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FL All Family 141Mandatory

Supervised Visitation Acknowledgment

Washington · Washington State Courts · Effective July 1, 2025

This form is an acknowledgment used when a court orders supervised visits between parents and children. It requires signatures from the supervisor and the supervised parent to confirm understanding of the court order and the rules for the visits.

Open the official PDFfrom Washington State Courts

Where this fits in a case

Hearing

Stage: Hearing

This form is used after a court has ordered supervised contact between parents and children. It must be signed by the supervisor and the supervised parent before any visits can take place.

Either party may file.

Common questions

Who needs to sign this form for visits to happen?
No visits can happen until the supervised parent and the supervisor (or a representative) have signed this form, and the supervised parent gives a signed copy to the other parent and the supervisor.
What does the supervisor agree to on this form?
The supervisor agrees to protect the children from harm, intervene if rules are broken, and follow the court order. They also state they can withdraw as supervisor by writing to the parties or the court.
What does the supervised parent acknowledge?
The supervised parent acknowledges that their visits might be stopped by the court if they break the court order. They also confirm they must follow the court order.

Revision history

No changes recorded since we started tracking this form on October 9, 2026. The current version took effect July 1, 2025.

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