Form 349V Rev 2/18 Page 1 of 2 The Family Court of the State of Delaware In and For New Castle County Kent County Sussex County CONSENT ORDER 226 VISITATION Petitioner v. Respondent Name Name File Number D.O.B. D.O.B. Street Address Street Address Petition Number P.O. Box Number P.O. Box Number City/ State/Zip Code City/State/Zip Code Attorney Name Attorney Nam e 2nd Petitioner (if any) 2nd Respondent (if any) Name Name D.O.B. D.O.B. Street Address Street Address P.O. Box Number P.O. Box Number City/ State/Zip Code City/State/Zip Code Attorney Name Attorney Nam e IN THE INTEREST OF the following child(ren): Name (Child #1) Date of Birth Name (Child #2) Date of Birth Name (Child #3) Date of Birth Name (Child #4) Date of Birth Name (Child #5) Date of Birth Name (Child #6) Date of Birth American LegalNet, Inc. www.FormsWorkFlow.com Form 349V Rev 2/18 Page 2 of 2 The parties in the above-entitled cause hereby agree upon the following arrangement and do consent to the entry on an Order providing for the same: Visitation Awarded to: Relationship: Address: Visitation shall be as follows: This agreement of the parties is subject to review of the parties222 criminal histories by a hearing officer before entry as an order of the court. Affidavit of Consent Be it remembered that on the above named petitioner and respondent personally came before me, the subscriber, a Notary Public for the State and County listed below, who being duly sworn to law did depose and say: I, the undersigned hereby agree upon the following custodial/visitation agreement for the above-named child(ren). I have signed this consent agreement voluntarily and of my own free will. If signed by a Commissioner, we hereby waive our right to a Review of a Commissioner222s Order because this Order is entered pursuant to this Voluntary Agreement. Petitioner Respondent State of State of County of County of Sworn to subscribed before me: Sworn to subscribed before me: Mediator/Notary Public Mediator/Notary Public So Ordered this Date: Judge/Commissioner American LegalNet, Inc. www.FormsWorkFlow.com