Fillable Printable Parenting Plan Example - Georgia
Fillable Printable Parenting Plan Example - Georgia
Parenting Plan Example - Georgia
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
1
IN THE SUPERIOR COURT OF _____________COUNTY
STATE OF GEORGIA
________________________,
Plaintiff,
vs. Civil Action No. _______________
________________________,
Defendant.
PARENTING PLAN
The parties have agreed to the terms of this plan and this information has been furnished by both parties to meet the
requirements of OCGA Section 19-9-1. The parties agree on the terms of the plan and affirm the accuracy of the
information provided, as shown by their signatures at the end of this order.
This Plan:
is a new plan.
modifies an existing Parenting Plan dated: __________
modifies an existing Order dated: _________
Child’s Name
Date of
Birth
Child’s Name
Date of
Birth
I. CUSTODY AND DECISION MAKING:
A. Legal Custody (choose one:)
Joint
Father
Mother
Other __________
B. Primary Physical Custodian
Child’s Name
Primary Physical Custodian
Joint
Mother
Father
Joint
Mother
Father
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
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Joint
Mother
Father
Joint
Mother
Father
Joint
Mother
Father
C. Day-To-Day Decisions
Each parent shall make decisions regarding the day-to-day care of a child while the child is residing
with that parent, including any emergency decisions affecting the health or safety of a child.
Other:
D. Major Decisions
Educational Decisions
e.g., school choice, educational support services, speech
therapy, tutoring, educational planning
Joint*
Mother
Father
Non-emergency Health Care
e.g., scheduled examinations, dental and vision care, vision
care, psychological treatment
Joint*
Mother
Father
Religious Upbringing
e.g., choice of religion, religious education or training,
Joint*
Mother
Father
Extracurricular
e.g., sports, arts and music, camps, summer programs
Joint*
Mother
Father
Other:
Joint*
Mother
Father
E. Disagreements and Tie-breaking Authority
The parties shall at all times confer with each other on all above-referenced “major decisions,” as well as on any and
all other important matters pertaining to the welfare of the minor child(ren) with a view toward arriving at a
harmonious policy calculated to promote the child(ren)’s best interest. When Joint* Decision Making is selected in
Section I.D above, disagreements in decisions will be resolved as outlined below.
Educational Decisions
Mother
Father
Non-emergency Health Care
Mother
Father
Religious Upbringing
Mother
Father
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
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Extracurricular
Mother
Father
Other:
Mother
Father
II. PARENTING TIME/VISITATION SCHEDULES
A. Day to Day Parenting Time/Visitation
During the term of this parenting plan the non-custodial parent shall have at a minimum the following rights of
parenting time/ visitation (choose an item):
The first and third weekend of each month beginning on (day) at (time) am/pm and ending on
(day) at (time) am/pm.
The first, third and fifth weekend of each month beginning on (day) at (time) am/pm and ending
on (day) at (time) am/pm. [A weekend beginning on the fifth Friday in a month will be defined
as a “fifth weekend”]
The second and forth weekend of each month beginning on (day) at (time) am/pm and ending on
(day) at (time) am/pm.
Every other weekend beginning on (day) at (time) am/pm and ending on (day) at
(time) am/pm.
Other:
and weekday parenting time/visitation on (choose an item):
Every (day) evening beginning at (time) pm and ending at (time) pm.
Every (day) evening during week prior to non-visitation weekend beginning at (time) pm
and ending at (time) pm.
Every (day) and (day) evening beginning at (time) pm and ending at (time) pm.
Other:
This parenting schedule begins: Date of this Parenting Plan
_________________________
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
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B. Major Holidays and Vacation Periods
The day to day schedule established in section A. above shall apply during any holiday unless other arrangements
are set forth below [i.e., leaving blanks empty means that the schedule established in section A will apply]:
Thanksgiving
Unless specified differently herein, Thanksgiving break shall begin at 6:00 pm on the Wednesday before
Thanksgiving and end on the Sunday after Thanksgiving at 6:00 pm. The day to day schedule shall apply unless
other arrangements are set forth below:
_________________________________________________________________________________
_________________________________________________________________________________
Winter Vacation [a/k/a “Christmas Holiday”]
The
MOTHER
FATHER
shall have the child(ren) for the first period from the day and time school is
dismissed until December at (time) am / pm in
ODD
EVEN
years.
The other parent will have the child(ren) for the second period from the day and time indicated above until 6:00pm
on
the evening
two evenings
before school resumes. Unless otherwise indicated, the parties shall alternate
the first and second periods each year.
Other: ________________________________________________________________________
Summer Vacation
Define summer vacation period:
Definition of Summer: Summer vacation shall be defined as commencing at 10:00 am the day after school
ends for the school year, and ending at 6:00 the day before the start of the new school year.
Split Summer: This time period shall be split in half, with Part A being the first half and Part B being the
second half with the exchange date on ______________ (date).
