FL-341(A) PETITIONER/PLAINTIFF: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY: CASE NUMBER: SUPERVISED VISITATION ORDER Attachment to Child Custody and Visitation (Parenting Time) Order Attachment (form FL-341) Petitioner Respondent 1. Evidence has been presented in support of a request that the contact of with the child(ren) be supervised based upon allegations of abduction of child(ren) physical abuse drug abuse neglect other (specify): sexual abuse domestic violence alcohol abuse Other Parent/Party Petitioner Respondent Other Parent/Party disputes these allegations and the court reserves the findings on these issues pending further investigation and hearing or trial. 2. The court finds, under Family Code section 3100, that the best interest of the child(ren) requires that visitation by Petitioner Respondent Other Parent/Party must, until further order of the court, be limited to contact supervised by the person(s) set forth in item 6 below pending further investigation and hearing or trial. THE COURT MAKES THE FOLLOWING ORDERS 3. CHILD(REN) TO BE SUPERVISED Child's Name Birth Date Age Sex 4. TYPE a. Supervised visitation b. Supervised exchange only 5. SUPERVISED VISITATION PROVIDER Professional (individual provider or supervised visitation center) a. 6. AUTHORIZED PROVIDER Name Address b. Nonprofessional Telephone Any other mutually agreed-upon third party as arranged. 7. DURATION AND FREQUENCY OF VISITS (see form FL-341 for specifics of visitation): 8. PAYMENT RESPONSIBILITY 9. Petitioner: % Respondent: % Other Parent/Party: % Petitioner will contact professional provider or supervised visitation center no later than (date): Respondent will contact professional provider or supervised visitation center no later than (date): Other Parent/party will contact professional provider or supervised visitation center no later than (date): 10. THE COURT FURTHER ORDERS Date: JUDICIAL OFFICER Page 1 of 1 Form Adopted for Mandatory Use Judicial Council of California FL-341(A) [Rev. January 1, 2015] Family Code, §§ 3100, 3031 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com SUPERVISED VISITATION ORDER