Please complete this form and if necessary 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.

The forms do not have to be signed by both parties. Parties can sign separate forms if preferred.

The completed form can be sent in any of the following ways:

Email (scan):
In Person: 282 Hotham Creek Rd, Willow Vale
Post: PO Box 1500, Oxenford, Gold Coast Qld 4210

If there is a change to the arrangement, you will need to fill out a new Intake Form as per the instructions above.

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

Parents play a vital role in making contact visits an enjoyable and positive experience for themselves and their child,
and both the parties/parents have roles and responsibilities in this regard.

The Carer Parent (the parent with whom the child resides) has the role and responsibility of preparing the child, in a
positive way, in advance of the visit about travelling/being with another person (the Supervisor) and spending time
with the other parent.

Lilly Pilly recognise that parents may find the presence of a contact supervisor at their visits stressful and challenging.
However, the overall aim of contact supervision is to assist you and your child to have an enjoyable and positive

The following information on roles and responsibilities for each of the parties is intended to identify and clarify
protocols and boundaries for the parties. In providing this information, Lilly Pilly also seeks that the parties agree upon all arrangements associated with the contact visits.


  1. A Contact Supervisor will be required to be present at all times during the contact visit, unless Lilly Pilly receives
    clear instructions to the contrary. They will seek to help you and your child have a pleasant time and facilitate
    a positive time for your child before and following the contact.
    Lilly Pilly Service Agreement 2 of 11
  2. The Lilly Pilly Supervisor has responsibility to ensure the safety, welfare and wellbeing of the child/ren they
    are supervising, however, there is an expectation that the parent having contact with the child/ren takes
    responsibility for managing the child/ren’s behaviour during the visit.
  3. Unless agreed with the Contact Supervisor, it is important that the Contact Supervisor to be able to hear and
    see all that is occurring. You will not be able to take your child out of the sight or hearing of the Contact
  4. This can be challenging for some parents, however, it is important to remember that supervisors may be
    required to write a report following the visit and by being in close proximity they are able to truly reflect what
    occurred – the positives, as well as negatives. We encourage you to view this as a positive and an opportunity
    for you to demonstrate your parenting and care-giving skills.
  5. The Supervisor may write a report following the visit which is often filed at court by the legal representatives
    of the parties involved. This report is comprehensive and if you do not want information included in the report
    of a personal nature, it is best to not discuss this information during the contact.
  6. The report may give details of (a) who attended the visit, (b) what activities and interactions took place (c)
    what was talked about and other information relevant to the wellbeing and welfare of the child. While
    supervisors seek to manage negative behaviour, any adverse events where your child showed distress, or other
    events such as where information was shared with your child that was inappropriate or hurtful (e.g. negatively
    mentioning another parent, discussing the issues to do with court or making/breaking unreasonable promises
    to the child/young person) will be recorded in the report. Reports are prepared with the principal
    consideration of the child’s safety, welfare and wellbeing.

B. SUPERVISED PARENT – How to act and behave:

  1. Plan to be on time for the visit, allowing for additional time to get to the centre should there be a delay while
    in transit. This is especially important if you are unfamiliar with a new meeting place or contact centre.
  2. Plan and prepare during the visit for when the contact ends.
  3. While we understand such visits can be a difficult and an emotional time, try to be as calm and positive as
    possible throughout contact. It has been proven that demonstrating a positive emotional state will assist and
    benefit the wellbeing of your child/ren, thus ensuring their visit is a positive experience.
  4. Do not discuss court matters with your child/ren.
  5. Do not engage the supervisor or your child/ren in negative discussions about other parties involved in your
  6. It is your responsibility to manage your child/ren’s behaviour during the contact visit. Please try to do this in
    a positive way.
  7. Supervision is provided to the person named in the court orders, or on the received referral form.
    Lilly Pilly Service Agreement 3 of 11
  8. Please be aware that some foods are not nutritionally good for children and can, and often do, affect their
    behaviour. Please try to buy or bring food to the visit that is healthy, with low sugar levels and minimal
    amounts of artificial colours and flavours. It is okay to bring a special treat, but keep these to a minimum.
    Please understand that unhealthy and sugary foods will impact on your child’s ability to remain calm and enjoy
    their time with you.
  9. From time to time, Contact Supervisors may give directions regarding your children. This may include: pointing
    out that your child/ren are engaging in dangerous activities that may result in falls/accidents; suggesting
    alternative methods for disciplining the child/ren; reminders to change a child’s nappy etc. You are expected
    to follow these reasonable directions.
  10. Parents and participants at the visits and others involved in some way are not to film, photograph or record
    during visits, if this is specified as a restriction in an order at the time of making the referral. Supervisors are
    not to be photographed or filmed at any time by any parties involved.
  11. Any activities planned for contact must be appropriate and allow the Supervisor to perform their role, and be
    an agreed-upon activity by Lilly Pilly. Lilly Pilly venues do have swimming pools and open water etc. Unless
    instructed otherwise, it is the Supervisors discretion whether certain activities are participated in.
  12. The meeting location of the contact is confirmed prior to the contact date and advised by the referring parties.
    Any changes to this location must be agreed and arranged prior to the contact day and LILLY PILLY informed
    with appropriate notice.
  13. Contact Supervisors and children being supervised at the contact visit, are NOT permitted to travel in the
    vehicle of the person/s being supervised, or other vehicles nominated by the person/s being supervised.
    If transportation is required during a contact visit, the supervisor will transport the children and meet the
    person being supervised at the designated venue. The person being supervised may be allowed to travel in
    the front seat of the Supervisor’s car at the discretion of Lilly Pilly Management. If arranged prior to the
    contact, or agreed by Lilly Pilly Management, the Contact Supervisor may travel with the person being
    supervised on a public conveyance, such as bus, tram, ferry, train, taxicab etc.


