Form 13 STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO:__________________ COUNTY OF BUNCOMBE Plaintiff/Petitioner v. Defendant/Respondent ) ) ) ) ) ) ) ORDER FOR SUPERVISED VISITATION EXCHANGES FOR VISITATION The Family Visitation Center Plaintiff is represented by:__________________________. Defendant is represented by: ___________________. GAL Advocates for the child(ren) are_____________________________________________. The parties are the parents of the following child(ren), in the legal custody of __________________________________________. _________________________________ (D.O.B.) _________________________________ (D.O.B.) _________________________________ (D.O.B.) _________________________________ (D.O.B.) From these facts the Court concludes that it would be in the best interest of the child(ren) for visitation or exchanges for visitation to be supervised by TFVC: a. to assure the safety of a child; and/or b. to assure the safety of a parent; and/or c. to avoid conflict between the parents; and/or d. other:____________________________________________________________ Now, therefore, it is hereby ORDERED as follows: 1. The parties shall contact TFVC at (828) 225-0740 for orientation and scheduling visitation or exchanges. 2. Each party shall sign a TFVC “Service Agreement” shall abide by the policies and procedures of TFVC, and shall abide by the instructions and decisions of TFVC staff. 3. Each party shall deliver and pick up the child(ren) as directed by TFVC staff. TFVC is authorized to rearrange times specified in this order to accommodate holidays, high demand at particular times, availability of staff, or for other good cause. 4a. The Supervised Visitation shall be for 1 hour: ______ times per week, or ______ times per month, or Other ______________________________________________________. 4b. Monitored Exchanges shall take place according to the following visitation schedule: Plaintiff Defendant shall be entitled to the child(ren) from __________________ (specify day) ___ am/pm to ________________ , (specify day) _____ am/pm every ___________ (specify frequency) and/or ____________________ , beginning ______________ or as soon thereafter as TFVC can schedule the visit. 5. The following person(s)  may  shall not accompany  Plaintiff  Defendant to TFVC for the visitation: _____________________________________________________________. Otherwise TFVC is authorized to determine who can participate in any exchange or visit. 6. TFVC is hereby authorized to terminate any visit, if in its discretion the emotional or physical well-being of the child(ren) or of either party would otherwise be jeopardized. American LegalNet, Inc. www.FormsWorkflow.com Form 13 7. A. Fees for Exchanges or Supervised visits shall be paid as follows: entirely by Plaintiff. Defendant. half (or such lesser amount as TFVC directs) by each parent. B. Fees for all Court Reports prepared shall be paid as follows: entirely by Plaintiff Defendant half by each parent. C.   Fees for appearances in court ($65/hour) shall be paid as follows: Plaintiff. Defendant. entirely by half by each parent. D. There is a $15 orientation fee (or such lesser amount as TFVC directs) that applies to both parties, except victims of domestic violence, whose fees are waived. 8. A copy of the most recent custody order and/or any domestic violence order in this matter shall be provided to TFVC by ______________________________ on or before (date) _____________________. 9. A review hearing shall be conducted in this matter on the ________day of ___________, 20____, in District Court Room _______. Orders for Supervised Visitation must have a review date or will receive time-limited services pending a review. 10. pending further order for one year from this date (only for This Order shall remain in Effect Monitored Exchange Orders)  other: _____________________________________________________________________________________. 11. TFVC shall report to the Court regarding the exchanges or visits, in writing with copies to all parties, counsel, children’s advocates and Guardian Ad Litem(s), whenever, in its discretion, a report is necessary, and/or if the service is terminated; or  on or before the following date: __________________________ . This the________day of______________________, 20_________. _____________________________________________ District Court Judge Presiding cc: The Family Visitation Center P.O. Box 7524 Asheville, NC 28802 Phone: 828-225-0740 Fax: 828-225-0490 Revised 05/05/2005 American LegalNet, Inc. www.FormsWorkflow.com