WE ARE THE CHILDREN'S HAVEN
WE ARE THE CHILDREN'S HAVEN
W.A.T.C.H. program
QUESTIONNAIRE
Each party is to fill out questionnaire before visitation starts
Today’s Date: _________________
INFORMATION ON YOURSELF:
Custodial Parent/Non-Custodial Parent (CP/NCP)
Please circle whether you are CP or NCP.
Name: ______________________________________________
Home address:_______________________________
City:________________ State_____________
Zip Code________
County:______________ DOB:____________________
Cell Phone: ______________
Other number:_______________
E-Mail address: _______________
Fax number:___________
Driver's License Number: ___________
Issuing state: _______
Year and make of car you are using:_____________________
License plate number: ______________________
Emergency contacts:
Name:__________________________ Phone:____________
Name: __________________________ Phone:___________
If represented by counsel in this matter: Please complete the following:
Attorney name:_______________________________
Street address:________________________________
City:_____________ State:___________
Zip code: ________
Phone number:________________
Fax number:___________
Email address: __________________
Amicus Attorney:
Attorney name: ____________________________________
Street address: ______________________________
City:_____________ State:___________
Zip code: ________
Phone number:________________
Fax number:___________
Email address: __________________
Case information:
Court number: __________ Cause no.____________
Any hearing dates:___________________________
Please attach any current orders regarding supervised visitation.
Children's information
Name:_____________________________ DOB:________
Name:_____________________________ DOB:________
Name:_____________________________ DOB:________
After filling out questionnaire and executing the rules and regulations, scan and email them to me at: hcastanj@aol.com
Also, provide the program with a copy of your driver's license front and back.