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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.

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. 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.

Applicants may either fill out the online form below or contact us for a printable version of the form on 03 5822 8100 or

If you require assistance with paperwork please contact the service.

Applicant details

Street number, street name

Children details

Information regarding other parent

Additional information

Legal information

Client consent

Type your name to sign/authorise