• Referral Form

  • Brayden Supervision Services

    Office: 416-620-7712 || Fax: 416-245-4166 || Toll-Free: 1-855-222-7712 

    info@braydensupervision.com || www.braydensupervision.com

  • Please note prior to proceeding

    Both parties are required to independently complete and sumbit the Client Referral Form. As a neutral third party, we cannot contact the other party on your behalf. 

    Brayden Supervision Services cannot mediate or negotiate between parties. Discrepancies with details such as location, duration, frequency and payment responsibility must be resolved prior to service commencing.

    Please only submit information that is relevant to your Referral.

  • Client Information

  • Please select*
  • I am the ...*
  • Birth Date
     - -
  • Format: (000) 000-0000.
  • Are you requesting service in a language other than English?*
  • Child/ren's Information

  • Your relationship to the child/ren ....*
  • Child/ren requiring supervision *
  • Does your child/ren have any diagnosed medical conditions and/or require accomodations during Supervised Parenting Time?*
  • Legal Representation

  • At this time ...*
  • Format: (000) 000-0000.
  • Legal Representation - Other Party*
  • Format: (000) 000-0000.
  • Child Welfare Involvement

  • Is your family currently involved with a child welfare organization?*
  • Format: (000) 000-0000.
  • Service(s) Requested

  • PLEASE NOTE: Where applicable, Supervised or No-Contact Transfers will be implemented at the beginning and end of Supervised Parenting Time visits to comply with any communication or contact restrictions between parties. 

  • I am requesting ... (select all applicable options)*
  • In-Centre Location
  • Transfer Location: In-Centre
  • Parenting Time Schedule*
  • Family Court Documents

  • Please select*
  • Is there a No-Contact or Restraining Order in place?*
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  • Criminal Court Documents

  • Criminal court documentation is collected to support the safety of all participants involved in our Supervised Parenting Time services. This information helps us understand any applicable court conditions or restrictions so that services can be provided safely and in accordance with applicable legal requirements, while supporting participants in maintaining compliance with their existing legal obligations.

  • Please select*
  • Please select*
  • I have been convicted of a sexual offence involving a child.*
  • I am currently subject to SOIRA and/or OSOR and/or sex offender registration obligation.*
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  • Payment Responsibilities

  • Please see page 4 of our Service Agreement for full details regarding Rates for Service.

    The Registration Referral/ Intake Fee is non-refundable and due once the Referral Forms and supporting court documentation have been received from both parties. The Registration Referral/ Intake Fee must be paid in full before the file is tranferred to a Service Director for service coordination. Payment for Intake Fees and Service Fees can be made by credit card, debit card, or e-transfer. 

  • Intake Fee*
  • Service Fees*
  • Please select one*
  • Client Service Agreement

  • Please read this Agreement carefully and keep a copy for your reference as it explains what is expected of you as a client, the roles and responsibilities of the Service Director and Supervisor, and the procedural and operational guidelines everyone is expected to follow.

    1. STANDARD PRACTICE

    The Brayden Supervisor must be able to see, hear, and understand all interactions between the child(ren) and the supervised party. The supervised party is responsible for the day-to-day care and management of the child(ren) at all times during the visit.  

    The Supervisor’s role is as follows: 

    1. To promote safe, neutral and child-focused parenting time
    2. To adhere to the visit plan provided by the Service Director 
    3. To communicate essential information about the child’s needs at the beginning and end of the visit 
    4. To observe and document the parenting time in an objective, factual and unbiased manner 
    5. To intervene when necessary to prioritize the safety and well- being of the child(ren)
    6. To maintain clear, professional boundaries and communicate in a respectful manner with all parties. 

    2. PARENTING TIME VISITS

    It is expected that the child(ren) will be supported and encouraged to attend the supervised parenting time. Brayden Supervision Services does not negotiate the visit location, schedule, division of payment or type of service. These terms are to be agreed upon by the parties through their lawyers, and/or may be part of a Court Order/Endorsement.

