Transcription of DV-150 Supervised Visitation and Exchange Order
1 Supervised visits shall be visit(s) per week of hours(s) each, to be arranged with the form is attached to Name of Protected Person:Other Parent s Name:The Court Orders:Parent to be Supervised is:Schedule of Supervised VisitsType of ProviderProvider s InformationName:Telephone number:Costs Will Be Paid As Follows:Contact With ProviderJudicial Council of California, Rev. January 1, 2016, Mandatory Form Family Code, 3100, 3031DV-150, Page 1 of *If Other, specify relationship to child:Address: Supervised Visitation and Exchange Order (Domestic Violence Prevention) , Visitation and Visitation and Exchange OrderDV-150 Case Number:Parties must go to mediation at: Visitation of children is of children are , Temporary Restraining OrderDV-130, Restraining Order After HearingDV-140, Child Custody and Visitation OrderMomDadOther*MomDadOther*MomDadOther (name):All visits as provided in the schedule on Form DV-140, item (d) are to be schedule of Supervised visits is attached.
2 (Check here and attach a sheet of paper with DV-150 , Other Schedule for a title.) (individual or Supervised Visitation center) to pay: %Dad to pay: %Other: 8 Mom to contact provider before (date):Dad to contact provider before Other: 414235679 The court also orders (specify):This is a Court Order .(date):For your protection and privacy, please press the Clear This Form button after you have printed the form.
