SAFE SUPERVISED VISITATION PROGRAM AGREEMENT TO PARTICIPATE
(PRIVATE VISITS)
The mission of the SAFE Supervised Private Visitation Program is to provide a safe and stress-free environment for
children to have private supervised visits with their non-custodial parents when allegations have been made or it has
been determined that visits in an unsupervised setting would place the child or custodial party at risk of physical or
emotional harm.
¨ Please initial beside each section and sign the last page of the document. ¨
THE REGISTRATION PROCESS
1. ________ NO VISITS are scheduled until the completion of the registration process by both parties. Parties will
be notified, via mail, of the date visits are scheduled to begin.
2. ________ A non-refundable registration fee of $75.00 will be assessed to each party during intake, and annually
thereafter, unless: 1.) a court order is provided that specifically addresses SAFE Program fees; 2.) the Custodial
Party is not a biological parent; 3.) there has been a Protective Order in effect within the past three years. Under
these conditions, all registration fees will be assessed to the visiting party. (Example: If a 2-year Protective Order
was obtained 2/2002, the non-custodial party would be responsible for all annual registration fees until 2/2007 – 3
years after the Protective Order expires.) Registration is not considered complete till payment of registration
fee. These fees are assessed annually during the month of original registration. All registration fees are non-
refundable. (A $10.00 late fee will be assessed monthly until the entire fee is paid.)
3. ________ If a visiting party is currently on probation, a copy of probation conditions must be provided to the SVP
office before visits will be scheduled.
4. ________ NO CONTACT PROVISION: Harris County bail bonds prohibit contact with victims or witnesses in a
criminal case. If the District Attorneys office confirms a child may be testifying as a witness in a case against the
visiting party or their spouse, visits will be denied unless special provisions are recommended by the District Attorney’
s office or Judge presiding over the criminal case.
5. ________ The SAFE Program has the right to deny services to a family if a party’s participation poses a clear
and present danger to him/herself or others. (Determination at discretion of the SAFE Program Director).
6. ________ Participants and guests are subject to rules and regulations established by SAFE. SAFE is not a party
to the lawsuit. If the SVP is unable to provide services in accordance with the Court Order, it is the participant’s
responsibility to request the court to modify the Order in the absence of a mutual agreement.
7._________ The visiting party will be asked to complete a "Possible Visit Location" form to aid in future schedule-
ing of visits. (Exceptions may be added.)
THE POLICIES AND GUIDELINES
1. ________ Private visits will be scheduled in accordance with the court order, within the boundaries and limitation
of the Program. Visits are scheduled subject to the availability of the Supervisor, child, and the parties. (Visits can
occur for a minimum of 2 hours).
2. ________A list of possible visit sites is provided at intake. (Special events may also be available.) Any
supervision concerns will be discussed during intake (Ex: flight risk, conversation, etc.) SAFE Director will approve
visit site based on family circumstances. Visits must occur in a public place and any exceptions must be approved by
the SAFE Director.
3. ________ Private visit requests must be submitted at lease 72 hours in advance of a scheduled visit. No private
visit will be allowed without adequate notification.
4. ________ Due to liability concerns, travel of any kind is strongly discouraged and requires the approval of the
SAFE Program Director and Executive Director. If travel is approved, the supervisor will drive his/her automobile and
the travel/seating arrangements will be established by the SAFE Program Director. (All drivers are required to
provide proof of liability insurance to the office prior to transporting any child or party.) If a child is 5 years old or
younger, of 36" in height (or shorter) there must be a child safety seat provided. No visit will take place unless
requirements of law are satisfied.
5. ________ Visits are scheduled for the visiting party ONLY. Guests must be relatives and named in the court
order and approved by the SAFE Director. The number of guests may be limited. All guests are required to follow
same rules as visiting party regarding conversation, cell phones, photos, etc. Failure to comply will result in
termination of visiting privileges. Visits will be terminated immediately if guests who have not previously
been approved show up during a visit. Guest fees: $10.00/over age five, to be paid in cash the day of the
visit.
6. ________ CUSTODIAL PARTY ARRIVAL/DEPARTURE TIMES: The custodial party or their designee is required
to arrive no earlier than the scheduled time the visit is to begin. The custodial party will not be allowed on the
premises until the times the visit is scheduled to begin and end. If the custodial parent arrives earlier than the
designated time of drop-off or pick-up, they will be asked to leave the premises and return at appropriate time. After
the first 15 minutes, a $10.00 late fee will be charged for each 15-minute period the party is late to pick up the
children.
