PRIVATE PARENTING ASSESSMENT CONTRACT
Adapted for the Conditions of the COVID-19 Pandemic
I, ______________________________________, understand that Chantal Bourgeois, BSW, MSW, RSW, is
acting as an independent clinician/registered Social Worker/Assessor. Ms. Bourgeois shall perform a
comprehensive parenting assessment and provide recommendations regarding the decision-making
responsibilities and parenting time of my child(ren), namely: _______________________________________,
which may be used for helping resolve the parenting dispute and proceedings in family court.
Please read the following stipulations and sign at the bottom to indicate that you have read and understand
them all.
1. The assessment process shall include the following:
a. Pre-interview questionnaires shall be sent to parents once their contracts and retainers have
been received. They should be completed by parents and submitted at least two working days
prior to their scheduled individual interviews in order to give time for Ms. Bourgeois to review
before the parent meeting and prepare parent consents for professional collaterals.
b. Individual parent interviews– Parents shall have the option of completing their interview in
person at their home or by videoconference. There may be follow-up interviews required,
depending if there was enough time to cover everything. Following this detailed interview(s),
there will be continued contact with parents throughout the assessment process. Parents may
contact this clinician to express any additional concerns or issues following their individual
interview, and the clinician may contact either party for issues requiring further clarification. It is
important that the evaluator be kept up to date with any changes in the parent or family
situations. The evaluator may contact either party during the assessment to seek further
clarification of concerns, allegations, issues, or information gathered.
c. Observational interviews (approx. 1.5 hours to 2 hours) shall be conducted with each parent
and their child(ren) in each parent’s home and/or the normal location of the parent-child
access. The observation should include the persons normally present in the home, such as
stepparents, stepsiblings, grandparents, or roommates. The parties agree to be present during
the course of the observation and shall not expect the evaluator to care for the child alone. The
parties are responsible for coordinating the transportation arrangements for these observations.
Unless access is being held at a supervised access center, these observations will most often
take place during the day (Monday to Friday) and may require parents and children to take a
small amount of time off of work/school and/or exceptionally adapt the parenting schedule to
facilitate the observation. These observations may take place in inside the home with Ms.
Bourgeois wearing a mask or outside, if weather permits.
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 1
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
Young children unable to be interviewed: If a child is too young to be reliably interviewed, two
observations with each parent shall be conducted in order to comprehensively assess the
developmental needs and personality of the child and the parent-child interactions.
d. A minimum of three individual interviews with the child(ren) (approx. 1 hour for each interview)
shall be conducted in person or by videoconference, depending on the COVID-19 situation
and age and maturity of child. As long as the child(ren) are seeing both parents, the interviews
shall alternate being held in each parent’s homes. For the third interview, it will be arranged at
a time convenient to the assessor prior to the disclosure meeting or may respect the child’s
preference for location. In the case of allegations of parental influence/coaching, the final
interview will be divided in two and one held at each parent’s home.
The interviews with the child(ren) are not intended to be stressful and shall utilize different play
and other techniques to increase the children’s comfort level. There is a minimum of three
weeks left in between each child interview to assess consistency over time. The last interview
shall be scheduled as close to the disclosure meeting as possible.
If a child is too young to be reliably interviewed and attends daycare, she/he shall also be
observed in their daycare setting with their peers on one occasion, if accessible and open
during COVID-19.
e. Parent’s new partners or spouses living with the parent and child(ren) in the home shall be
interviewed individually (in person or virtually) and they are expected to be present for the
family observation. They will also be asked to consent to conduct a police and CAS check on
their behalf. New partners not living with the parent and children will be interviewed by
telephone. If a parent is proposing to have their new partner live with them and the children in
the future, then they shall be interviewed individually in person or virtually and a police and
CAS check shall also be conducted.
f. Stepsiblings and half-siblings living with the child(ren) shall also be interviewed (if old enough)
in person and they should likewise be present for the observation. Normally, they will be
individually interviewed just prior or following the family observation in a private location.
g. Collateral interviews with professionals associated with the family (police, child protection
agency/workers,, community organizations, child’s therapists/psychologists/ counsellors, child’s
doctors, child’s dentist, optometrist or other involved medical professional, CHEO, child’s
teacher(s), day care provider, parent’s doctors/ therapists/psychologists/counsellors, parent’s
past couple counsellor, past therapists, etc.) shall be performed by telephone or by obtaining
written feedback/disclosure of information and records. In some unusual cases, an in-person
interview shall be conducted. Parents are expected to provide a list of all involved professionals
with them and their children at the onset of the process. It is important that consents be signed
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 2
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
quickly at the onset of the process as it takes a significant amount of time to receive
documentation or information back from a variety of professionals.
h. Collateral interviews with family members or friends – In addition to new partners/spouses,
stepsiblings or halfsiblings, parents may select up to two family member(s) or friend(s) to be
interviewed if they are often in a caregiving role or they are/have been particularly involved in
the current family situation or may have witnessed something in particular. These interviews
shall be conducted by telephone or virtually. If parents wish to add more personal collaterals,
then the other parent shall likewise be given the opportunity to add more collaterals on their
side to ensure it is balanced.
