Family Supervision Referral Form

Please complete this form and forward it to the other party/parent through your appropriate communication channel (i.e. via legal representatives or other means) for their agreement and signature.

Once the parties have reached an agreement, the COMPLETED Referral Form and Service Agreement documents plus a copy of the payment receipt for the Intake fee ($75) should be forwarded to the PRFC office by one of the parties. If you make amendments to the information on this form completed by the other party, please return to the other party for agreement to those changes PRIOR to sending to PRFC.

We will not accept referrals that are not signed by both parties nor will we accept referrals whereby the parties do NOT agree on the arrangement.

The completed form can be sent as an email attachment along with receipt for intake payment by mail or fax:



Mail:          PO Box 71, Oatlands NSW 2117

Fax:            02 9875 2123


This form is the sole document we will refer to for your contact supervision arrangements, including agreed venues and attendees.

If there is a change to the arrangement, you will need to complete a new Referral Form as per the instructions above.

PRFC is not able to negotiate between the parties. Therefore, ALL negotiations must be completed by the parties, and this may involve their legal representation.




Handover - Will both parents be present at the handover address?

Handover - Supervision Agreement


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