Complete your profile below:
Becoming a Member is Quick and Easy: Design your personalized member profile by completing the information, pay the annual membership fee of only $99.00 using your credit or debit card. After we review your information and confirm your payment, your membership will be activated. Please allow up to 10 days for your information to appear in the registry. A $25.00 fee applies for profile changes after posting. There is a no refund policy. Thank you for being a valued part of the Los Angeles County Supervised Visitation Monitor Registry.
Indicate today"s date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Check appropiate box
*
Initial Membership
Renewal
Update
Business name
Adminstrator’s name
First Name
Last Name
Monitor’s name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
What is your website ?
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What languages do you speak ?
*
What ages do you provide services?
Check all that apply
*
Infant -3 years
4-12 years
12-18 years
All of the above
What areas/geographic do you service ?
*
What services do you provide ?
*
intake
on-site monitoring
off-site monitoring
Exchange
Court Appearances
Other
Indicate fees/rates below:
Rates may vary.
Intake per parent
Monitoring visit (HOURLY RATE PER CHILD)
Exchange
Court Appearance
Report
Administrative
Share a brief description of your business
Include comments you want to include on your profile associated with your fees, and or the agency,
Upload proof of training (certificate for the monitor)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload proof of Trust Line Registry (obtained by of the monitor) TrustLine 800-822-8490)
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Upload proof of completion of Online Mandated Report Training of the monitor
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
What payment methods do you accept?
Cash
Zelle
Website
Other
Check appropriate box below (for all submissions leave the (1) quantity
*
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Registry Registration
$99.00
$
99.00
Quantity
1
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8
9
10
Profile Update
$25.00
$
25.00
Quantity
1
2
3
4
5
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7
8
9
10
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
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