i. Legal documents: Counsel shall provide a copy of all non-financial pleadings, court orders,
agreements, restraining orders, etc. filed in the case. If there is a court appearance or
upcoming court date, this assessor shall be informed and provided any of the relevant
orders/pleadings. If there are any new police or child protection investigations opened during
this process, the evaluator must be informed, as the assessment must be put on hold until the
investigation is complete.
j. Other written materials: Parents may choose to send text messages, emails or other
documentation, but please limit it to a reasonable amount to highlight a specific issue or
concern. Please also ensure that you provide the context of text messages with dates, who is
speaking, and the full conversation of the difficult dialogue in order to see the lead-up and end
to text exchange. Please ensure that the other parent is provided with a copy of this information
so that he/she may have the opportunity to respond. The time taken to review this
documentation is billed.
k. A disclosure meeting (approx. 2-3 hours) is convened with both parties, their respective legal
counsel and involved mediator (if desired) at the close of the assessment in order to disclose
this assessor’s findings, impressions and recommendations. This meeting will be held virtually
or moved to an in-person format when the public health conditions change. Discussions during
the disclosure meeting are “open,” and therefore may be included in the report. This meeting
can also be used as an opportunity to resolve the matter. The content of any settlement
discussions, however, are considered “closed,” therefore cannot be used in the report. The
disclosure meeting will not be held if payment for services is not up to date.
l. A final report shall be submitted at the disclosure meeting (if in-person) and final payment is
required in advance of the disclosure meeting and submission of this report. If the meeting is a
virtual disclosure meeting, the report shall be sent by email (PDF) on the same day following
the disclosure meeting and the original signed version will be sent in the mail. A full report shall
include the purpose of the report, the sources of the information, summary of the legal
decision-making responsibilities and parenting history, current and historical decision-making
and parenting arrangements, summary of each party’s parenting concerns, parent’s parenting
plans, individual parent histories, parent relationship history, detailed child(ren) information
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 3
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
according to the parents, children’s experiences, views and preferences, new partner history,
summary of all collateral interviews and reports, analysis of the observations and child
interviews, clinical impressions and discussion, and detailed, structured decision-making
responsibilities and parenting plan recommendations. A report shall not be submitted if the
parties are not up to date for the payment of clinical services.
m. Duration of process: The assessment process will typically take approximately 90 days from
the time of parent interviews to the point of the final disclosure meeting and the report being
submitted. The process may be extended depending on the delays associated with scheduling
appointments, obtaining collateral information or other issues outside this assessor’s control.
n. Language: Parents may choose to have interviews and consents completed in English or
French, but the final report shall be prepared in English.
2. Virtual Interviews: For parents opting for a virtual interview, they will need to have access to a cell
phone or computer with a camera and microphone and internet/data on their cell phone. An invite will
be sent by prior to the interview. Parents must commit to being in a private location without other family
members present who can overhear the conversation. These interviews should never be recorded.
Certain documents will be sent to you via email, which you may print or look at electronically.
3. In-person interviews during COVID-19: In order to comply with public health recommendations, the
interviews can he held inside while using a mask or outside 6 feet apart. If a participant has any
symptoms of COVID-19 (cough, fever, flu-like symptoms, loss of smell or taste, etc.), then the visit
should be cancelled and scheduled at a time when everyone is healthy. Upon arrival at the parent’s
home, Ms. Bourgeois will have antiseptic for all participants to use and an infrared thermometer (no
touch) will be used to take everyone’s temperatures. All participants are encouraged to wash their
hands or use antiseptic at the end of the meeting as well.
4. Liability during COVID-19: All participants (including Ms. Bourgeois) waive any liability associated with
any inadvertent and non-purposeful exposure to COVID-19 during the interviews or observations.
Following the visit, if one participant develops symptoms of COVID-19 or receives a positive diagnosis
of COVID-19, this individual must commit to informing all participants in order to ensure they can take
the appropriate precautions.
5. Cost: The above parenting assessment services shall be charged at a rate of $195 per hour plus
HST, travel, and collateral fees. The duration of the assessment is dependent on the length of parent
interviews and extent of ongoing parent communication, complexity of the case, number of children
involved, length of children’s interviews, the amount of collateral information required, and the length of
the report.
6. Travel Time and Mileage: In order to simplify travel fees, they are combined at set rates depending on
your location. Below is the set amount by region per trip:
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 4
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
Ottawa region: $150 Stormont, Dundas and Glengarry: $75
Prescott-Russell region: $75 Leeds and Grenville: $200
Kingston region: $275
7. Terms of Payment: The parents agree to equally share the total costs of the assessment. The parties
agree that a retainer deposit of $7,000 is payable at the onset of the assessment. Clients shall
receive a detailed invoice outlining the work completed. Parents will be invoiced for any work above
the retainer amount, and payment is due upon receipt. Final payment is required prior to the disclosure
meeting and submission of the report. Payment may be made by Interac e-transfer to
cbourgeois@chantalbourgeois.ca or cheque payable to Chantal Bourgeois.
