Client Registration

Read below before filling out this registration form!

This form is meant for existing clients or individuals undergoing the intake process at the Heaven’s House facility. If you are in need of supervised visitation and exchange services then you need to contact our office to schedule an intake. It is important for you to understand that by filling out this form without undergoing an intake/orientation does not mean Heaven’s House is going to¬†provide you with the services you are seeking. Every party involved must complete an intake before services are granted.

Because we care about the safety of your personal files this registration form requires that you pick a strong password in order to submit it. Our website is certified safe through McAfee Secure.

Contact Name is required

Invalid Email, proper format “”
Email is required

Select which service you require through Heaven’s House

Services needed is required

Current Address is required

00/00/000 format

Your Date Of Birth is required

Drivers License Number is required

Minor Child(ren)’s Last Name is required

List the child(ren) first and last names involved in the court action from oldest to youngest. Include Birthdays.

Children is required

Are you the Custodial or Non-Custodial Parent/Gaurdian? is required

Is there a Restraining Order? is required

Are there sexual abuse allegations? is required

Can be found on your court documents…

If you have an attorney please list their name, phone number, e-mail, and the paralegal assigned to your case. If you don’t have all this information supply what you do know. For no attorney type Pro Per.

If there has been a minors counsel assigned to the case please supply their name here

Username is required

Password is required

Confirm Password is required
>> HINT: The password should be at least seven characters long. To make it stronger, use upper and lower case letters, numbers and symbols like ! ” ? $ % ^ & ).


Check to Enable



Terms/Conditions is required