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How to Request an Order for Supervised Visitation

These instructions and forms were produced by Massachusetts Law Reform Institute and Community Legal Services And Counseling Center in consultation with the Massachusetts Coalition for Supervised Visitation.

What forms do you use to request an order for supervised visitation?

Motion for Visitation Supervised by an Individual

Proposed Order for Visitation Supervised by an Individual

Affidavit in Support of  Motion for Supervised Visitation

Motion for Visitation at a Supervised Visitation Center

Proposed Order for Visitation at a Supervised Visitation Center

The forms you use depend on your situation and the kind of supervised visitation you are requesting.

When do you use these forms?

If you are a custodial parent and you want the court to allow visits with your children so long as the visits are supervised, you can wait until the non-custodial (visiting) parent serves you with a motion for visitation. When you are served with the motion you can file a

Proposed Order for Visitation at a Supervised Visitation Center

and/or

Proposed Order for Visitation Supervised by an Individual

When you file a Proposed Order, you should also file an Affidavit in Support of Motion for Supervised Visitation.

If you are a custodial parent and you want the court to order supervised visits, but you do not want to wait until the visiting parent takes the first step by serving you with a motion for visitation, you would also need to file a

Motion for Visitation at a Supervised Visitation Center

and/or

Motion for Visitation Supervised by an Individual

It is very important for victims of domestic violence to get legal advice and do safety planning before filing one of these motions.

General instructions

Where the form says something like “custodial parent/guardian”, cross out the word that does not apply, like this, custodial parent/guardian

If the other parent filed a motion for visitation, and you are filing a Proposed Order for Visitation at a Supervised Visitation Center or a Proposed Order for Visitation Supervised by an Individual (with an Affidavit in Support of Motion for Supervised Visitation along with the Proposed Order), you must serve copies of these papers at least one business day before the hearing on the motion for visitation. If you mail the papers to the other parent or his attorney, you must mail them at least four days before the hearing.

You can file a Proposed Order for Visitation at a Supervised Visitation Center or a Proposed Order for Visitation Supervised by an Individual or both. You might file both if you want the court to order one kind of supervised visitation if it does not order the other.

If you are filing a Motion, you must mail copies of the completed forms to the other party at least ten days before the hearing on the Motion.

Completing the proposed order form

Fill out a Proposed Order for Visitation at a Supervised Visitation Center and/or a Proposed Order for Visitation Supervised by an Individual, depending on what kind of supervised visitation you are seeking. Court rules require filing a proposed order when you ask the court to make an order. You use the proposed order to inform the judge and other parent about what you want included in the Supervised Visitation Order. The Proposed Order forms included in these materials will help you remember to deal with each item that a Supervised Visitation Order should include.

The Proposed Order forms include the following items:

  1. Children Put the names of the children whose visits will be supervised in this section of the Proposed Order
  2. Parents/Guardians Put the name of the visiting parent and the name of the custodial parent/guardian.
  3. Supervisor You use this section of the Proposed Order for Visitation Supervised by an Individual to say which of two kinds of supervisor you want the court to order. Check the box next to the kind of supervisor you want to court to order and put the name of the proposed individual supervisor.
  4. Supervisor’s or supervised visitation center’s role and duties Check each box that applies. Be sure to find out whether the proposed supervisor or supervised visitation center can perform the duties you have checked.
  5. Schedule In this section of the proposed order you write down how often you propose that the visits take place (frequency) and how long each visit should be (duration). Be sure to check with the proposed supervisor or supervised visitation center first to be sure that they can supervise the visits according to your proposal. Be specific about the schedule. For example, every Saturday beginning October 18, 2008, from 10 to 11 AM.
  6. Location applies to visitation supervised by an individual. Write the street address and city or town where the visitation will take place.
  7. Drop off and pick up applies to visitation supervised by an individual. Check each box that applies. If you check the second box, put the address where the drop off and pick up will take place.
  8. Fees and costs Check each box that applies. If you check the third box, where the parties share certain costs and fees, be specific about how the costs and fees will be shared by writing who will pay what percentage. For example, if you check that the parties will share the costs and fees of the supervised visitation center, to be specific you might propose that the visiting parent will pay 50% and that the custodial parent/guardian will pay 50%.
  9. Review Propose a date for the court to review the visitation.
  10. Additional Provisions Check the box next to each additional provision that you want to propose. Fill in specifics for each box that asks for specifics.

Fill out the top of the Proposed Order form as you filled out the top of the Motion. See instructions 1 – 3 under Completing the motion form.

Completing the affidavit in support of motion for supervised visitation

Use the Affidavit in Support of Motion for Supervised Visitation to write down what you have seen or what has happened to you or your child. An affidavit is a sworn statement. When you sign it, you are swearing that what you have written is true.

If you have a restraining order that is currently in effect, say so in the affidavit and attach a copy.

If there have been prior restraining orders, not currently in effect, say so and attach a copy.

If to the best of your knowledge the visiting parent does not know where you live, say so.

If you believe that you or your child(ren) are at serious risk of further abuse if the court does not order supervised visitation, say so.

  1. Fill in the title of the case just as in 1, 2, and 3 in the Completing the Motion section below.
  2. Write down the basic facts saying what you have seen or what has happened to you, including the approximate dates, using numbered sentences. Examples:
    • On or about January 15, 2005, the defendant John Doe struck me with his fist while I was trying to give the baby a bath.
    • On or about June 20, 2005, the defendant John Doe threw a dish at Tommy when he came home with bad grades on his report card.
  3. Write the date, month, and year that you sign the Affidavit.
  4. Sign the Affidavit.

Completing the motion form

  1. Print the name of the county where the case is filed in the top line of the MOTION, in front of the word “DIVISION.”
  2. Print the docket number of your case if you know it.
  3. Print the name of the plaintiff, the person who filed the case, and the name of the defendant. For example, if the case is a divorce case, and you filed the divorce, you are the plaintiff. If you spouse filed the divorce, you are the defendant.
  4. Print your name after the word “I” in the first sentence of the MOTION.
  5. Check the box next to each reason you are asking for a supervised visitation order.
  6. Sign your name and then print your name, address, and telephone number. If your address or telephone number are impounded by the Court, write “Impounded” in these spaces.
  7. Arrange a date (by speaking to the appropriate clerk) for a hearing on your Motion. You will complete the Certificate of Service and Notice of Hearing after you get a hearing date from the clerk.
  8. After you get the hearing date complete the Certificate of Service and Notice of Hearing on the third page of the motion.
    1. Print the other parent’s name (the “opposing party”) and address where indicated. If the other parent has an attorney in the case, write the name and address of the attorney, not the other parent’s name and address.
    2. Write the date, time, and name of the city or town where the hearing will take place.
    3. Sign and date the Certificate of Service with the date that you mail the Motion to the other parent or the attorney.

Copying, filing and mailing the forms

  1. Make copies of original, completed forms for yourself and for the opposing party.
  2. File the original, completed forms at the court.
  3. Mail copies of the Proposed Supervised Visitation Order, Affidavit in Support of Motion for Supervised Visitation, and Motion for Supervised Visitation (if you filed one), to the opposing party.

Go to court on the day of the hearing

On the day of the hearing go to the assigned courtroom and be prepared to tell the judge why he or she should issue an order for supervised visitation. Use your Proposed Order, Affidavit, and Motion as your guide for what to say.

Produced by Massachusetts Law Reform Institute and Community Legal Services And Counseling Center in consultation with the Massachusetts Coalition for Supervised Visitation
Last Updated March, 2015

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