    Brayden Supervision Services will not negotiate or impose restrictions on the visits, unless the restrictions are listed in a Court Order, Endorsement or Written Agreement provided by the parties or their lawyers (hereinafter referred to as the “Governing Document”), and/or our staff deem the activity/location as unsafe and/or inappropriate. Any new restrictions must be brought to the attention of the Service Director immediately.

    Brayden Supervision Services may impose additional restrictions on the supervised party if there are allegations, charges or convictions of a sexual nature involving a minor. This will be reviewed with your Service Director at the time of Intake.

    3. USE OF ILLICIT DRUGS AND ALCOHOL

    The use of illicit drugs and/or alcohol before or during supervised parenting time is strictly prohibited. If the Supervisor suspects the supervised party may be impaired, the visit will be terminated. In addition, the child(ren) will not be permitted to leave the visit with an adult suspected of being impaired by illicit drugs substances, cannabis or alcohol. The police will be called, if necessary, to determine if an adult is able to transport a child safely and alternative arrangements for transportation will be made in collaboration with our Service Director if necessary.

    4. SMOKING

    To protect the health and safety of the child(ren) and Supervisor during supervised parenting time, smoking is not permitted indoors or in vehicles at any time. This includes tobacco, cannabis (medical or recreational), and electronic cigarettes/vaping of any substance. Smoking is only allowed outdoors, away from both the child(ren) and Supervisor, to prevent exposure to second-hand smoke. The supervised party may only step away to smoke if the child(ren) is old enough to be left briefly unsupervised or if another responsible adult is present. Supervisors are not responsible for supervising the child(ren) while the parent is smoking. The child(ren) must remain in a safe, secure environment at all times.

    5. TRANSPORTATION

    Brayden staff do not transport children. The supervised party may be permitted to transport the child(ren) and Supervisor during the parenting time, if it is not prohibited by the Governing Document, and provided the driver submit a copy of their valid driver’s license and insurance and there are no charges or concerns related to substance misuse, impaired judgement and/or dangerous driving. Drivers must obey all traffic laws, including but not limited to proper car seats, seat belts and cell phone use. The Supervisor maintains the right to order a taxi, Uber, or Lyft at the supervised party’s expense if at any time the supervised party’s driving appears unsafe, reckless, or they appear to be under the influence of drugs or alcohol.

    6. GUESTS ATTENDANCE AND CONDUCT

    Brayden Supervision Services does not restrict guest attendance during supervised parenting time (including phone or FaceTime contact) unless specifically set out in the Governing Document. Any issues or disagreements about guest attendance must be resolved through legal counsel before services begin, as Brayden does not mediate these matters and will follow the terms of the Governing Document. All guests must follow this Service Agreement. The supervised party is responsible for sharing this Agreement with any guests and ensuring they understand and agree to follow the terms and restrictions. Guests must provide their full legal name to the Supervisor upon arrival. Guest attendance and general interactions may be documented in the visit notes. The Supervisors role is to observe and document the supervised party. They are not responsible for supervising the guest(s) conduct or interactions with the child(ren), as they are unable to continuously monitor multiple interactions at the same time. If supervision of a guest is required, visits must occur at a Brayden centre, or an additional Supervisor must be arranged in advance at the requesting party’s expense.

    7. GIFT GIVING

    The supervised party is generally permitted to give gifts to their child(ren) during Supervised Parenting Time, unless restricted by the Governing Document. All gifts must be age-appropriate, safe, and suitable for the visitation setting. The Supervisor has the discretion to remove any gift deemed unsafe, or likely to cause distress. Removed items will be returned to the supervised party at the end of the visit.

