Policy Agreement

If Holiday cancellations are made less than one week prior to scheduled visit, the parent that cancels is responsible for the cancellation fee equal to the scheduled visit hour(s). Holidays: New Year's Eve, New Year's Day, Christmas Eve, Christmas Day, Thanksgiving Day, Day After Thanksgiving, Easter Sunday, Hanukkah, Yorn Kippur, July 4th Memorial Day, Labor Day, Mother's Day, Father's Day (HOLIDAYS have premium rates).
Reports will be completed upon a verbal or written request by the parent or attorney requesting a report. A Summary Report consists of a list of visitation dates, times and locations only. A Detailed Report gives a list of visitation dates and brief up to specific details of each visit.

  • Any request must be made within the following time frames:

  • Summary Report within a 6-10 business day request = $75.00

  • Summary report within a 1-5 business day request= $100.00

  • Detailed report within  a  6-10 business day request= $200.00

  • Detailed report within  a 1-5 business day request= $250.00

  • Declaration= $75.00 (1 page); $150 (2 page)

  • Reports where substitute Providers are used are written by the substitute Provider and paid for separately.

  • Reports consisting of an extending period of time (12 visits or more) will be quoted a separate fee.

Supervised Visitation Guidelines
The following procedures must be followed:

  • The Provider will be present at all times during the visit.

  • The Custodial parent will arrive fifteen (15) minutes prior to the start of the scheduled exchange and return exactly at the end of the scheduled exchange. Custodial parent and/or designees will be required to leave the area immediately upon signing in/dropping off child(ren) and picking up child(ren).

  • The Non-custodial parent will arrive at the exact hour of the scheduled exchange and will return fifteen (15) minutes prior to the end of the scheduled exchange.

  • Fees for services must be paid in full, in-cash, prior to each visit. No refunds.

  • The visiting parent must arrive promptly at the scheduled time.

  • If a parent or designee is more than 5 minutes early or late, he/she will have to pay $2.00 for each additional minute. No refunds.

  • Use of alcohol or non-prescribed drugs is prohibited.

The following must be avoided:

  • Inappropriate touching of the child(ren)s body

  • Inappropriate demands for physical contact

  • Use of foul language

  • Shouting or yelling at ANYONE

  • Threat of physical abuse or violence to ANYONE

  • Attempts to move child(ren) away from the sight and/or hearing range of the Provider

  • In SA cases, in addition to the above guidelines, the following must be avoided:

  • Allow no exchanges of gifts, money, or cards;

  • Allow no photographing, audio taping, or videotaping of the child;

  • Allow no physical contact with the child such as lap sitting, hair combing, stroking, hand holding, hugging, wrestling, tickling, horse playing, changing diapers, or accompanying the child to the bathroom;

  • Allow no whispering, passing notes, hand signals, or body signals; and

  • Allow no supervised visitation in the location

  • Parents and/or designees must avoid each other completely.

  • There will be no correspondence (e.g. regarding child support) or messages to the other parent by means of child(ren), Provider, etc. It is prohibited to use the visitation, scheduled exchange site or surrounding areas for the service of court documents.

  • Providers will only exchange information in regards to the child(ren)'s medical needs (i.e. medications, allergies,  dietary  needs)  or  visitations.  Only prescription medication may be sent in pre-measured doses. Any other dietary (food) requests are not monitored or enforced. Custodial and visiting parties are responsible to meet the needs of children while children are in each individual's care, e.g. diaper bag, baby food, or meals.

  • Parents must not share detailed court information or court documents with the chiid(ren) or make promises to the child(ren) about future living arrangements, time sharing, or visitation modifications. Discussions and activities should focus on the present so as to avoid added pressure and/or disappointment of the child(ren).

  • Parents will not speak negatively about the child(ren)'s other parent and his/her family in front of the child(ren). Concerns should be addressed during office hours.

  • Parents must not question the child(ren) about the other parent's whereabouts or activities.

  • Parents will not use alcohol or non-prescribed drugs 24 hours prior to or during their visit with the child(ren). Visits will be cancelled if a parent is suspected of using these substances.

  • Parents and children must speak English during the supervised visit unless there is a Provider present who speaks a family's native language. Parents must speak loud enough for Provider to hear. No whispering.

  • Phone calls to other individuals are not permitted at anytime during the supervised visit. The use of cellular phones is not permitted during the scheduled visit unless in case of emergencies only.

  • Weapons (including off duty fire arms) or any articles that could be used as weapons are not permitted on the supervised visit.

