CHILD'S NAME:

CASE NUMBER:

JV-400

VISITATION ATTACHMENT: PARENT, LEGAL GUARDIAN, INDIAN CUSTODIAN, OTHER IMPORTANT PERSON

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 the mother
a.

In-person visitation

(1)
(2)

Unsupervised

          Supervised by the

(a)
(b)
(c)
(d)

(a)

(c)

(4)

Location

(a)

(c)

          other (specify):

county agency

(b)

          foster family agency

(3)

Frequency and duration

            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):

Agency visitation facility

(b)

Foster family agency facility

Other (specify):

(5)

(6)

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

          foster family agency.

county agency.

(b)

(c)

          other (specify):

Other orders concerning in-person visitation (specify):

Other types of contact permitted (specify):

b.

c.

a.

Contact restrictions.  The following contact between the child and the mother would be detrimental to the best 
interest of the child at this time, and the mother is to have no such contact with the child:
            
(1)

Telephone contact

In-person contact

(3)

(2)

          Written communication

4.

Contact between the child and 

presumed father 
alleged father 

biological father 

other (specify):     
:

legal guardian 

In-person visitation
(1)
(2)

Unsupervised
          Supervised by the

(3)

Frequency and duration

(a)

(c)

          other (specify):

county agency

(b)

          foster family agency

(a)
(b)
(c)
(d)

            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):

Form Approved for Optional Use 
Judicial Council of California 
JV-400 [Rev. January 1, 2007]

VISITATION ATTACHMENT: PARENT, LEGAL GUARDIAN, INDIAN 
CUSTODIAN, OTHER IMPORTANT PERSON

Page 1 of 2
Welfare and Institutions Code, § 361.2;
Cal. Rules of Court, rule 5.670 
www.courtinfo.ca.gov

CASE NUMBER:

JV-400

CHILD'S NAME:

4.

(4)

Location

Agency visitation facility

(b)

Foster family agency facility

(a)

(c)

Other (specify):

(5)

(6)

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

          foster family agency.

county agency.

(b)

(c)

          other (specify):

Other orders concerning in-person visitation  (specify):

Other types of contact permitted (specify):

Contact restrictions.  The following contact between the child and the specified person would be detrimental to 
the best interest of the child at this time and the person is to have no such contact with the child:
(1)

Telephone contact

In-person contact

(3)

(2)

          Written communication

5.

Contact  between the child and 

a.

In-person visitation

presumed father 
alleged father 

biological father 
other (specify):                     

legal guardian 

(1)
(2)

Unsupervised
          Supervised by the

(a)

(c)

county agency
          other (specify):

(3)

Frequency and duration

(b)

          foster family agency 

            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):

Agency visitation facility

(b)

Foster family agency facility

Other (specify):

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

          foster family agency.

county agency.

(b)

(c)

          other (specify):

Other orders concerning in-person visitation  (specify):

Other types of contact permitted (specify):

(a)
(b)
(c)
(d)
Location

(a)

(c)

(4)

(5)

(6)

b.

c.

b.

c.

Contact restrictions.  The following contact between the child and the specified person would be detrimental to 
the best interest of the child at this time and the specified person is to have no such contact with the child:
(1)

Telephone contact

In-person contact

(3)

(2)

          Written communication

6.

Other (specify):   

JV-400 [Rev. January 1, 2007]

VISITATION ATTACHMENT: PARENT, LEGAL GUARDIAN, 
INDIAN CUSTODIAN, OTHER IMPORTANT PERSON 

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