Application for supervised time

Each parent completes their own application. Before you begin, please make sure you have read and understood the procedures and services agreement. If anything is unclear, contact us — we're happy to talk it through.

Takes about ten minutes · Fields marked * are required

Application received

Thank you. We'll review your application and call you within one working day to arrange the intake session. A copy has been sent to your email address.

Back to For Parents

Leave this field empty

1 — YOUR DETAILS

You are the…

Supervised parent Parent the child lives with Other carer

First name *

Surname *

Date of birth

Phone number *

Email address *

Postcode *

Home address

2 — THE OTHER PARENT

Full name *

Phone number

Email address

Relationship to the child

3 — THE CHILDREN

Tell us about each child who will attend. Add as many as you need.

Child's name

Age

Lives with

Allergies, medication or needs

4 — COURT ORDERS & LEGAL

Are there court orders in place?

Yes No Proceedings ongoing

Your solicitor (if any)

Next court date (if known)

Any conditions we must follow

5 — THE ARRANGEMENT YOU'RE ASKING FOR

Which service(s) do you need?

Supervised contact visits Changeover assistance Observational report

Preferred frequency

Preferred session length

Days you're generally available

Mon Tue Wed Thu Fri Sat

6 — SAFETY & BACKGROUND

This helps us plan safely. Anything you share here stays with our team and is not passed to the other parent.

Are there any safety concerns we should know about?

Anything about your child's history that would help the supervisor

7 — DECLARATION

I have read and understood the procedures and services agreement, and I agree to the fees set out in it. The information I have given is true and complete to the best of my knowledge. I consent to Bloom contacting my solicitor or caseworker about this application.

Full name (as signature) *

Date *

We'll confirm receipt by email and call you within one working day.

0477 794 698 info@bloomcontactservices.com

Mon–Fri 9am–5pm · Sat 9am–1pm

Home For Parents Services & Pricing About Us Contact Us