    8. PARENT CHILD CONTACT PROBLEMS

    Brayden Supervision Services will not force child(ren) to attend supervised parenting time. If a child is refusing to participate at the outset, the Supervisor will attempt to encourage them using a variety of supportive skills and conversation. The non-supervised party must assist the Supervisor in supporting the child(ren) to attend the visit. If a child refuses to stay or makes a request to end the visit, the Supervisor will attempt to encourage them to continue. If they appear in distress or verbalize that they are too uncomfortable to stay, the visit will end. These decisions are based on the age and maturity of the child(ren) and are made at the Supervisor’s discretion with the child’s best interest in mind.

    9. BATHROOM USE

    If age appropriate, the child(ren) will use the washroom independently. If the child(ren) is in diapers or requires assistance, the Supervisor must be present to observe the supervised party and the child(ren) in the bathroom. If the Governing Document restricts the supervised party from assisting with bathroom routines, arrangements will be made during the Intake process to ensure the child(ren)’s needs are met in a safe and respectful manner.

    10. MEDICAL NEEDS OF THE CHILD(REN)

    All relevant medical information for the child(ren) must be provided to the Service Director during the Intake Meetings. Brayden Supervisors do not administer medication or provide medical advice or intervention. In the event of a medical emergency during a visit, 911 will be called and the residing parent and Service Director will be notified immediately.

    Medication

    Over the counter medication will not be given unless agreed to by both parties. If prescription medication must be administered during Supervised Parenting Time, the residing parent must notify the Service Director and provide the medication in its original container along with written instructions, including the child’s name, dosage, and schedule, before the visit. The residing parent must provide the Supervisor with information regarding medications (including over the counter) that the child has taken the day of the visit. The supervised party is responsible for safely transporting and administering the medication during the visit or transfer.

    Medical/Therapy Appointments

    Brayden supervisors may not attend medical or therapy appointments for the child(ren) arranged by the supervised party unless authorized by the governing document or approved in advance by both parties. Medical appointments may not take place during parenting time unless both parties agree. If an appointment is agreed upon, a supervisor must be present.

    11. FOOD

    Brayden Supervisors will not restrict food or drinks provided to the child(ren) during supervised parenting time, unless restrictions are listed in a Governing Document. This excludes instances where the food contains an allergen that has been medically confirmed or identified by both parties during the Intake process.

    12. TRANSFER OF MATERIALS BETWEEN PARTIES

    Participants are not to use the child(ren) or Supervisor as an agent to exchange material goods, notes or mail, or ask a Brayden Supervisor to sign or transfer court documents or money. Exceptions may include signatures required for government documents (Passport, Birth Certificate) and report cards. All requests must be made through the Service Director two (2) business days prior to the service occurring.

    13. USE OF TECHNOLOGY DURING PARENTING TIME

    The supervised party may take photos and/or video clips of the child(ren) during parenting time. Photos, video or audio recordings are not permitted by either party during the transfer at the beginning or end of the visit. Any restrictions around taking photos or video clips must be specified prior to commencing service. Brayden Staff are prohibited from using their personal device to take audio and/or video recording of any kind during parenting time except in the case of an emergency. Covert tracking and/or recording or the attempt of covert tracking and/or record is strictly prohibited. This excludes instances where Governing Document conditions specify otherwise. Audio and/or visual recording of a Brayden Supervisor, or any Brayden Staff, under any circumstances is prohibited and may result in the termination of service.

    14. CONDUCT GUIDELINES

    These guidelines apply to the supervised party and their guest(s) during the supervised parenting time. The Supervisor and/or Service Director may interrupt, document, intervene or terminate a visit at their discretion for any of the following reasons, including but not limited to:

