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Here is the text we could read:

SUPERVISED VISITATION PROVIDER (Name and address): 

FL-324(NP)

FOR COURT USE ONLY

STATE:

ZIP CODE:

FAX NO. (Optional):

NAME:

CITY:

STREET ADDRESS:

TELEPHONE NO.:

E-MAIL ADDRESS (Optional):

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER:

RESPONDENT:

OTHER PARTY/PARENT:

SUPERIOR COURT OF CALIFORNIA, COUNTY OF
STREET ADDRESS:

DECLARATION OF SUPERVISED VISITATION PROVIDER 
(NONPROFESSIONAL)

CASE NUMBER:

1.   Purpose.  I submit this form to declare that (check all that apply):

I am not being paid to provide supervised visitation services.

I am in compliance with all mandatory requirements for a nonprofessional provider of supervised visitation as defined in 
Family Code                         and                        of the Standards of Judicial Administration.

I am in compliance with the alternative qualifications specified in 2b. 

2.   Qualifications (complete a or b):

Standard qualifications. I meet the qualifications to provide nonprofessional supervised visitation services under 
Family Code section 3200.5 as follows (check all that apply):

I have no record of a conviction for child molestation, child abuse, or other crimes against a person.

I will not be transporting the child.

I will be transporting the child by automobile and I have proof of automobile insurance.
I agree to adhere to and enforce the court order regarding supervised visitation.

There is no current or past court order in which I (the nonprofessional provider) was the person being supervised.

b.

Alternative qualifications. I meet other qualifications to provide nonprofessional supervised visitation services, as follows 
(check all that apply):

The court has ordered other qualifications and I meet those qualifications (see attached copy of the court order).

The parties have stipulated (agreed) to different qualifications and I meet those qualifications (see attached copy 
of the parties' stipulation (agreement), which was approved and signed by the court).

I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

a.

b.

c.

a.  

(1)

(2)
(3)
(4)
(5)

(1)

(2)

Date:

(TYPE OR PRINT NAME)

(SIGNATURE OF DECLARANT)

NOTICE: Additional requirements may apply to be able to serve as a nonprofessional supervised  
                visitation provider. See Standard 5.20 of the Standards of Judicial Administration.      

Form Approved for Optional Use 
Judicial Council of California    
FL-324(NP) [New January 1, 2021]

DECLARATION OF SUPERVISED VISITATION PROVIDER 
(NONPROFESSIONAL)

Page 1 of 1 

Family Code § 3200.5

Declaration of Supervised Visitation Provider (NonProfessional)

This info page is part of the LIT Lab's Form Explorer project. It is not associated with the California state courts. To learn more about the project, check out our about page.

Downloads: You can download both the original form (last checked 2023-03) and the machine-processed form with normalized data fields.

About This Form:

Sourced from selfhelp.courts.ca.gov (2023-03)
Page(s): 1
Fields(s): 31
Average fields per page: 31
Reading Level: Grade 10
LIST Grouping(s): Unknown

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Identified Data Fields:

We have done our best to automaticly identify and name form fields according to our naming conventions. When possible, we've used names tied to our question library. See e.g., user1_name. If we think we've found a match to a question in our library, it is highlighted in green. Novel names are auto generated. So, you will probably need to edit some of them if you're trying to stick to the convention.

Here are the fields we could identify.

