Registration - Supervised Parenting Time

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Program Registration

NOTE: The Peel Region Supervised Parenting Time Program is currently at full capacity. Clients requesting service in Peel region will be placed on a waitlist.

"*" indicates required fields

Registration Information

Please indicate your role

Residential Parent

Non-Residential Parent

Service Requested

Supervised Parenting Time

Supervised Virtual Parenting Time

Supervised Exchange

Supervised Communication Exchange

Service Location Request

Peel Region

York Region

Name of Residential Parent

First Last

Name of Non-Residential Parent

First Last

Address

Street Address City Province Postal Code

Date of Birth

DD slash MM slash YYYY

Email*

Consent for the program to email me?

Yes

No

Primary Contact Number

Secondary Contact Number

Service to be provided in:

English

French

Languages Spoken

Application Date

DD slash MM slash YYYY

Child Protection Agency Involvement?

Yes

No

Not sure

Previous involvement but file has closed

Open investigation

Office of Children’s Lawyer involvement?

Yes

No

Clinician or Lawyer's full name:

First Last

Has a court order been made to determine decision making responsibilities?

Yes

No

What are the arrangements?

Are there any current or previous charge of a sexual nature?

Yes

No

Are there any prior or pending criminal charges for you?

Yes

No

Are there any contact restrictions in place?

Yes

No

Do you have any accessibility needs or concerns?

Yes

No

Lawyer Information

Lawyer Name

First Last

Phone

Email

Address

Street Address Address Line 2 City Province Postal Code

Child/Chidren Information

Number of Children

Please enter a number from 1 to 8.

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Name

First Last

Date of Birth

DD slash MM slash YYYY

Reason for Referral

Comments

This field is for validation purposes and should be left unchanged.

Agreement For Service

Download and complete the agreement template PDF file for your requested service:

Supervised Communication Exchange Agreement Template

Supervised Virtual Parenting TIme Agreement Template

Supervised Exchange Program Template

Supervised Parenting Time in York & Peel Regions is a division of Social Enterprise for Canada and we gratefully acknowledge funding by the Ministry of Children, Community and Social Services of Ontario.

Quick Links

Supervised Parenting Time
Supervised Exchange
Supervised Virtual Parenting Time
Supervised Communication Transfer
User Fees
Program Policies
Child & Family Resources

Contact

For assistance, please call:
1-844-373-4515
1-844-373-4515

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