STATE OF NORTH CAROLINA IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION FILE NO.: _______________ COUNTY OF MECKLENBURG __________________________________________) ) __________________________________________) Plaintiff(s) ) ) vs. ) ) __________________________________________) ) __________________________________________) Defendant(s) ORDER FOR CONNECTIONS AT THE FAMILY CENTER ❏ SUPPORTED VISITATION ❏ EXCHANGES FOR VISITATION Upon Motion of: ❏ Plaintiff ❏ Defendant ❏ Children’s Law Center ❏ Other ❏ The Court COURT that Connections be utilized to facilitate visitation between the child(ren) of these parties and COUNTY . . _______________________________________________________________________________________________. . . . . . . . . . .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ❏ A hearing was conducted on ___________________. ❏ The parties consented to the entry of this order. Index No. : Calendar No. Plaintiff is represented by: _________________________Defendant is represented by: _________________________. : JUDICIAL Plaintiff(s) CLC Advocates for the child(ren) are _________________________Parent Coordinator is -against____________________________. SUBPOENA : A custody or psychological evaluation is being performed by:_______________________________. The report is : anticipated by:_____________________. The report will be made available to Connections by:__________________________________. : The parties are the parents of the following child(ren), and __________________________________ is their legal Defendant(s) custodian: : ...................................................... Name: _________________________________ DOB: ____________ Name: ____________________________________ DOB:_____________ Name: __________________________________DOB: ___________ Name: ____________________________________ DOB: _____________ THE PEOPLE OF THE STATE OF NEW YORK The following facts support utilizing Connections: ___________________________________________________________________________________________________ TO ___________________________________________________________________________________________________ __________________________________________________________________________________________ From these facts the Court concludes that it would be in the best interest of the child(ren). GREETINGS: 1. For supported or supervised visitation services to be provided by Connections. ❏ WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend a. to assure the child(ren)’s safety ❏ and parent the Honorable b. to facilitate reunification of child(ren) at the Court ❏of c. other: _________________________________________________________________________. located at County ❏ before 2. For exchanges for visitation to be facilitated by Connections. o'clock in the room , on the day of , 20 , at noon, and at any recessed or adjourned date,to avoid conflict give evidence as a witness in this action on the part of the to testify and between parents ❏ a. ❏in ❏ ❏ b. to assure the safety of the parent c. other:__________________________________________________________________________. Your failure to comply with follows: Now therefore it is hereby ORDERED as this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a EACH PARTY SHALL IMMEDIATELY CALL THE INTAKE OFFICE FOR SUPPORTED OR SUPERVISED VISITATION result of your failure to comply. OR THE EXCHANGE COORDINATOR FOR VISITATION EXCHANGES. Both can be reached at 376-7180. EACH PARTY SHALL PROVIDE ALL REQUESTED INFORMATION AND SHALL SCHEDULE AN Witness, Honorable , SHCEDULED BY CONNECTIONS. ASSESSMENT APPOINTMENT. EACH PARTY SHALL KEEP ANY APPOINTMENT one of the Justices of the EACH PARTY SHALL SIGN A RELEASE AUTHORIZING CONNECTIONS TO REPORT TO THE COURT REGARDING Court in County, day of , 20 VISITATIOINS. Connections will only provide visitation services after each party has completed an assessment and orientation and after all required paperwork has been received. (Attorney must sign above and type name below) CCF-51 Attorney(s) for 8/00 Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com , I. ____ SUPPORTED VISITATION ___________________ shall have visitation with the minor child(ren) for a period of ___________hours per _________. ____ Visitation shall be reduced or extended as the staff of Connections determines is appropriate. OR II. ____ EXCHANGE FOR VISITATION ____ Plaintiff ____Defendant shall be entitled to visitation with the minor child(ren) for a period of ____________hours per _______________________, every __________________________________________________________(specify day(s) and frequency) beginning on ________________________________________________(This service is available during the following times: Wednesdays, 3:00 to 7:45; Fridays, 3:00 to 6:15; and Sundays 3:30 to 6:30.) IF THE CHILD(REN) IS (ARE) NOT RETURNED AS ORDERED, ANY LAW ENFORCEMENT OFFICER SHALL LOCATE AND SIEZE THE CHILD(REN) AND RETURN THE CHILD(REN) TO HIS/HER (THEIR) LAWFUL CUSTODIAN. COURT Each party shall comply with Connections policy & protocol in relation to visits and exchanges. COUNTY OF ...................................................... : Connections is authorized to rearrange, in its discretion, the times and dates specified inNo. orderto accommodate Index this holidays, high demand at particular times and/or based on availability of staff. : Calendar No. The parties shall deliver and pick-up the child(ren) as directed by Connections staff. : Connections is hereby authorized to terminate any visit, if in its discretion, the emotional well-being of the child(ren) or the JUDICIAL SUBPOENA Plaintiff(s) safety of the child or either party would otherwise be jeopardized. -against- : ________________________ may ______________________________ shall not accompany child(ren) to Connections for supervised visitation or exchange. Otherwise, Connections is authorized to determine who can participate in any : exchange or visit. Fees for Connections will be paid as follows: ____% by the Plaintiff and/or: ____% by the Defendant for the following reasons:____________________________________________________________________________________________ Defendant(s) ___________________________________________________________________________________________________ : ...................................................... ___________________________________________________________________________________________________ ______________________________________. Payment shall be made before services will be received. This order shall remain in effect: ____ pending further order, ____ from one year from this date, other:__________________________________________________________________________. THE PEOPLE OF THE STATE OF NEW YORK ____ or A review hearing shall be conducted in this matter on the _____________ day of ______________, 20 ____, at TO _____________O’clock __________(a.m./p.m.) in District Court Room __________, or during the ________ week term beginning __________, 20 ____. Connections is requested to provide a court report regarding supported supervised visitation or exchange services in writing (Form CCF-53) with copies to all parties, counsel, child(ren)’s advocates and any parent coordinator, ____ on or GREETINGS: before_________________, ____ whenever, in its discretion, a report is necessary; and if the service is terminated or it concludes that the service is no longer necessary. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before ____ Honorable shall complete the Parent Education course offered by United Family Services, if not already completed. the Both parties at the Court located at County of ____This Order was entered in a 50B case, All reports to the Court from Connections should be directed to the Chief in room , on the day of , 20 , at o'clock in the noon, and at any recessed District Court Judge. or adjourned date, to testify and give evidence as a witness in this action on the part of the ____ This Order was entered in a Chapter 7A or 50 custody matter. All reports to the Court from Connections should be directed to the assigned Judge. This the __________________day of with this subpoena is punishable as Your failure to comply ______________________, 20 ____. a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. _________________________________________________ District Court Judge Presiding Witness, Honorable Cc: Connections at the Family Center Court in Box 35458 County, day of PO Charlotte, NC 28235 Plaintiff Defendant CCF-51 , one of the Justices of the , 20 (Attorney must sign above and type name below) Attorney(s) for 8/00 Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com ,