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Post Separation Services Application Form

Application form for our 2 programs for separated parents and their children: the Children's Contact Service and Supporting Parents After Separation.

Applicants may either fill out the online form below or contact us for a printable version of the form on 03 5822 8100 or pss@berrystreet.org.au.

AN APPLICATION FORM IS TO BE FILLED OUT BY EACH PARENT* Application forms need to be received from both parents before we can consider your request. If you require assistance with paperwork please contact the service. * The term ‘parent’ is interchangeable with significant person in the child’s life requiring this service. All applications that do not proceed will be disposed of after a twelve month period.

Applicant details

Street number, street name

Children details

Information regarding other parent

Additional information

Legal information

Client consent

Type your name to sign/authorise