    1. The child(ren) becomes acutely distressed, is observably traumatized, or repeatedly expresses that they want the visit to end.
    2. The Supervisor deems that the child(ren) is in a situation of possible risk, either physically or emotionally.
    3. Any participant making inappropriate demands for physical contact with the child.
    4. There is suspicion that the supervised party and/or their guest is under the influence of drugs or alcohol.
    5. Any participant exhibiting threatening, belligerent, defiant or other inappropriate behaviour.
    6. Any participant threatening or using physical discipline or emotional abuse/put downs of any type while parenting the child(ren).
    7. Any participant interrogating the child(ren) and/or speaking negatively about the other parent and/or their family or inquiring about the other parent’s whereabouts or activities.
    8. Any participant appearing to coach the child(ren) to repeat the supervised party’s views and preferences.
    9. Any participant sharing details of legal proceedings or adult conflict with the child(ren).
    10. Any participant making promises or predictions about the future living arrangements and/or visitation modifications.
    11. Any participant attempting to pass correspondence or messages to the other parent through the child.
    12. Any participant attempting to make permanent alterations of the child(ren) without prior written consent from the residing parent (defined but not limited to haircuts and piercings).
    13. Any participant speaking in a language that is not understood by the Supervisor. All communication during visits must be in English unless a language-specific Supervisor is available, or an approved, professional interpreter has been arranged (at the expense of the requesting party) during the Intake process.
    14. Any participant attempting to confront or cause conflict with the other party during the parenting time or transfer.

    If the supervised party and/or guest is being repeatedly redirected or fails to amend or modify their behaviour, the Supervisor may terminate the parenting time. The supervised party and/or guest agree not to question the Supervisor’s decision during the visit. If required, clarification should be sought in a respectful manner after the child(ren) have left, or by contacting the Service Director once the parenting time has ended.

     15. DUTY TO REPORT

    Section 125 of the Children, Youth and Family Services Act (CYFSA), states that the public, including professionals who work with children must promptly report any suspicions that a child is, or may be, in need of protection to a Children’s Aid Society. Brayden Supervision Services are not bound by confidentiality to withhold information where disclosure is bound by law. Brayden Supervision Services must report suspected child abuse and neglect to a Children’s Aid Society or call the police if they believe someone is in immediate danger. This duty shall be exercised in the sole discretion of Brayden Supervision Services.

    16. NOTETAKING

    The Supervisor may take rough notes during the visit and/or transfer using paper, a cellphone, or a digital notepad. Visit notes are timeline-based observations of what has occurred during the parenting time and will not include any assessment or opinion of the supervised party’s capacity to care for the child(ren). The notes are intended to objectively reflect the interactions between the supervised party and the child(ren). They are not meant to record every detail but give an overall snapshot of the parenting time. Any deviation from the Governing Document will be documented.

    Important Note: Observational notes are taken in a structured and supervised environment that may not reflect the full scope of the visiting party’s caregiving abilities or typical parenting practices outside of supervised settings. These notes should not be interpreted as a comprehensive assessment of parenting capacity.

    17. PAYMENT

    The Intake Fee is due once both parties have submitted their Referral Forms and supporting court documentation. Payment for each visit must be made two (2) business days prior to service. The supervised party is responsible for any expenses required to keep the family together during community-based visits. Costs related to providing service (admission, event tickets, parking, public transportation, etc.) will be charged upon completion of the parenting time pending the submission of receipts from the Supervisor. Failure to submit payment as outlined above may result in suspension or termination of service.

    18. RATES FOR SERVICE

    Brayden Supervision Services accepts payment by credit, debit, and/or e-transfer. We do not accept cash. Participants must confirm their method of payment prior to starting service. 

    Important Note: If parenting time extends beyond the scheduled end time due to the actions or delay of either party, the paying party may be responsible for any additional fees. All rates are non-negotiable.

  • Table breaking down the rates for service at Brayden Supervision Services.

  • 19. VISIT CANCELLATION

    The full fee will be charged for visits cancelled with less than 48 hours' notice. If Brayden Supervision cancels service, the payment will be credited to the next scheduled service. If service is no longer required, the payment will be refunded.

