Family Bridge Australia Application Form

Family Bridge Australia Application Form

Important: An application form must be completed by each parent (the term “parent” includes any significant person in the child’s life requiring this service). Applications must be received from all parties before the service can progress. All information provided is managed in accordance with applicable privacy and confidentiality obligations, and sensitive information will not be disclosed unless required by law, where there is a duty of care or safety concern, or with the relevant party’s consent.
About You (Parent / Applicant)
Full Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: 0000000000.
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Gender
Relationship to the child/children
Email
example@example.com
Your Role
Other Parent / Guardian Details
Full Name

First NameLast Name
Relationship to the child/children
Other Parent Phone Number
Please enter a valid phone number.Format: 0000000000.
Other Parent Email
example@example.com
Has the other parent already submitted an application?
Child / Children Details
Child 1: Full Name

First NameLast Name
Child 1: Date of Birth

MonthDayYear
Date
Child 2: Full Name

First NameLast Name
Child 2: Date of Birth

MonthDayYear
Date
Child 3: Full Name

First NameLast Name
Child 3: Date of Birth

MonthDayYear
Date
Important information about your child/children (medical, developmental, behavioural, or emotional needs)
Service Required
Preferred days
Preferred time(s)
Expected frequency (if known)
Safety Information
Are there any safety concerns we should be aware of to ensure visits and changeovers are safe for everyone involved?
If yes, please briefly outline (e.g., family violence orders, intervention orders, safety plans, substance use concerns, or other relevant matters)
Court Order & Legal
Is there a current court order, parenting order, or written agreement in place?
Are there any FVIO/IVO or protection orders (current or past)?
If yes, please briefly describe the order or agreement below and attach a copy of the most current order or agreement.
Attach a copy of the most current order or agreement

Cancelof
Are there any upcoming court dates?
If yes, date(s) and purpose:
During the service, are there any communication restrictions between parents/carers?
If communication allowed, please specify any limits
Legal Representation (If applicable)
Legal representation status
Solicitor / Law firm
Contact person
Email
example@example.com
Phone number
Please enter a valid phone number.Format: 0000000000.
Independent Children's Lawyer (If applicable)
Solicitor / Law firm
Contact person
Email
example@example.com
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Any other details you would like us to know
Emergency Contact
Name

First NameLast Name
Relationship
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Consent & Acknowledgement
Signature
Date

MonthDayYear
Date
Should be Empty:

Family Bridge Australia Application Form

About You (Parent / Applicant)

Other Parent / Guardian Details

Child / Children Details

Safety Information

Court Order & Legal

Legal Representation (If applicable)

Independent Children's Lawyer (If applicable)

Emergency Contact

Consent & Acknowledgement