f_l_n_p_page_case_number was FL-324NP[0].Page1[0].CaseNumber[0].CaseNumber_ft[0] (0.56 conf)
f_l_n_p_page_info_name was FL-324NP[0].Page1[0].ProviderInfo[0].Name[0] (0.38 conf)
f_l_n_p_page_info was FL-324NP[0].Page1[0].ProviderInfo[0].Street[0] (0.38 conf)
f_l_n_p_page_info_city was FL-324NP[0].Page1[0].ProviderInfo[0].City[0] (0.38 conf)
f_l_p_page_provider_info_state was FL-324NP[0].Page1[0].ProviderInfo[0].State[0] (0.38 conf)
f_l_n_p_page_provider_info__1 was FL-324NP[0].Page1[0].ProviderInfo[0].Zip[0] (0.38 conf)
f_l_n_p_page_info_phone was FL-324NP[0].Page1[0].ProviderInfo[0].Phone_ft[0] (0.39 conf)
f_l_n_p_page_provider_info__2 was FL-324NP[0].Page1[0].ProviderInfo[0].Fax_ft[0] (0.44 conf)
f_l_n_p_page_info_ft was FL-324NP[0].Page1[0].ProviderInfo[0].AttyFor_ft[0] (0.43 conf)
f_l_n_p_page_county_ft was FL-324NP[0].Page1[0].CourtInfo[0].CrtCounty_ft[0] (0.41 conf)
f_l_n_p_page_street_ft was FL-324NP[0].Page1[0].CourtInfo[0].Street_ft[0] (0.36 conf)
f_l_n_p_page_court_info was FL-324NP[0].Page1[0].CourtInfo[0].MailingAdd_ft[0] (0.41 conf)
f_l_n_p_page_court_info_city_zip_ft was FL-324NP[0].Page1[0].CourtInfo[0].CityZip_ft[0] (0.36 conf)
f_l_n_p_page_info_branch was FL-324NP[0].Page1[0].CourtInfo[0].Branch_ft[0] (0.40 conf)
f_n_p_page_title_party_name__1 was FL-324NP[0].Page1[0].TitlePartyName[0].Party1_ft[0] (0.36 conf)
f_n_p_page_title_party_name__2 was FL-324NP[0].Page1[0].TitlePartyName[0].Party2_ft[0] (0.36 conf)
f_n_p_page_title_party_name__3 was FL-324NP[0].Page1[0].TitlePartyName[0].Party3_ft[0] (0.36 conf)
f_l_p_page_list_check_box__1 was FL-324NP[0].Page1[0].List1[0].LI1[0].CheckBox1[0] (0.37 conf)
f_l_p_page_list_check_box__2 was FL-324NP[0].Page1[0].List1[0].LI2[0].CheckBox2[0] (0.37 conf)
f_l_p_page_list_check_box__3 was FL-324NP[0].Page1[0].List1[0].LI3[0].CheckBox3[0] (0.37 conf)
f_l_n_p_page_list_qual was FL-324NP[0].Page1[0].List2[0].LI1[0].Qual_a[0] (0.39 conf)
f_l_p_page_list_check_box__4 was FL-324NP[0].Page1[0].List2[0].LI1[0].List1[0].LI1[0].CheckBox_a1[0] (0.37 conf)
f_l_p_page_list_check_box__5 was FL-324NP[0].Page1[0].List2[0].LI1[0].List1[0].LI2[0].CheckBox_a2[0] (0.37 conf)
f_l_p_page_list_check_box__6 was FL-324NP[0].Page1[0].List2[0].LI1[0].List1[0].LI3[0].CheckBox_a3[0] (0.37 conf)
f_l_p_page_list_check_box__7 was FL-324NP[0].Page1[0].List2[0].LI1[0].List1[0].LI4[0].CheckBox_a4[0] (0.37 conf)
f_l_p_page_list_check_box__8 was FL-324NP[0].Page1[0].List2[0].LI1[0].List1[0].LI5[0].CheckBox_a5[0] (0.37 conf)
f_l_n_p_page_list_qual_b was FL-324NP[0].Page1[0].List2[0].LI2[0].Qual_b[0] (0.39 conf)
f_l_p_list_b_check_box__1 was FL-324NP[0].Page1[0].List2[0].LI2[0].SB_Qual_b[0].LI1[0].CheckBox_b1[0] (0.39 conf)
f_l_p_list_b_check_box__2 was FL-324NP[0].Page1[0].List2[0].LI2[0].SB_Qual_b[0].LI2[0].CheckBox_b2[0] (0.39 conf)
f_n_p_sign_date_time was FL-324NP[0].Page1[0].DeclarationSub[0].Sign[0].DateTimeField1[0] (0.39 conf)
f_n_p_page_sign_name was FL-324NP[0].Page1[0].DeclarationSub[0].Sign[0].NameINFO[0] (0.35 conf)

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The Legal Innovation & Technology Lab's Form Explorer Beta @ Suffolk Law School Last updated 2023-04-02

Declaration of Supervised Visitation Provider (NonProfessional)

About This Form:

Identified Data Fields:

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The Legal Innovation & Technology Lab's Form Explorer ^Beta @ Suffolk Law School Last updated 2023-04-02