8. Responsible Party for Payment: It is understood that both parties shall equally cover the full costs of
this parenting assessment, unless otherwise specified.
9. Disbursements: Charges for collateral reports, courier fees, fax or photocopying fees ($0.10 per page),
and excessive long-distance telephone charges shall be charged.
10. Insurance Receipts: For some clients, insurance coverage may be a possibility for the portion
associated with individual parent interviews and child interviews. If this is an option, please let me
know and a separate receipt for insurance purposes can be issued.
11. Audio and Visual Recording: In order to preserve the integrity of the process, parents are not permitted
to record any of the interviews, telephone calls, virtual interviews, observations, or the disclosure
meeting.
12. Cancellation: The client must provide at least 24-hour notice of cancellation of any interview. Please
note that visit times may not be easily changed without sufficient prior notice. Three cancellations may
result in re-evaluation of services and possibly termination of services. In the event that a client does
not show up for an appointment and does not provide sufficient notice, then there shall be a charge of
$60.
13. Transparency and Confidentiality: Due to the nature of a parenting assessment, the content of
interviews with all of the parties is open for disclosure to both parties for the purpose of disclosing
findings and preparing the final written report. Concerns or allegations shared by a parent will be
shared with the other parent in order to receive their perspective. This process is therefore transparent
and nothing a parent shares is kept secret from the other. Information gained from the interview with
the child may not be fully shared with the parents if the evaluator believes the child will be harmed or
put at risk by doing so. In the event that a parent has security concerns regarding their address being
known by the other parent, then their address is not shared.
14. Child Protection Concerns: It is an entrenched legal and professional obligation that child protection
authorities be informed if this assessor becomes aware of a child protection concern during this
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 5
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
process. Inappropriate physical touching between adults and children will result in the immediate
termination of a visit and may lead to the incident being reported to the local child protection agency. In
this case, this process will be put on hold until child protection authorities complete their investigation.
15. Assessor Position: This assessor does not represent the interests of either party, regardless of which
lawyer referred the case to the evaluator or which parent is covering the cost of this evaluation. If there
is any bias that exists, it is toward the best interests of the child.
16. Physical Safety: The safety and security of all parties, including this assessor, is of utmost importance.
Interviews shall not be conducted with anyone under the influence of drugs and/or alcohol or with
anyone exhibiting threatening or unusual behaviour that may pose harm to themselves, the other
parent, or the child. In the event that either party threatens the physical safety of this assessor or the
other party, then a referral shall be made to the appropriate police department for further assistance.
Harassment or threatening behaviour may be grounds to terminate the assessment process.
17. Testifying at Court: This assessor may be called as a witness at trial assuming that sufficient notice is
given to clear her schedule in order to attend court. The parent requesting the evaluator’s testimony or
issuing a summons/subpoena shall be responsible for all of the associated costs, including the hourly
tariff (preparation time and court time) transportation charges and disbursement fees.
I, _______________________________________, agree to the terms and conditions of this document, which
is signed in _________________ the _____ day of _______________ 2021.
______________________________________ _______________________________________
Name of Parent Signature of Parent
______________________________________
Chantal Bourgeois, BSW, MSW, RSW
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 6
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
Parent’s Contact Info:
Street and Apt _______________________________________________
City _______________________________________________
Postal Code ___________________________________________
Email: _______________________________________________
Home Tel: ___________________ Cell Tel: ________________________
Your Lawyer’s Contact Info:
Self-represented: YES or NO
Name of Lawyer: ________________________________________________________
Name of Firm: ________________________________________________________
Street ________________________________________________________
City _______________________________________________
Postal Code ___________________________________________
Email: _______________________________________________
Work Tel: ___________________ Fax Tel: ________________________
Name of the other parent: ________________________________________
Email of the other parent: ________________________________________
Tel. number of the other parent: ___________________________________
Is there a non-contact order in place preventing contact between both parents? NO YES, When does it
expire? _______________________________
Does the child(ren) have contact with this parent? NO YES, If so, where does it occur (home, community or
supervised access center)? ________________________________________________________________
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 7
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
Children’s Information:
Child 1 Name: ___________________________ Date of Birth: ______________ Grade: _____
Name & Address of School: ____________________________________________________
____________________________________________________________________________
Child 2 Name: ___________________________ Date of Birth: ______________ Grade: _____
Name & Address of School: _____________________________________________________
____________________________________________________________________________
Child 3 Name: ___________________________ Date of Birth: ______________ Grade: _____
Name & Address of School: _____________________________________________________
____________________________________________________________________________
Chantal Bourgeois, B.S.W., M.S.W., R.S.W., Acc. Family Mediator 8
P.O. Box 1203, Hudson, Quebec, J0P 1H0
Tel: 514-316-2936 |Cell: 514-770-7874 | Fax: 450-458-2728
cbourgeois@chantalbourgeois.ca | www.chantalbourgeois.ca