It is important to present positively for the visit. Contact visits will not proceed in the following circumstances:

  1. You come to the contact visit under the influence of drugs or alcohol
  2. You fail to comply with the agreed arrangements
  3. You are observed to be in an inappropriate emotional state, such as highly agitated, aggressive or abusive

The following actions are not permitted during the contact and may lead to cancellation of the visit:

  1. Consumption of drugs or alcohol
  2. You hit or physically discipline your child
  3. You threaten your child with physical punishment or violence
  4. You discuss the court case with your child or the supervisor
  5. You show your child you are angry or upset with the child’s other parent, extended family or the court
  6. You speak negatively about the child/ren’s other parent/family members
  7. You are aggressive or abusive towards the supervisor

Please note:
If any of these happen, the Contact Supervisor will firstly warn you to correct your behaviour, and will end the contact
if your behaviour continues. Make sure you listen to any directions the Supervisor may give about contact and follow
them carefully. Please keep in mind the Contact Supervisor is simply seeking the best outcome for all.

D. PARENT WITH WHOM THE CHILD RESIDES ~ Roles + Responsibilities:

  1. In instances where supervised contact is court ordered, it is the role of the parent/s and their legal
    representatives to interpret and abide by court orders; it is not Lilly Pilly responsibility. Lilly Pilly expects the
    parents, directly or through their legal representatives, to arrive at agreed arrangements consistent with the
    court orders and advise Lilly Pilly. Lilly Pilly will seek at all times to maintain a position of neutrality, with a
    focus on the welfare and wellbeing of the child.
  2. The parent with whom the child resides has responsibly for preparing the child for the visit and to ensure the
    child is well and positively prepared to attend and participate.
  3. Lilly Pilly Supervisors are trained to assist the child during handover, however, the work in advance of the visit
    by the parent with whom the child resides is crucial, as they are best positioned to positively prepare the child
    and Lilly Pilly expects this to occur.
  4. While parents with whom the child resides may sometimes feel they can dictate the terms of the visit, Lilly
    Pilly expects that they will arrive at an agreement with the parent with whom the child does not reside, and
    convey these agreed arrangements to Lilly Pilly.
  5. Lilly Pilly will seek to maintain a position of neutrality, with a focus on the welfare and wellbeing of the child.
  6. The primary parent is to ensure that essentials are packed for the care of children during contact. This will
    include water, food for a young baby such as milk etc., clothing to suit weather conditions, a hat, sunscreen
  7. Lilly Pilly may charge an Administration Fee at Lilly Pilly’s discretion if the work undertaken on behalf of your
    family falls outside the standard scheduling and administration obligations for arranging and facilitating
    contact supervision. The person requesting the excess work will be financially responsible for this fee.

Please note:

Lilly Pilly understands there is often conflict for both the parties associated with Supervised Visits, however, parent/s
are advised that they are not to deliberately or unintentionally seek to draw the Supervisor into the conflict. This also
means that parents are not to question/interrogate Supervisors before, during or after contact visits.

The Supervisor will provide feedback about the visit to ensure that the parent with whom the child resides is adequately informed as to what the child ate, when they attended the toilet and other such information.

This feedback will be in relation to the child, and detailed feedback about the visit will be provided in the report. The
feedback the Supervisor provides at the end of the visit is about equipping the parent/s to provide the best possible
support to their child, and is to support an understanding of what the child has experienced. It is not designed to be
used in furthering any dispute that exists between the parents.


  1. After making contact with Lilly Pilly, please ensure that the other parent/party are made aware of your
    intention/application to use Lilly Pilly services and ensure they are provided with the relevant documents. All
    relevant parties will be required to read the Lilly Pilly Information Pack and to complete and sign the Family
    Contact Service Agreement and Referral Form (these are included in the Pack). The referral cannot progress
    until Lilly Pilly receives completed documentation from both parties/parents.
  2. Should you wish to include other family/friends in contact visits, please ensure there is no restraints in any
    Court Orders and if possible the other party/parent is notified to those people attending. In such instances Lilly
    Pilly must be informed in advance of the contact visit. Where there is no court ordered restraints, it is Lilly
    Pilly’s sole discretion whether other people can attend the visits.
  3. To limit any perceived bias by either party, information and emails received from either party may be
    responded to by being sent to both parties in the same email.


  1. If you have any questions regarding the contact visit arrangements, please call the Lilly Pilly office on 07 55473600 The after-hours message on the office number provides other out of-hours options.
  2. Note that Supervisors are not involved in arranging contacts and are not able to give you information regarding
    your contact visits. Any queries regarding your contact MUST be communicated directly to the Lilly Pilly
  3. Please direct questions of a legal nature to your lawyer or other relevant professional.


Lilly Pilly may decide to suspend or cease providing service. This might be considered, for example where:

  1. The way the visit is proceeding is, in the view of the Supervisor often with support from a manager, too stressful
    or traumatic for the child.
  2. Lilly Pilly determines that it cannot effectively address the safety requirements or other issues involved in the
    particular case.
  3. The case is placing an undue demand on Lilly Pilly resources.
  4. One or both of the parties have failed to comply with the terms and conditions of the service.

Please note:
The decision to suspend or cease providing a service will be made known to the party/parties. Lilly Pilly personnel will
provide the reasons for the decision to suspend or cease providing a service and where such issues can be resolved,
Lilly Pilly would then review that decision.