COMMONWEALTH OF VIRGINIA
[NAME OF CIRCUIT/GENERAL DISTRICT] COURT
DOMESTIC VIOLENCE PROTECTION ORDER

Case No.: ___ Court File No.: ____

PETITIONER: [FULL LEGAL NAME] DOB: [MM/DD/YYYY]
Address: [STREET, CITY, STATE, ZIP] Tel.: [###-###-####]

v.

RESPONDENT: [FULL LEGAL NAME] DOB: [MM/DD/YYYY]
Address: [STREET, CITY, STATE, ZIP] Tel.: [###-###-####]

Effective Date & Time: ___ | Expiration Date & Time: _____
Jurisdiction: Commonwealth of Virginia, pursuant to Va. Code Ann. §§ 16.1-253.1, 16.1-279.1
Forum: [NAME OF COURT] (Family Division)

TABLE OF CONTENTS

I. Definitions .............................................. 2
II. Court Findings ........................................... 3
III. Operative Provisions ..................................... 4
IV. Representations & Warranties ............................. 7
V. Covenants & Restrictions ................................. 8
VI. Default & Remedies ....................................... 9
VII. Risk Allocation ......................................... 10
VIII. Continuing Jurisdiction & Dispute Resolution ............ 10
IX. General Provisions ...................................... 11
X. Execution Block ......................................... 12
XI. Notice to Respondent .................................... 13

[// GUIDANCE: Remove the Table of Contents if not required by local filing rules.]

I. DEFINITIONS

For purposes of this Protection Order, the following terms shall have the meanings set forth below. Terms defined herein and used elsewhere in this Order shall appear with initial capital letters.

1.1 “Court” means the [NAME OF COURT] of the Commonwealth of Virginia.

1.2 “Family Abuse” has the meaning set forth in Va. Code Ann. § 16.1-228.

1.3 “Firearm” means any weapon as defined in 18 U.S.C. § 921(a)(3).

1.4 “Protected Parties” means the Petitioner, any minor child(ren) identified in Section III.5, and any other individual(s) specifically listed in Section III.6.

1.5 “Stay-Away Distance” means [100] yards (or such other distance as set forth in Section III.1).

1.6 “Respondent” means the individual identified in the caption of this Order against whom relief is granted.

II. COURT FINDINGS

Based upon the verified petition, sworn testimony, and the record herein, the Court FINDS that:

A. Venue and jurisdiction are proper under Va. Code Ann. §§ 16.1-241, -243.

B. The Respondent and the Petitioner are [describe relationship sufficient for family abuse jurisdiction, e.g., “spouses,” “co-parents,” or “household members”].

C. Good cause exists to believe that Family Abuse has occurred and that Respondent represents a credible threat to the safety of the Protected Parties.

D. Issuance of this Protection Order is necessary to prevent further acts of Family Abuse.

III. OPERATIVE PROVISIONS

THEREFORE, IT IS HEREBY ORDERED that, effective immediately and for the duration specified on page 1, the Respondent SHALL comply with all provisions below. Any violation may subject Respondent to criminal prosecution under Va. Code Ann. § 18.2-60.4 and federal law.

3.1 No Contact
The Respondent shall have no contact, direct or indirect, by any means whatsoever—including but not limited to in-person, telephone, text, e-mail, social media, or through third parties—with any Protected Party, except as explicitly permitted under Section 3.4 (Child-Related Contact).

3.2 Stay-Away
The Respondent shall remain at least [STAY-AWAY DISTANCE] from:
a. The residence(s) of any Protected Party;
b. The place(s) of employment or education of any Protected Party; and
c. Any other location where the Court determines the Protected Parties customarily frequent, specifically: ______.

3.3 Exclusive Possession of Residence
Respondent shall immediately vacate the premises located at [ADDRESS], taking only personal clothing and effects until law enforcement escorts are arranged for retrieval of additional personal property pursuant to Va. Code Ann. § 16.1-279.1(B)(4).

3.4 Temporary Child Custody & Visitation
a. Temporary Custody of the minor child(ren) [NAMES & DOBs] is awarded to Petitioner.
b. Visitation: ☐ Suspended ☐ Supervised at [LOCATION] on [DAYS/TIMES] under the supervision of [AGENCY/INDIVIDUAL].
[// GUIDANCE: Tailor visitation terms to best interest factors under Va. Code Ann. § 20-124.3.]

3.5 Support
Respondent shall pay temporary child and/or spousal support in the amount of $[AMOUNT] per [week/month] commencing [DATE], through the Virginia Division of Child Support Enforcement (DCSE).
[// GUIDANCE: Support awards require statutory guideline calculations; attach worksheets as Schedule A.]

3.6 Additional Protected Parties
The following individuals are hereby included as Protected Parties: _______.

3.7 Prohibition on Firearms & Ammunition
Respondent shall not purchase, possess, or transport any Firearm for the duration of this Order and shall, within 24 hours, surrender all Firearms in Respondent’s possession to [LAW-ENFORCEMENT AGENCY] and file proof of surrender with the Court. See Va. Code Ann. § 18.2-308.1:4 and 18 U.S.C. § 922(g)(8).

