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Parent A

* First Name

* Surname

* Email Address

* Phone Number

* Street Address

* City

* State/Province

ZIP / Postal Code

Parent B

* First Name

* Surname

* Email Address

* Phone Number

* Street Address

* City

* State/Province

ZIP / Postal Code

Child Details

* Child's Full Name

* Date of Birth

* Age

* Gender Male Female Non-binary Prefer not to say

Current Living Arrangement

* Which parent does the child currently live with? Parent A Parent B

* Is there an Intervention Order in place? Yes No

* Is there a current court order or parenting plan in place? Yes No

* Is regular drug and alcohol screening required? Yes No

* Which parent will be financially responsible for paying the agency fees? Parent A Parent B

Medical Information

* Does your child have any medical conditions? Yes No

* Does your child take any medication during supervised visits? Yes No

* Does your child have any disabilities or additional support needs? Yes No

Allergies

* Does your child have any allergies? Yes No

Behavioural & Emotional Considerations

To help provide appropriate contact supervision with care, please tell us about anything we should know. Examples may include:

Anxiety
Autism Spectrum Disorder (ASD)
ADHD
Trauma history
Sensory sensitivities
Emotional regulation
Separation anxiety
Behavioural triggers
Other important considerations

Please provide details.

Cultural, Religious & Language Requirements

* Does your child have any cultural, religious, or language needs we should be aware of? Yes No

Examples may include:

Cultural practices
Religious observances
Interpreter required
Dietary requirements
Language spoken at home

Communication Preferences

How does your child communicate best? Verbal Non-verbal Visual supports Auslan Interpreter required Other

Please specify

Safety Considerations

* Are there any known safety concerns or risks our supervisors should be aware of? Yes No

Comfort & Wellbeing

What helps your child feel safe, calm, and comfortable during visits? Please provide details.

Parenting Arrangements

Please indicate which documents apply. Parenting Plan Parenting Order Family Court Order Consent Orders Intervention/Apprehended Violence Order (if applicable) Other

Upload Supporting Documents

Please upload any relevant documentation. Accepted documents include:

Court Orders
Parenting Plans
Consent Orders
Family Court documents
Medical Management Plans
Relevant assessments
Other supporting documents

* Will you require an observational report for your solicitor or legal representative? Yes No

Upload Files

Choose File(s)

Accepted formats: PDF, DOC, DOCX, JPG, JPEG, PNG | Maximum file size: 10 MB per file.

Additional Information

Please provide any other information that may assist SafeBridge Family Services in supporting your child. Please provide details.

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Application form