  • Family members as provided in the court order to participate in the visitation that do not comply with the Providers guidelines and rules will result in the cancellation of the supervised visitation (h4 and 113).where the alleged sexual abuse occurred.

  • The visiting parent may bring a snack for the child(ren) as long as both parents agree.

  • No gifts for the child(ren) are permitted unless both parents  agree,  with the exception of the child(ren)'s birthday(s), Christmas, Hanukkah or other holidays at which gifts are usually given. Gifts will also be allowed at the first visit when there has been a substantial time of separation between visiting parent and child(ren).

  • The Provider will monitor what is given for safety and security purposes. The Provider will observe and document what is given prior to the gift exchange. As a safety protocol, unwrapped gifts and gift bags are recommended.

  • If for any reason you are unable to bring the child(ren) or attend the visit with your child(ren) it is your responsibility to notify the Provider. The Provider will confirm cancellations. Both parents must confirm mutually agreed upon cancellations with the Provider. If cancellation notice is given to Provider prior to 24 hours of visit, there is no cancellation fee. If notice is given within 24 hours, cancellation fees apply.

  • When visits fall on a holiday, cancellation must be made no later than one week prior to the visit. If holiday cancellations are made less than one week in advance, canceling parent is responsible for paying the cancellation fee equal to the# of scheduled hours for the visit.

  • Failure of the visiting parent to arrive within 20 minutes of the designated time of arrival without calling to let us know that you will be running late, will result in a cancellation (equal to the number of scheduled hours for the visit.) The no-show parent will be responsible for paying the appropriate fee and children will be returned to the custodial part y.

  • Except for late cancellation or inability to arrive on time, all calls are to be placed to the Provider during office hours, Monday to Friday, 9:00 am to 6:00 pm. (PST).

  • Photographs may be taken during visits with the prior approval of the custodial parent (unless it is an SA case). The custodial party must sign consent form prior to photographs being taken. Photographs should not be taken of Providers at any time. Providers shall not take photographs of the parents and child(ren) NO audio or visual recording is permitted for any reason.

  • There are to be no changes in the supervised visitation schedule unless approved by the court and/or Provider. Once the day and time has been set, it will be followed on a consistent basis, unless either party requests a change. Changes in the schedule need to be done one week prior to visitation.

  • There shall be no permanent alteration  of  the  child(ren)  during  visitation  without  prior  approval  of  the custodial parent. This includes, but not limited to: haircuts, tattoos, body/ear piercing, etc.

  • Non-compliance with any rule or challenging the supervised Provider may lead to termination of services.

  • If medication is needed during visits, the custodial parent (guardian) must provide written consent giving the visiting parent permission to administer the medication. Only prescription medication will be accepted in a pre measured dose.


  • Observation notes will be kept by the Provider during each visit. Provider will also keep a record of all phone calls and other interactions between clients.

  • I will receive a copy of the report as well as all parties.

  • If a visit is terminated or if services are terminated for any reason, all parties and the Court will be notified via written notice, which will give reason(s) for the termination.


  • The Provider reserves the right to refuse access, cancel or terminate a visit or all services if I, the non-custodial parent , violates the Agreement for Service or if the Provider feels threatened or if he/she feels that it is not in the  best interest of my child(ren) or myself to continue (or accept) my case


  • No privilege of confidentiality exists between me and the Provider. This includes any communication, whether written, observed or heard between Provider and myself, myself arid my child(dren) Provider and child, or myself and other parties.

  • The observation notes, heard comments, spoken information or any other information will be shared when:

  • Requested by the court mediator, court investigator, or evaluator in conjunction with a court ordered mediation, investigation or evolution.

  • Required by Child Protective Services.

  • Required by a law enforcement agency.

  • When a report is requested by either party or their attorney.

  • In  addition,  my  case  file  may  be  reviewed  during  an  evaluation  by  the evaluator or attorney.

  • The Provider will keep identifying information such as, addresses, place of work, phone numbers, etc. confidential. This information will not be included in any reports except when ordered by the court, reporting child abuse or to police agencies in the event of abduction.

This Agreement for Services has been explained to me and I agree to and understand the terms and conditions listed above. I have been given a copy of this agreement. I understand that failure to comply may result in immediate withdrawal of service(s) being offered.

Visit: Call for appointment

4016 West Slauson Avenue

Los Angeles, CA 90043

Call: 9:00 am - 7:00 pm

T: 424-291-2774

© 2019 by Empower Training Institute, Inc.

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