7. ________ VISITING PARTY ARRIVAL/DEPARTURE TIMES: The visiting party is required to arrive 15 minutes
prior to the scheduled time of the visit. If the visiting party is not present at the time the child arrives, and
has not called to advise they are running late, the child will be signed in and out and leave the
premises. If the visiting party is being dropped off or picked up by another individual, the designated individual is
required to comply with the same provisions set forth for the visiting party.
8. ________ Staggered arrival and departure times are established for the protection of all parties. There is to be
NO CONTACT between the parties. This includes physical and visible contact. Therefore, if either party is observed
attempting to “see” the other party, appropriate action will be taken
9. ________ Gifts for the child(ren) are allowed, but should be moderate and reasonable in number and size. Gifts
must be taken home with the child(ren) after a visit. No money is to be given to the child(ren) unless prior approval is
received from the SVP. The SVP is not responsible for any lost or damaged items brought to the visit.
10. _________ Children will not be allowed to talk on the phone unless approved by the Supervisor. If a child is
observed on the phone, immediate termination and possible termination of future visits will occur. Visiting parents &
guests are not allowed to talk on a cell phone during visitation.
11. ________ The Supervisor observes and documents all periods of visitation. SAFE records, including visit
reports, are released by subpoena ONLY. A business records affidavit certifies records are accurate. A fee of $1.00
/page is assessed to the party requesting copies. Custodian of Records is available at no cost to provide court
testimony with a receipt of a subpoena. Any site supervisor, security, or worker subpoenaed will be paid a rate of
$100.00 per hour and $50.00 travel cost for testimony.
12. ________ If a child discloses any form of abuse or if any physical signs of abuse are observed, by law, a call to
Child Protective Services (CPS) will be made.
13. ________ Parties are responsible for informing the SAFE Program office staff of any changes in address or
phone numbers immediately. A $10.00 fee will be charged for each return mail item.
14. ________ Photographic and video recordings may occur during the visitation. If one party does not agree to
photographs they will be asked to provide reasons for denial and SAFE staff will advise of decision.
15. ________ A $60.00 fee will be charged for the first visit hour, and $25.00 an hour thereafter. Fees are to be
paid in cash at the beginning of the visit by the visiting party, unless otherwise ordered by the court. Failure to
pay may result in the termination of services or suspension of visits.
16.________ If a law enforcement officer is required for supervision, fees will vary and be slightly higher than rates
charged by other supervisors. Fees will be confirmed prior to setting up the visit.
17. If there are more than one child, and conversation is a major concern, two supervisors may be required, with
standard fees applying for each supervisor.
18.________ If the custodial party is late dropping off the child(ren), they will be charged based on the $25.00/hour
visit rate, pro-rated for time late. The time is expected to be made up at the end of the visit if the visiting party and
supervisor are able to do so.
19.________ If either party is a "No Show", they will be responsible for the entire scheduled visit fee.
This fee must be paid prior to the scheduling of another private visit.
PARTICIPATION BEHAVIOR
1. ________ No party will be allowed visitation if his/her behavior compromises a safe and stress-free environment.
Threatening, aggressive or argumentative behavior with children, staff and/or other participants of any nature will
cause immediate termination of the visit or future visits, and may result in the filing of a court and/or police report. All
parties must conduct themselves in a manner that clearly demonstrates that the well being of the child(ren) is the
highest priority.
2. ________ If a visit is terminated, the supervisor will immediately leave the premises with the child(ren) in a
manner that does not upset the children. (Visit fees, paid at the beginning of the visit, will not be returned.)
3. ________ Parties are expected to take care of and be responsible for their children during visits. Parties are
expected to set limits and discipline appropriately when needed without the use of physical discipline.
4. ________ Interrogation of the child(ren), derogatory comments about the opposing party, promises made that
may not be able to be kept, discussion regarding the litigation and/or the court, unsupervised visits or living
arrangements, or any other statements that the staff may interpret as negative and inappropriate will not be tolerated
and may result in immediate termination of visit.
5. ________ Supervised visits provide the opportunity for the parties to interact with children in a positive and
enjoyable environment. Conversations should be natural and directed by the child’s interest, not the adults. If your
child has a question regarding the family situation, the a supervisor will assist in addressing any questions the child
may have.
6. ________ The staff will not discuss a party’s case, litigation, concerns or complaints during the visits. Only
questions relating to the well-being of the child during the particular visit will be allowed. Any other questions or
information must be directed to the office during SAFE Program regular business hours.
7. ________ No child(ren) will be turned over to a party or designee if the use of alcohol or drugs is suspected.
