Declaration of Supervised Visitation Provider
Shasta Superior Court · Family Law
Verified current as of July 22, 2026
This form is used by a professional or trained individual to declare that they are qualified and willing to supervise visits between a parent (or other relative) and a child when a court has ordered that visits must be supervised for safety reasons. A person would need this form if they work for or operate a supervised visitation service and are assigned to oversee these court-ordered visits.
This form must be printed and filled by hand, or opened in Adobe Acrobat.