Monitored Party Intake Form

Monitored Party Intake Form

Section 1: Court Case Information
What type of visitation is stipulated in your Court Order?*

Supervised VisitationSupervised Visitation in a Secured Facility
What's is your language preference for the visitations?
For a language that is not listed here, please contact the office prior to filling in the intake form.
Court Case Number:*
(e.g. FC2025-123456)
Petitioner:*

First NameLast Name
Petitioner's Legal Counsel (if applicable):
Defendant:*

First NameLast Name
Defendant's Legal Counsel (if applicable):
Best Interest Attorney (if applicable):
Court appointed evaluator (if applicable):

Monitored Party Intake Form

Section 2: Monitored Party Information
Monitored Party:*

First NameLast Name
Relationship to monitored children:*
Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is your address court-protected?*

YesNo
What is your payment responsibility in percentage for the supervised visitations?*
(e.g. 0, 50%, 100%, etc.)
Driver's license number:
Vehicle Make, Model and Year:
e.g. 2022 Toyota Prius
Vehicle color:
e.g. white, black, silver, red. etc.
Vehicle's license plate:
Please upload here a copy of your driver's license (front and back).

If you have any issues submitting the files here, please e-mail them at office@horizonsupervision.com. The Agency cannot process your intake application without the requested files.
Cancelof
Please upload here a picture of your vehicle.

If you have any issues submitting the files here, please e-mail them at office@horizonsupervision.com. The Agency cannot process your intake application without the requested files.
Cancelof
Please upload here a copy of your vehicle's insurance.

If you have any issues submitting the files here, please e-mail them at office@horizonsupervision.com. The Agency cannot process your intake application without the requested files.
Cancelof

Monitored Party Intake Form

Section 3: Legal Documents
Date the court order was issued pertaining to the supervised visitation:*

MonthDayYear
Court order date
How much parenting time was the Monitored Party awarded?*
Please indicate exactly as stated in the court order (e.g. maximum four hour per week)
Does any of the following supervised visitation restrictions apply to your case?

Secure Facility RequiredResidence RestrictedDriving Restricted
Are there any additional restrictions, limitations, or conditions in the current court order that are not reflected in this intake form? If yes, please describe here:
Please upload the Court Order regarding supervised visitation.

If you have any issues submitting the files here, please e-mail them at office@horizonsupervision.com. The Agency cannot process your intake application without the requested files.
Cancelof
Do you have an Order of Protection (OOP) in place against the Non-Monitored Party?*

YesNo
Please upload a copy of your OOP against the Non-Monitored Party (if applicable).

If you don't have a copy at this moment, you can e-mail a copy at office@horizonsupervision.com. However, the Agency is not able to process the intake application until all requested documents have been submitted.
Cancelof
Does the Non-Monitored Party have an Order of Protection (OOP) in place against you?*

YesNo
Please upload a copy of the OOP that the Non-Monitored Party has against you (if applicable).

If you have any issues submitting the files here, please e-mail them at office@horizonsupervision.com. The Agency cannot process your intake application without the requested files.
Cancelof

Monitored Party Intake Form

Section 4: Non-Monitored Party Information
Non-Monitored Party:*

First NameLast Name
Relationship to children:*
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number:
Please enter a valid phone number.
Email:
example@example.com

Monitored Party Intake Form

Section 5: Children's Information
How many children are included in the court order supervised visitations?*
Please provide information for each monitored child:*
Please use additional space to describe the children's allergies, medical conditions and dietary restrictions that the Monitor needs to be aware of:
Have there ever been any allegations - substantiated or not - of emotional, physical and sexual abuse or neglect, regarding any of the children included in the supervised visitation? If yes, please describe. (Please skip if not applicable)

Monitored Party Intake Form

Section 6: Supervised Visitation Availability
Availability for Supervised Visitation

A minimum booking of two (2) hours is required for all scheduled sessions unless the governing court order expressly permits a shorter duration.

To promote consistency and reduce scheduling delays, the Agency strongly encourages establishing a recurring visitation schedule on the same day(s) and at the same time(s) each week, when feasible.

A consistent routine helps streamline coordination with the Non-Monitored Party and supports stability for the child(ren).

While the Agency will make reasonable efforts to accommodate all requested availability, scheduling remains subject to monitor availability, safety considerations, operational capacity, and compliance with the court order.
Please indicate your availability for supervised visitation below.*
When would you like to start supervised visitations?
Please type additional information regarding your availability/scheduling preferences.

Monitored Party Intake

Section 7: Third Parties
Are any third parties permitted by court order to be present during supervised visitation?*

YesNo
If yes, please list the names of all court-approved individuals and attach the relevant portion of the court order: (skip if not applicable)

Monitored Party Intake Form

Section 8: Acknowledgment
Signature*

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