Determination of substance use is at the discretion of the visit supervisor and the visit supervisor has the authority to
terminate a visit at any time. The party will be asked to call for a ride. If they leave, law enforcement will be notified
and future visits may be suspended. A report will be made to all attorneys and /or court. If alcohol or drugs is
suspected by a visiting party, they may be required to submit a drug test in order to continue participation in the
SAFE program.
8. ________ If drug or alcohol use is suspected by the visiting party, the visit will be immediately terminated. SAFE
has the right and will require any party suspected of consuming drugs or alcohol prior to a visit to submit to a drug
screening test either by hair or blood sample within three (3) hours. This policy applies if for any reason the staff or
supervisors of the SAFE Program suspects that a party visiting a child in any setting, whether the party is visiting a
child in a group setting, privately supervised visit, or a custodial party picking up a child from the SAFE Program or a
party participating in the exchange of children for visitation, has consumed or used drugs or alcohol prior to arriving
at the SAFE Program location. Failure to comply with the request for a drug test may result in termination of
services.
9. ________ Notes, gifts, etc. for the other party will not be allowed to be passed through the child(ren). All such
information or items should be conveyed through and approved by supervisor.
10. ________ No clothing with inappropriate language, symbols, and/or pictures will be allowed. Clothing must be
tasteful and appropriate for a supervised visit with your child(ren). (Nothing low-cut, too short, and/or tight).
11. ________ Staff has the right to determine appropriate and inappropriate behaviors and conversations with the
child(ren). Continued infractions may result in the suspension of visits.
CANCELLATION AND NO-SHOW POLICY
1. ________ Proper Cancellation of a visit can be made 24 hour a day, 7 days a week by calling the main office
number (713) 755-5625. Visit cancellations should be made 24-hours prior to a scheduled private visit.
Cancellations after that time may be subject to a $75.00 fee for improper cancellation, at the discretion of the SAFE
Program Director. In the case of an emergency, parties should call the main office number or their private visit
supervisor’s cell number. In the event of a “no-show” by either party, that party will owe the entire fee that
was to be collected for that visit.
2. ________ No Show Fees: A “no-show” is defined as ‘late arrival, no arrival, or improper cancellation notice for a
visit. A no-show fee of $75.00 will be assessed to each party responsible for improper notification. The fee must
be paid before scheduling of additional visits.
3. ________ If the parties mutually agree on the cancellation of a visit, notification must be given to SAFE by
each party. Failure to give notice will result in a no-show fee assessed to the parties failing to provide notification.
4. ________ If a family will no longer be utilizing the services of the SAFE Program, each party should provide
notification to the office. The SAFE Program is not a party to the suit, therefore the court does not notify the
Program of hearings or changes in visitation arrangements.
OTHER RULES
1. ________ All conditions of this Agreement to Participate are subject to modification by the Victim Assistance
Centre, Inc., with or without notification to parties.
2. ________ I have read and received a copy of these rules. My signature below indicates that I understand these
rules and agree to follow these rules.
3. ________ I understand that the information gathered during my supervised visitations may be released to
attorneys, therapists, the court, or other pertinent agency involved with my case.
4. ________ I further understand the SAFE Program is not a party to the suit and are not ordered to provide
services, and reserve the right to terminate services for violations of the policies and procedures set forth by the
SAFE Program.
5. ________ I hereby give consent for my child(ren) to participate in this program and all activities and I release the
Victim Assistance Centre, their shareholders, officers, employees, and volunteers against any claim or liability arising
out of my child’s participation in the SAFE Family Programs.
6. ________ I further release the Victim Assistance Centre, their shareholders, officers, employees, and volunteers
against any claim or liability arising out of my participation in the SAFE Family Programs.
7. ________ The Agreement to Participate does not override any court ordered access. Any conflict arising
between the Agreement to Participate and Court Order will mean that the court order controls. If the SAFE Program
is unable to provide the services in accordance with the court order, it is the responsibility of the participants to
request the court to modify the Order in the absence of a mutual agreement. (This includes termination of visits,
modification of scheduling, etc.
8. ________ The supervisor’s responsibility is the safety of the children. If the supervisor is forced to make a
decision that is not specifically stated in the Agreement to Participate for the protection of the parties, the parties are
to abide by the decision and direct any problems to the SAFE Program office the following business day. Failure to
comply with the rules will result in immediate termination of the visit and/or future visits.
9. ________ I understand rules are subject to change at the discretion of the SAFE program or to accommodate
special circumstances or court orders.
__________________________________ ___________________________
Signature (CP/ NCP) Date
__________________________________ ___________________________
Witness Date
SAFE Private Visit Agr to Parti 805