– ––––– ––––– ––––– ––––– Date: ––––– JUDICIAL OFFICER page 1 of 1 Form Adopted by for Manditory Use Judicial Council of California [Rev. January 1, 2003] ] SUPERVISED VISITATION ORDER Family Code, §§3100, 3031 4electronic form ã 2002 WWW.LawCA.com Law Publishers