STATE OF NORTH CAROLINA COUNTY OF MECKLENBURG IN THE GENERAL COURT OF JUSTICE DISTRICT COURT DIVISION _____-CVD-__________ Plaintiff, vs. Defendant. ORDER FOR SUPERVISED VISITATION/EXCHANGE Visitation provisions of the following children are being addressed in a Domestic Violence Protective Order or other Order in a case in which there are domestic violence issues. This order is being entered to effectuate the supervised visitation or exchange provisions of said Order. The parties are ordered to apply to use the Mecklenburg County Supervised Visitation and Exchange Center ("Center") for the following minor child(ren): a. b. __________________________ d/o/b:___________ __________________________ d/o/b:___________ c. ___________________________ d/o/b:___________ d. ___________________________ d/o/b:___________ The parties shall contact the Center at 980-314-8680 within ________ days to initiate the process for Supervised Visitation or Exchange. Both parties shall complete the Center's orientation. The parties are ordered to comply with all policies, procedures, and directives of the Center. If the Center is able to accept this case, the court is ordering supervised visitation or exchanges at the Center as follows, or as close to as follows as the Center can accommodate. The Center may stagger arrival times of the parties. The party exercising visits is Plaintiff Defendant. Visitation : (1 hour) Frequency: Weekly Bi-weekly Monthly Day of week _______________Time of Day __________ Frequency of Visit: Weekly Bi-weekly Monthly Day(s) and Time(s) of Exchange: Visit begins: Day of Week ____________Time of Day ________ Visit ends: Day of Week ___________ Time of Day ________ Exchanges: Other: _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ So ordered this ______ day of ____________, 20___. ____________________________________ JUDGE PRESIDING CCF-50 American LegalNet, Inc. www.FormsWorkFlow.com