I understand that I must accompany the minor child(ren) and the person to be supervised on any and all excursions, no matter how short or long in duration, as required by the custody order and if such excursions are permissible in this case.

supervised on any and all excursions, no matter how short or long in duration, as required

I will make prompt notations of any behavior of the person to be supervised which I believe to be harmful to the best interests of the child(ren) in this matter and I will make a prompt report of those observations to counsel for both parties.

I believe to be harmful to the best interests of the child(ren) in this matter and I will make

I will not permit the person to be supervised to drive a motor vehicle after having consumed alcoholic beverages or controlled substances, or while under the influence of alcohol or controlled substances, with the child(ren) present in the motor vehicle. At all times, I shall ensure that the child(ren) are securely fastened in an appropriate passenger restraint.

consumed alcoholic beverages or controlled substances, or while under the influence of
presence of the child(ren) after having consumed alcoholic beverages or controlled

I understand that I cannot delegate my responsibility as a supervisor to anyone else without prior approval of the Court.

without prior approval of the Court.
Additional Provisions

I agree to be fully accountable to the Court as a supervisor in this matter.

DATE

Signature of Supervisor

Print Name
Street Address
City/State/Zip Code
Home Phone
Work Phone
Email Address

Affidavit of Accountability of Supervisor Page 2 of 2