    A Cancellation Note will be provided to both parties for their records. If parenting time is cancelled due to illness, it is the expectation that parenting time be rescheduled as soon as possible, subject to the terms of the Governing Document.

    20. INCLEMENT WEATHER POLICY

    The safety of all parties is our highest priority. Supervised Parenting Time and Supervised Transfers may be cancelled in the event of inclement weather. The Service Director or Supervisor will have the final authority to determine if conditions are unsafe for travel. Parties may also choose to cancel a visit if they believe the weather poses a safety concern. It is expected that any weather-related cancellations will be rescheduled at the earliest mutually convenient time, subject to the terms of the Governing Document. All parties will be notified of any cancellations no later than two (2) hours before the scheduled visitation. Fees paid for cancelled visits due to weather will be credited to the payors account for future services. If services are no longer required, a refund will be issued.

    21. COURT APPEARANCE PROCESS

    The Service Director must be present for any meetings between legal counsel and Brayden Supervisors related to affidavit review or court preparation. All witness subpoenas must be served in accordance with the applicable Family Law Rules or Governing Document and directed to Brayden Supervision Services at 290 North Queen Street, Suite 112, Etobicoke, Ontario, M9C 5L2. Any required witness fees must accompany the subpoena and be payable to the staff member being called to testify.

    22. ANIMALS

    Participants must disclose the presence of any animal(s) in the home during their Intake meeting. Not all Supervisors are comfortable supervising visits where an animal(s) is present, and as such, failure to disclose or contain pets may result in limited staff availability and/or visit termination.  To ensure the safety and comfort of all participants, animals are not permitted in our parenting time centres. An exception applies to service animals, subject to appropriate documentation.   

    23. COMMUNICATION WITH BRAYDEN SUPERVISION SERVICES

    Brayden Service Directors will communicate directly via email, phone, and mail with participants, lawyers, and other professionals. Service Directors ARE NOT available 24/7. Time sensitive matters will be responded to accordingly. Both parties will receive the contact information for their Service Director during the Intake process. Instances where a matter involves additional correspondence or communication outside of those necessary for the making and confirming basic parenting time arrangements may be subject to an additional administration charge. Communication between Brayden Supervision Services and the parties are considered confidential. Any release of communications must be court ordered, compelled, or on consent, unless otherwise stated herein.

    24. WORKPLACE VIOLENCE & HARASSMENT

    All parties understand that service with Brayden Supervision Services is a privilege, not a right. Brayden Supervision Services prohibits threats or acts of intimidation, verbal aggression and/or physical violence. Any contentious or disruptive behaviour will not be tolerated. Service may be suspended or terminated at any point due to failure to act with respect towards all Brayden employees. Any harm resulting from a breach of this provision will be the liability of the parent or participant in the service.

    25. COMPLAINTS PROCEDURE

    Any concerns regarding Brayden Supervision Services should be raised directly with the Service Director. If not resolved, complaints will be handled in accordance with the Participant Complaint Procedure.

    26. PRIVACY POLICY

    We collect personal information necessary to provide our services, including but not limited to:

    • Names, contact details of both parties, children, authorized guests and payment information
    • Court orders, endorsements, or written agreements relevant to supervised parenting time
    • Medical information for the child(ren) as required for their safety during visits
    • Observational notes taken by supervisors during visits (timeline-based, not assessments)

    A. Use of Personal Information

    Personal information is used for the following purposes:

    • To facilitate and supervise parenting time as ordered or agreed
    • To ensure the safety and well-being of children and participants
    • To comply with legal obligations, including mandatory reporting requirements under the Children, Youth and Family Services Act (CYFSA)
    • For communication with participants, legal representatives, and authorized professionals
    • For billing and administrative purposes

    B. Disclosure of Personal Information

    We may disclose personal information:

    • To the Court or others authorized by Court Order
    • To Children’s Aid Society or Police if there are concerns about child safety or as required by law
    • To both parties simultaneously if observational notes are requested by either party
    • To authorized professionals involved in the case (e.g., lawyers, therapists), with consent or as required
    • To both parties and their counsel if service is suspended or terminated

    We do not share personal information with third parties for marketing or unrelated purposes. 

