Joint Agreement Form
Please fill out the details of the agreement and ensure both parties provide their signatures.
Party 1 Full Name
*
First Name
Last Name
Party 2 Full Name
*
First Name
Last Name
Agreement Terms and Conditions
*
Date of Agreement
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Mother/Guardian
Name of Father/Guardian
Visiting Day 1
Visiting Day 2
Visiting Day 3
Visiting Day 4
Visiting Day 5
Visiting Length of time 1
Visiting Length of time 2
Visiting Length of time 3
Visiting Length of time 4
Visiting Length of time 5
Who will be responsible for the Intake fees per party
Who is responsible for the hourly fees for the Supervised Visits
Payments and Fees clause
Compliance clause
Are Off-site visits allowed?
Yes
No
Is there any mobility, medical, or emotional concerns?
Yes
No
If yes, please describe mobility, medical, or emotional concerns
If additional care needed, can visiting parent provide medicine or other needs?
Yes
No
Additional care notice
Are there restraining orders or other court ordered considerations?
Yes
No
Restraining order / court considerations details
Attach court orders / TRO / restraining orders (upload)
Upload a File
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Choose a file
Cancel
of
Attachment instruction
Agreement acknowledgement
Mother/Guardian Name
Mother: Custodial Parent or Non Custodial Parent
Custodial Parent
Non Custodial Parent
Party 1 Signature
*
Father/Guardian Name
Father: Custodial Parent or Non Custodial Parent
Custodial Parent
Non Custodial Parent
Party 2 Signature
*
Notary (Mother) Affix Stamp Here
Notary (Father) Affix Stamp Here
Submit Agreement
Submit Agreement
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