Parents Place, Inc. offers the Safe Exchange program which facilitates safe exchanges for those families that need a safe, non-confrontational location for supervised exchange services for children. Parents Place is able to provide this supervised exchange program in which neutral drop-off and pick-up is made available for parents to exchange children for visitation compliance. This is structured in a way that will increase the level of comfort and safety for both the parents and the children.

All safe exchanges are facilitated at the Parents Place office at

S22 W22660 Broadway, Suite 2, Waukesha WI 53186

Exchange schedules will be determined by the Supervised Visitation/Safe Exchange Program Manager

There is a $10 fee per exchange and assessed to the non-custodial parent, unless otherwise noted.

There is no contact between parents unless court ordered.

Exchanges are not documented unless court ordered. Those that are documented will include names, times, no-shows, and critical incidents only.

REFERRAL PROCESS

Complete No Contact Safe Exchange Referral Form
Read and Sign No Contact Safe Exchange Policies - Note: this form will redirect you to the $75.00 non-refundable intake fee
Pay $75.00 non-refundable intake fee

1 - no contact Safe exchange REFERRAL FORM

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

E-mail any questions to SVManager@parentsplacewi.org

No Contact Safe Exchange Referral Form 3

Child(ren) Approved for the Exchange:

Name

First Name

Last Name

Birthdate

YYYY

Name

First Name

Last Name

Birthdate

YYYY

Name

First Name

Last Name

Birthdate

YYYY

Name

First Name

Last Name

Birthdate

YYYY

Visiting Parent

Name

First Name

Last Name

Birthdate

YYYY

Home #

(###)

###

####

Cell #

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Ethnicity

ethnicity is kept confidential and is for the purpose of funding

Estimated Annual Income

income is kept confidential and is for the purpose of funding

Emergency Contact

First Name

Last Name

(###)

###

####

Relationship:

Custodial Parent

Name

First Name

Last Name

Birthdate

YYYY

Home #

(###)

###

####

Cell #

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Ethnicity

ethnicity is kept confidential and is for the purpose of funding

Estimated Annual Income

income is kept confidential and is for the purpose of funding

Emergency Contact:

First Name

Last Name

(###)

###

####

Relationship:

Attorneys or Family Court Social Workers Involved:

Name

First Name

Last Name

Phone #

(###)

###

####

Name

First Name

Last Name

Phone #

(###)

###

####

Name

First Name

Last Name

Phone #

(###)

###

####

2 - no contact Safe exchange policies

No Contact Safe Exchange Policy

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

First Name

Last Name

E-Signature

First Name

Last Name

Date

YYYY

I Read and Agree to the No Contact Safe Exchanges Procedure/Policy

Name of Custodial Parent

First Name

Last Name

E-Signature

First Name

Last Name

Date

YYYY

I Read and Agree to the No Contact Safe Exchange Procedure/Policy

3 - Pay $75.00 non-refundable intake fee

You will be automatically redirected to the $75.00 nonrefundable intake fee

1 - no contact Safe exchange REFERRAL FORM

2 - no contact Safe exchange policies

3 - Pay $75.00 non-refundable intake fee

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