Stanislaus — Petitioner Respondent Other Party/parent

Source: https://www.stanislaus.courts.ca.gov/system/files/forms-and-filings/fl-324np-declaration-supervised-visitation-provider-nonprofessional.pdf

FL-324(NP) SUPERVISED VISITATION PROVIDER (Name and address): FOR COURT USE ONLY NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

TELEPHONE NO.: FAX NO. (Optional):

E-MAIL ADDRESS (Optional):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME:

PETITIONER: RESPONDENT:

OTHER PARTY/PARENT: DECLARATION OF SUPERVISED VISITATION PROVIDER CASE NUMBER: (NONPROFESSIONAL)

1. Purpose. I submit this form to declare that (check all that apply): a. I am not being paid to provide supervised visitation services. b. I am in compliance with all mandatory requirements for a nonprofessional provider of supervised visitation as defined in Family Code section 3200.5 and standard 5.20 of the Standards of Judicial Administration. c. I am in compliance with the alternative qualifications specified in 2b.
2. Qualifications (complete a or b): a. Standard qualifications. I meet the qualifications to provide nonprofessional supervised visitation services under Family Code section 3200.5 as follows (check all that apply): (1) I have no record of a conviction for child molestation, child abuse, or other crimes against a person. (2) I will not be transporting the child. (3) I will be transporting the child by automobile and I have proof of automobile insurance. (4) I agree to adhere to and enforce the court order regarding supervised visitation. (5) There is no current or past court order in which I (the nonprofessional provider) was the person being supervised. b. Alternative qualifications. I meet other qualifications to provide nonprofessional supervised visitation services, as follows (check all that apply): (1) The court has ordered other qualifications and I meet those qualifications (see attached copy of the court order). (2) The parties have stipulated (agreed) to different qualifications and I meet those qualifications (see attached copy of the parties' stipulation (agreement), which was approved and signed by the court).

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

Date:

(TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT)

NOTICE: Additional requirements may apply to be able to serve as a nonprofessional supervised
visitation provider. See Standard 5.20 of the Standards of Judicial Administration.

Form Approved for Optional Use Family Code § 3200.5Judicial Council of California DECLARATION OF SUPERVISED VISITATION PROVIDER www.courts.ca.gov FL-324(NP) [New January 1, 2021] (NONPROFESSIONAL) For your protection and privacy, please press the Clear This Form button after you have printed the form. Print this form Save this form Clear this form