CHILD'S NAME:

CASE NUMBER:

JV-402

VISITATION ATTACHMENT: GRANDPARENT

Anyone who appears to be under the influence of alcohol or any controlled substance will not be allowed to participate in a 
scheduled visitation with the child.  The visitation supervisor may terminate the visit if this order is violated.

Matters relating to the allegations of the petition or issues related to the child's placement are not to be discussed with the 
child during visits except under the guidance of a counselor in a therapeutic setting.  The visitation supervisor may terminate 
the visit if this order is violated.

1.  

2.

3.

Contact  between the child and grandparent

a.

Contact  between the child and the
maternal grandmother
maternal grandfather
other maternal grandparent (specify): 
is in the best interest of the child at this time and will serve to strengthen family ties.
(1)

In-person visitation
(a)

Unsupervised

(b)

          Supervised by the 

(c)

Frequency and duration

(i)

(iii)

          other (specify):

county agency

(ii)

          foster family agency

(i)  
(ii)
(iii)
(iv)
Location

(i)

(iii)

(d)

(e)

(f)

            times per week for a total of          hours per week

            times per month for a total of          hours per month
An overnight visit               every week               every other week             
Other (specify):

County agency visitation facility

(ii)

Foster family agency facility

Other (specify):

Transportation of the child to and from the visits will be provided by the
(i)

          foster family agency

county agency.

(ii)

(iii)

          other (specify):

Other orders concerning in-person visitation  (specify):

(2)

Other types of contact permitted (specify):

(3)

Contact restrictions 
The following contact between the child and the 

maternal grandmother
maternal grandfather
other maternal grandparent (specify): 
is not in the best interest of the child at this time and the specified person is to have no  
such contact with the child:
(a)

Telephone contact

In-person contact

(c)

(b)

          Written communication

Form Approved for Optional Use 
Judicial Council of California 
JV-402 [Rev. January 1, 2007]

VISITATION ATTACHMENT: GRANDPARENT

Page 1 of 2

Welfare and Institutions Code, § 361.2;
Cal. Rules of Court, rule 5.670 
www.courtinfo.ca.gov

CHILD'S NAME:

CASE NUMBER:

JV-402

3.

b.

Contact  between the child and the

paternal grandmother
paternal grandfather
other paternal grandparent (specify): 
is in the best interest of the child at this time and will serve to strengthen family ties.
(1)

In-person visitation
(a)

Unsupervised

Supervised by the 
(i)

county agency

(iii)

          other (specify):

(c)

Frequency and duration

(ii)

          foster family agency

(i)  
(ii)
(iii)
(iv)
Location

(i)

(iii)

(b)

(d)

(e)

(f)

            times per week for a total of          hours per week

            times per month for a total of          hours per month
An overnight visit               every week               every other week             
Other (specify):

County agency visitation facility

(ii)

Foster family agency facility

Other (specify):

Transportation of the child to and from the visits will be provided by the
(ii)
(i)

          foster family agency.

county agency.

(iii)

other (specify):

Other orders concerning in-person visitation  (specify):

(2)

Other types of contact permitted (specify):

(3)

Contact restrictions 
The following contact between the child and the 

paternal grandmother
paternal grandfather
other paternal grandparent (specify): 
is not in the best interest of the child at this time and the specified person is to have no 
such contact with the child:

(a)
(b)

          Written communication

In-person contact

(c)

Telephone contact

4.

Other  (specify):

JV-402 [Rev. January 1, 2007]

VISITATION ATTACHMENT: GRANDPARENT

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