Case Number:

Form PS–06 Petition for Visitation

Page 1 of 2 Rev. 8/08

In the Court of (county): County, Alabama

v.
Plaintiff’s First and Last Name Defendant’s First and Last Name
(the person listed as Plaintiff on any previous Order in this case) (the other parent)

Important! If this is the first time you are asking the court for orders for these children, you must file this
form in the same county where the child/ren live.
Do not use this form in a child support case filed by Alabama DHR.
Print your answers.
q Your personal information:
Name: Age:
first middle last
Your relationship to the children above: Mother Father Other (explain):
Address:
street address city county state zip
Phone #: ( )

w Information about the other parent

Name: Phone #: ( )
first middle last
Address:
street address city county state zip

e Information about the children

Names and dates of birth of the child/ren under 19 involved in this visitation case (print):
Name: Date of birth:
Name: Date of birth:
Name: Date of birth:
Name: Date of birth:
Where do the children live now?
Address:
street address city county state zip

r Information about the custody order you have now

Who has legal custody of the children now? The other parent
Other (name and relationship):
Address of person with legal custody now:
Where was your current order made? County: State:

t Other cases involving these children

List any other court cases, like child support, juvenile, or DHR about the child/ren below:
When and where were the orders made? What kind of orders did the court make?
Date County State

Rev. 10/08 © 2008 Alabama State Bar

Form PS–06 Case Number:
Page 2 of 2 Rev. 8/08
Petition for Visitation

y Best place to pick up and drop off the child/ren

Pick up at: Drop off at:

u Visitation Schedule Requested

Describe the visitation schedule you are asking for below:

i The person asking for visitation must read and sign below:
• I am asking the Court to make the visitation order I have asked for in this Petition. I want to be
involved in raising the child/ren, and I believe visitation is in the child/ren’s best interest.
• I have a safe place for the child/ren to stay during visitation.
• I will support the child/ren as ordered by the court to the best of my ability.
• I want to have access to the child/ren’s medical, school, and court records.
• I swear that I am able to take care of the child/ren listed above. I am a fit and proper person.

Date:
Signature of person asking for visitation

Rev. 10/08 © 2008 Alabama State Bar