Supervised Visitation Referral Forms and Policies

In an effort to reunite families that have been disrupted, Parents Place provides the Supervised Visitation Program for Wisconsin families. The program allows children who have been separated from their families the opportunity to maintain a relationship with their parent/s while a permanency plan is being formulated.

Children and their non-custodial parent's are able to spend quality time together in a safe and nurturing environment under the guidance of professionally trained staff who provide education, observation, documentation, and intervention, when necessary.

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Supervised Visitation Referral Form

In order to begin the intake process, please fill out, complete, and submit this form along with all the required forms. During the online intake process, you will be required to pay a $50.00 nonrefundable intake fee by means of credit card. If you’d like to pay using cash or check, please call to inquire. Please provide an e-mail address so that we can communicate updates and acknowledge receipt of paperwork.

E-mail any questions to Karen.

I have read and agree to the above expectations and requirements. I understand that violating any provisions of this policy or making any threatening actions or abusive comments, can result in the termination of my visits on a permanent basis.

*
E-Signature *
E-Signature
Date *
Date
*
Note: submitting this form will direct you to the $50.00 nonrefundable intake fee required to begin the scheduling process
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no contact safe exchange referral form

In order to begin the no contact safe exchange process, please fill out, complete, and submit this form along with all the required forms. Please provide an e-mail address so that we can communicate updates and acknowledge receipt of paperwork.

E-mail any questions to Karen.

I have read and agree to the above expectations and requirements. I further understand that violating any provisions of this agreement may lead to the termination of my exchanges.

Name of Visiting Parent *
Name of Visiting Parent
E-Signature *
E-Signature
Date *
Date
*
Name of Custodial Parent *
Name of Custodial Parent
E-Signature *
E-Signature
Date *
Date
*