    C. Confidentiality and Security

    • All staff are trained on confidentiality obligations
    • Observational notes are factual and do not include assessments or opinions unless required by a specific program
    • Staff do not use personal devices to record audio or video during parenting time except in emergencies
    • Any use of technology (e.g., security cameras in homes) must be disclosed at intake
    • All records are stored securely, and access is limited to authorized personnel only

    D. Retention of Information

    Personal information is retained only as long as necessary to fulfill the purposes outlined above or as required by law.

    27. LIABILITY AND INSURANCE

    In consideration of participating in supervised parenting services, I agree to release and hold harmless Brayden Supervision Services and its owners, directors, supervisors, employees, and volunteers (collectively referred to as the “Released Parties”) from any claims, liabilities, damages, losses, or expenses arising from or related to my participation, or the participation of my child(ren) or guests, except where such matters result from gross negligence or intentional wrongdoing by the Released Parties.

    I acknowledge that I am responsible for my own conduct, as well as the conduct of my child(ren) and guests during supervised parenting time. If any injury, damage, loss, policy violation, or other incident occurs as a result of my actions, omissions, or circumstances within my control, I accept full responsibility for any resulting consequences or costs.

    Where transportation of a Brayden supervisor is required, I confirm that the driver will possess a valid Ontario driver’s licence and that the vehicle used will be properly insured in accordance with Ontario law, including liability and accident coverage. I understand that maintaining valid licensing and insurance is solely my responsibility. I further agree to accept responsibility for any injury, damage, or loss involving a Brayden supervisor that may occur during transportation connected to my supervised parenting time.

    I agree not to commence, support, or participate in any legal claim or action against the Released Parties relating to supervised parenting services, except where such limitation is not permitted by applicable law.

    28. GOVERNING LAW AND JURISDICTION

    This Agreement is governed by the laws of the Province of Ontario and the federal laws of Canada applicable therein. Any disputes shall be resolved exclusively in the courts of Ontario.

    29. SEVERABILITY

    If any part of this Agreement is found to be invalid or unenforceable, the remaining provisions shall remain in full force and effect.

    ACKNOWLEDGEMENT OF UNDERSTANDING OF SERVICES AND GUIDELINES

    Either party may withdraw from this Agreement for Service at their sole discretion.

    By signing and/or printing your name, you agree to the following:

    1. I confirm that I have read understood and voluntarily signed this Service Agreement. I acknowledge that I had the opportunity to seek independent legal advice, and I am aware that by signing, I am waiving certain legal rights, including the right to sue.
    2. I will share the Service Agreement with any guests attending my supervised parenting time and inform them that they are expected to comply with the terms and conditions outlined.
    3. I understand that working with Brayden Supervision Services is a privilege, not a right and failure to comply with the terms of this Agreement may result in suspension or termination of service.
    4. I understand that Brayden Supervision Services does not provide family therapy or individual counselling. Brayden Supervision Services will not make treatment recommendations or offer assessment or opinions regarding the requirement for supervised parenting time, parenting capacity or the quality of parent-child interactions.
    5. I understand that Brayden Supervision Services cannot advise participants on legal matters or provide legal advice of any kind, including interpretation of a Governing Document.
    6. I understand that the information gathered during the supervised parenting time visits may be released to the court and/or others authorized to have such information.
    7. I understand and acknowledge that participation in supervised parenting time may involve inherent risks related to the actions or negligence of others.
    8. I agree to the Terms and Conditions of this Service Agreement.

    Changes to this Service Agreement

    This Service Agreement may be updated from time to time. Clients will be notified of significant changes via email.

  • Electronic Communication Consent*
  • Information Accuracy*
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