WE ARE THE CHILDREN'S HAVEN - W.A.T.C.H. program
QUESTIONNAIRE
 
Each party is to fill out and return to supervisor before visitation starts
 
Today’s Date: _________________ 
 
INFORMATION ON YOURSELF:  
             
Custodial Parent/Non-Custodial Parent (CP/NCP)
Please circle whether you are CP or NCP.
 
Name: ______________________________________________                                                                                                              
Home  address:_______________________________
City:________________ State_____________ 
Zip Code________
County:______________ DOB:____________________
Cell Phone: ______________
Other number:_______________
E-Mail address: _______________ 
Fax number:___________
Driver's License Number: ___________ 
Issuing state: _______
 
Year and make of car you are using:_____________________
License plate number: ______________________
 
Emergency contacts:
 
Name:__________________________ Phone:____________
Name: __________________________ Phone:___________
 
If represented by counsel in this matter: Please complete the following:
 
Attorney name:_______________________________
Street address:________________________________
City:_____________ State:___________ 
Zip code: ________
Phone number:________________ 
Fax number:___________ 
Email address: __________________
 
Amicus Attorney:
 
Attorney name: _____________________ ______________                                                  _
Street address: ______________________________
City:_____________ State:___________ 
Zip code: ________
Phone number:________________ 
Fax number:________                      ___ 
Email address: __________________
 
 
Case information:
Court number: __________ Cause no.____________
Any hearing dates:___________________________
 
Please attach any current orders regarding supervised visitation.
 
Children's information
 
Name:_____________________________ DOB:________
Name:_____________________________ DOB:________
 
 
 
 
 
 
After filling out questionnaire and executing the rules and regulations,  scan and email them to me at: hcastanj@aol.com
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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