3.8 Counseling / Batterer Intervention
Respondent is ORDERED to enroll in and complete a certified batterer intervention program approved by the Virginia Batterer Intervention Program Certification Board within 30 days of this Order and provide proof of enrollment to the Court.

3.9 Law Enforcement Assistance
Any law-enforcement officer is hereby directed to serve, execute, and assist in the enforcement of this Order, including accompanying Petitioner to obtain possession of the residence and escorting Respondent for limited property retrieval as provided herein.

IV. REPRESENTATIONS & WARRANTIES

4.1 Petitioner’s Representations
Petitioner affirms under penalty of perjury that the factual allegations contained in the Petition are true and correct to the best of Petitioner’s knowledge.

4.2 Respondent’s Notice
Respondent was provided actual notice of the hearing and an opportunity to be heard consistent with due-process requirements.

4.3 Court Representations
The Court represents that statutory prerequisites under Va. Code Ann. §§ 16.1-253.1 and 16.1-279.1 have been satisfied.

V. COVENANTS & RESTRICTIONS

5.1 Compliance Monitoring
Respondent shall remain in regular contact with the probation officer or other supervisory authority designated by this Court and shall promptly provide documentation evidencing compliance with Sections 3.5, 3.7, and 3.8.

5.2 Notice of Address Change
Respondent must notify the Court and Petitioner in writing of any change of residential address within 48 hours.

5.3 Prohibited Acts
Respondent shall not:
a. Commit or threaten any further Family Abuse;
b. Damage, destroy, or tamper with Petitioner’s personal property;
c. Use or menace with a Firearm or other deadly weapon.

VI. DEFAULT & REMEDIES

6.1 Events of Default
Any of the following shall constitute a Default:
a. Violation of any provision of Section III;
b. Failure to complete the batterer intervention program;
c. Failure to pay ordered support.

6.2 Remedies
Upon Default, the Court may, in addition to criminal penalties under Va. Code Ann. § 18.2-60.4:
i. Hold Respondent in civil contempt;
ii. Issue additional injunctive relief;
iii. Extend or modify this Order for up to two (2) years;
iv. Award attorney’s fees and costs to Petitioner.

6.3 Criminal Enforcement
Pursuant to Va. Code Ann. § 18.2-60.4, a willful violation is punishable as a Class 1 misdemeanor and may elevate to a felony for repeat offenses or contemporaneous stalking, assault, or weapon violations.

VII. RISK ALLOCATION

7.1 Indemnification
Not applicable.

7.2 Limitation of Liability
Not applicable; the Court retains sovereign immunity for actions taken in the issuance and enforcement of this Order.

7.3 Force Majeure
Inapplicable to injunctive relief; no circumstance shall excuse Respondent’s performance of the obligations herein.

VIII. CONTINUING JURISDICTION & DISPUTE RESOLUTION

8.1 Governing Law
This Order is governed exclusively by the laws of the Commonwealth of Virginia.

8.2 Continuing Jurisdiction
The Court retains exclusive, continuing jurisdiction to modify, extend, or dissolve this Order upon motion of a party or sua sponte consistent with Va. Code Ann. § 16.1-279.1(E).

8.3 Arbitration & Jury Trial
Not applicable; matters arising under this Order shall be determined by the Court sitting without a jury.

8.4 Injunctive Relief Preservation
Nothing herein limits Petitioner’s right to seek additional emergency or permanent relief under applicable federal or state law.

IX. GENERAL PROVISIONS

9.1 Service & Effectiveness
This Order shall be effective upon personal service on Respondent or upon Respondent’s presence in open court when the Order is pronounced.

9.2 Amendments & Extensions
Any amendment or extension shall be made by written Order of this Court.

9.3 Severability
If any provision of this Order is held invalid, the remaining provisions shall remain in full force.

9.4 Integration
This Order constitutes the entire protective relief granted; any prior oral or written protective provisions are merged herein.

9.5 Copies & Transmittal
Certified copies shall be forwarded forthwith to the Virginia Criminal Information Network (VCIN), each law-enforcement agency with jurisdiction, and any other entity required by law.

X. EXECUTION BLOCK

ENTERED this _ day of _, 20, at ____ __.m.

Judge, [NAME OF COURT]

Printed Name: ______

[COURT SEAL]

ATTEST: _____
Clerk of Court

XI. NOTICE TO RESPONDENT

• A willful violation of this Order is a criminal offense under Va. Code Ann. § 18.2-60.4 and may also subject you to federal prosecution under 18 U.S.C. § 922(g)(8).
• This Order will be enforced in all 50 states, the District of Columbia, tribal lands, and U.S. territories pursuant to 18 U.S.C. § 2265.
• Possession, shipment, transportation, or receipt of a Firearm while this Order is in effect may constitute a separate federal crime.
• You may, within 30 days of entry, petition the Court for a hearing to dissolve or modify this Order.
• Keep a copy of this Order with you at all times. Law enforcement officers must enforce the terms herein upon presentation of a certified copy.

[// GUIDANCE: Attach schedules (e.g., Support Worksheet) or supplementary affidavits as required by local rules. Verify exact Virginia Code sections and local standing orders prior to filing.]