IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT, - DOC

							             IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT,
                      IN AND FOR PALM BEACH COUNTY, FLORIDA

                                                                         Case No:
       Petitioner,

vs.

       Respondent,
_________________________/

                                FAMILY CONNECTIONS ORDER

The Court authorizes and orders the following persons to use the service of the FAMILY
CONNECTIONS PROGRAM of this Circuit. Visits shall be limited to the parties named,
1.______________________ and 2.________________________ who shall contact Family Connections
within seven days from the date of this order at (561) 355-3200 to make arrangements for visitation.
This order authorizes only the person(s) named above to visit the children. No one else, other than
Family Connections staff, may be present during the visits.

Please Check Desired Service:
SUPERVISED VISITATION: _______
MONITORED EXCHANGE: _______ (Cost $10.00)
MINI MONITORED EXCHANGE: _______(Cost $10.00)

Visitations shall involve the following child(ren):
1.    ______________________________ 3.______________________________
2.    _______________________________ 4.______________________________


Visitation shall occur as follows: (Mark appropriate box)
Level of Supervised Visitation (ranked lowest to highest level of supervision):
Level 3: Cost $25.00 Sight Only __________
Level 2: Cost $25.00 One on One, Sight and Sound ____________
Level 1: Cost $35.00 Intensive Guided Interaction ____________

Length of visits:         Two Hours
Frequency:                (subject to availability) Bi-Weekly ___ Weekly _____ Monthly _______
Day of Week:              (subject to availability) Sat. A.M.___ Sun. P.M.___

Payment shall be made by: Petitioner/Respondent/Both/ Waived for ___________________

THIS COURT ORDER WILL EXPIRE 6 MONTHS FROM THE DATE VISITATION
STARTS. A STATUS CONFERENCE MAY BE SCHEDULED BY THE COURT PRIOR
TO THE EXPIRATION OF THIS ORDER.

DONE AND ORDERED IN PALM BEACH COUNTY, FLORIDA this ____ day of ________, 2006.


                                                          __________________________
                                                          Circuit Judge


Copies furnished to:


Rev. 11/06