Application Form | Olivian Family Services

Application For Supervised Time

Each parent is required to complete the following application form. Ensure you have first read and understood the Procedures and Services Agreement. Please contact us if you have any questions or concerns.

All information provided will be treated confidentially and will not be released to any other party except where required by law or court order.

Your Role In This Application *

Child Currently Live With Me
Child Will Be Supervised With Me
Legal Guardian
Other

First Name *

Last Name *

Date of Birth *

Email Address *

Contact Number *

Residential Address *

Your Legal Representative (If Applicable)

Do you consent to Olivian Family Services communicating with your solicitor regarding intake, scheduling, and compliance matters? *

Yes
No

Other Parents Name *

Other Parents Contact Number (If Available)

Other Parents Email (If Available)

Other Parents Legal Representative (If Known)

Relevant Childrens Name & Date Of Birth For Supervision *

Who Does The Child/Children Currently Live With *

Is There A Court Order Or Parenting Plan Currently In Place *

Yes
No

If Yes, please provide details below: Court name, Date of most recent order, Interim or final orders

Is there a current Intervention Order / Family Violence Order in place? *

Yes
No

Is regular drug and/or alcohol screening required under any order or agreement? *

Yes
No

Type of service requested *

Supervised time
Supervised changeovers

Proposed duration and frequency (e.g. 2 hours weekly / 3 hours fortnightly) *

Preferred days and times (if any) *

Who is responsible for payment of Olivian Family Services fees? *

I am
Other parent
Shared between parents

Is there anything else Olivian Family Services should be aware of to assist with suitability assessment, safety planning, or service delivery? *

12. Agreement & Declaration Electronic Signature (required) By submitting this application, I acknowledge and agree that: The information provided is true and correct to the best of my knowledge Olivian Family Services is an independent and neutral se *

I have read, understood, and agree to the Procedures and Services Agreement
I consent to the collection and storage of my information in accordance with the Privacy Policy

contact@olivianfamilyservices.com.au