Judicial Council of California,

Cal. Form DV-140

California Superior Local Rules

Name: Date of birth: d. Name: Date of birth: (Check here if you have more children to list. On a separate piece of paper write “DV-140, Children” at the top and attach it to this form.) 4 No Travel With Children Without Permission Person in Person in Other (name): must have written permission from the other parent, or a court order, to take the children outside of: a. County of (list): b. State of California c. United States d. Other place(s) (list): 1 2 This is a Court Order. Form DV-310

Rev. January 1, 2026 Child Custody and Visitation Order (Domestic Violence Prevention) Case Number: 5 Stop Access to Children's School, Health, and Other Information a. The person in must not access or have access to the records or information for:2 3All the children listed in . Only the children listed here (names): b.

From the following (check all that apply): Medical, dental, and mental health providers School and daycare providers Extracurricular activity providers (including summer camps and sports teams) Child’s employers (including volunteer and unpaid positions) Other (describe): If you are a provider listed above, you must not release information or records regarding the children listed in a to the person in . 5 2 6 Judge's Decision on Request for Orders to Prevent Child Abduction (attach form DV-145) 7 Child Custody a.

Legal Custody (The person who makes decisions about the child’s health, education, and welfare.) Sole to Person in 1 Jointly (shared) by persons in and 1 2 Sole to Person in 2 Other (describe): b.

Physical Custody (The person who the child regularly lives with.) Sole to Person in 1 Jointly (shared) by persons in and 1 2 Sole to Person in 2 Other (describe): Visitation (Parenting Time) With Children (See 8 – 15 .) 2Person in must have no visitation with the children in until further order of the court. 8 3 (If this form is attached to form DV-110, Temporary Restraining Order, this means that the judge has stopped your right to visit with your children temporarily. If you do not agree with this order, attend your court hearing.) This is a Court Order. DV-140, Page 2 of 6

Rev. January 1, 2026 Child Custody and Visitation Order (Domestic Violence Prevention) Case Number: DV-140, Page 3 of 6 This is a Court Order. 9 Professional Supervised (Monitored) Visits With Children a. Person to be supervised: Person in 1 Person in 2 b. Professional provider to supervise visits (check 1, 2, or 3):

(1) Person in must contact chosen provider by (date):1 Person in must contact chosen provider by (date):2 Telephone: Address (if known): Chosen provider: If the chosen provider cannot provide services, parties must use the alternate provider. Alternate provider: Telephone: Address (if known):

(2) Person in 1 Person in 2 is attached to this order. given in court to . Person in 1 Person in 2 must choose and contact a provider by (date): A list of providers (check one):

(3) Other: c. Frequency of visits (check one): Once a week, for (number of hours): each visit. Twice a week, for (number of hours): each visit. Other (describe): Fees paid by: Person in 1 % Person in 2 % Other %d. Visits must be: e. Virtual (not in person). (Before a provider is chosen, confirm that the provider offers virtual visits.) In person at a safe location. Other:

Rev. January 1, 2026 Child Custody and Visitation Order (Domestic Violence Prevention) Case Number: This is a Court Order. 10 Nonprofessional Supervised (Monitored) Visits With Children a. Person to be supervised: Person in 1 Person in 2 b. Nonprofessional provider (person) to supervise visits Name: Relationship to child: Telephone (if known):Address (if known): c.

Schedule for visits (check one): Follow the Visitation Plan listed in .13 Other

schedule (give a detailed schedule): d. Location of visits: In person at a safe location (give location): Virtual (not in person). (Provider, child, and visiting parent may need access to internet.) Other: (For more information on safe locations and virtual visits, go to selfhelp.courts.ca.gov/guide-supervised- visitation.) 11 Supervised Exchanges (Drop-Off and Pick-up of Children) (Complete this item and go to to describe visitation plan.)12 a. Person to be supervised: Person in 1 Person in 2

(1) Professional Provider Name of provider (if known): Telephone (if known): Address (if known): Fees paid by: Person in 1 % Person in 2 % Other % Person in must contact provider by (date):1 Person in must contact provider by (date):2 Location of exchanges to be decided by provider. Nonprofessional Provider Name: Relationship to child: Telephone (if known): Address (if known): Safe location for exchanges: (For more information on safe locations, go to selfhelp.courts.ca.gov/guide-supervised-visitation.) (2) b. Provider (Person) to Supervise Exchanges DV-140, Page 4 of 6

Rev. January 1, 2026 Child Custody and Visitation Order (Domestic Violence Prevention) Case Number: This is a Court Order. 12 Visits With No Supervision (Unmonitored) Person in 1 Person in 2 will visit with the children listed in 3a. b. Visits must be: In person Virtual (not in person) (Child and visiting parent may need access to the internet. For more information on virtual visits, go to selfhelp.courts.ca.gov/domestic-violence-child-custody.) Other: Described below: c.

Listed in .13 The visitation plan is (check one): 213 Visitation Plan for Person in Time Location of drop-off/pick-up Monday Start: End, if applies: Tuesday Start: End, if applies: Wednesday Start: End, if applies: Thursday Start: End, if applies: Friday Start: End, if applies: Saturday Start: End, if applies: Sunday Start: End, if applies: Every week Every other week Other Start date for visits (month, day, year): Visit must be virtual Person to bring children to and from visit (or make child available for virtual visit) Follow the plan listed above (check one): DV-140, Page 5 of 6

Rev. January 1, 2026 Child Custody and Visitation Order (Domestic Violence Prevention) DV-140, Page 6 of 6 For your protection and privacy, please press the Clear button after you have printed the form. Case Number: 14 Mandatory Findings (Findings required under Family Code sections 3011, 3044, and 3100.) a. No findings required by law b. Findings required by law Other: The court has made the required findings. The court’s reasons are in writing (check one):

(1) On form DV-150, Mandatory Findings for Child Custody and Visitation Order. In a minute order By a court reporter Other: The court has made the required findings. The court’s reasons were recorded (check all that apply):(2) 15 Other Orders Describe additional orders in the space below or use a separate attachment (e.g., FL-341(C), Children’s Holiday

Schedule Attachment). 16 Criminal Protective Order List any criminal protective order protecting the person in or any child in from the person in .1 2 Case number: County: Case number: County: (If a criminal protective order is in effect, law enforcement must follow the priority of enforcement on form DV-110 or DV-130.) 3 17 Country of Habitual Residence The country of habitual residence of the child or children in this case is (check one): The United States, Other (name of country): . 18 Jurisdiction and Notice This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (part 3 of the California Family Code starting with

section 3400). The responding party was given notice consistent with the laws of the State of California. 19 Penalties for Violating This Order If you violate this order, you may be subject to civil or criminal penalties, or both. This is a Court Order.

Document details

Collection	California Superior Local Rules
Citation	Cal. Form DV-140
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	78315c8fb6a8b71b9468c9d8f97a491b2175535d

Source file is stored in the law ingest library (pdf).