Other: _____________________________________________________________________
During summer, the day to day schedule under Section II.A above shall apply unless other arrangements are set forth
below:
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The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
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_____________________________________________________________________________________________
_______________________________________ beginning (year).
Spring Vacation (if applicable)
Define: __________________________________________________________________________
The day to day schedule shall apply unless other arrangements are set forth below:
_________________________________________________________________________________
____________________________________________________________beginning (year).
Fall Vacation (if applicable)
Define: __________________________________________________________________________
The day to day schedule shall apply unless other arrangements are set forth below:
_________________________________________________________________________________
____________________________________________________________beginning (year).
OTHER: ______________________________________________________________________
C. Other Holiday Schedule (if applicable)
HOLIDAY
MOTHER
FATHER
MLK, JR. Day (January)
Odd
Even
Every
Odd
Even
Every
President’s Day (February)
Odd
Even
Every
Odd
Even
Every
Mother’s Day (May)
Odd
Even
Every
Odd
Even
Every
Memorial Day (May)
Odd
Even
Every
Odd
Even
Every
Father’s Day (June)
Odd
Even
Every
Odd
Even
Every
July Fourth (July)
Odd
Even
Every
Odd
Even
Every
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
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Labor Day (September)
Odd
Even
Every
Odd
Even
Every
Halloween (October)
Odd
Even
Every
Odd
Even
Every
Children’s Birthday
Odd
Even
Every
Odd
Even
Every
Religious/Other Holidays (list)
1.
2.
Odd
Even
Every
Odd
Even
Every
Odd
Even
Every
Odd
Even
Every
D. Other extended periods of time during school (defined by the school schedule):
_________________________________________________________________________________
E. Start and end dates for holiday visitation:
For purposes of this parenting plan, the holiday will start and end as follows:
Holidays that fall on Friday will include the following Saturday and Sunday.
Holidays that fall on Monday will include the preceding Saturday and Sunday.
Other: _____________________________________________________________________
F. Coordination of Parenting and Children’s Schedules
Check if applicable:
The holiday parenting time/visitation schedule takes precedence over the regular parenting time/visitation
schedule.
Each party agrees that the other party shall have the first right of refusal to keep the child(ren) in the event
that the other party will be unable to care for the child for a period of ________ hours or more. In the event
that the other party is unable to care for the child, the party needing child care will insure that a qualified and
appropriate family member or child care provider is employed to care for the child.
The parent in possession of the minor child(ren) will be responsible for supervising and assisting in any
schoolwork immediately due and for any activity scheduled for the child. The parents agree to give each
other reasonable notice of any activities scheduled during the other parent’s possession of the child(ren).
When the child(ren) are with a parent for an extended period of time (such as summer), the other parent shall
be entitled to visit with the child(ren) during the extended period, as follows:
___________________________________________________________________.
G. Transportation Arrangements
For visitation, the place of meeting for the exchange of the child(ren) shall be:
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
7
_________________________________________________________________________________
The
Mother
Father
will be responsible for transportation of the child(ren) at the beginning of visitation.
The
Mother
Father
will be responsible for transportation of the child(ren) at the conclusion of visitation.
Transportation [e.g. airplane, train, long-distance] costs, arrangements and supervision, if any, will be allocated
as follows:
_________________________________________________________________________________
Both parties will be diligent in having the child ready with the necessary belongings and available at the appointed
time and the transporting party shall be prompt in picking up and delivering the child, provided however, that the
transporting parent for visitation shall have a grace period of fifteen (15) minutes for pick-up and delivery if both
parties live within a distance of fifty (50) miles from each other. If the one way distance to be traveled is in excess of
one hundred (100) miles, the grace period shall be thirty (30) minutes. In the event the visiting parent exceeds the
grace period, the visitation for that weekend is forfeited unless prior notification and arrangements have been made
and except in cases where the visiting parent suffers an unavoidable breakdown or delay en route and the visiting
parent promptly notifies the custodial parent by phone of the delay. Repeated violations by either parent shall be
cause for a modification of the custody order either by changing the custody or curtailing visitation, as the case may
be.
H. Contacting the Child(ren)
When the child(ren) are in the physical custody of one parent, the other parent will have the right to contact the child
or children as follows:
Telephone: When the child is with each parent, that parent will ensure that the child has access to a telephone at
all times. The other parent may telephone the child at all reasonable times, however, these calls shall not unduly
interfere with that parent’s time with the child. Likewise, the parent with physical custody will allow the child to
telephone the other parent at all reasonable times.
Other: ________________________________________________________________________
I. Supervision of Parenting Time (if applicable)
Supervised parenting time shall apply during the day to day schedule as follows:
Place:
Person/organization supervising:
Responsibility for Costs:
Other: _____________________________________________________________________
J. Communication Provisions [Must check one option below:]
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
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A parent changing residence must give at least 30 days notice of the change and provide the full address of the
new residence. Each parent shall promptly notify the other of a change of phone number.
Due to prior acts of family violence, the address of the child(ren) and victim of family violence shall be kept
confidential. The protected parent shall promptly notify the other parent, through a third party, of any change in
contact information necessary to conduct visitation.
Other: _____________________________________________________________________
III. ACCESS TO RECORDS AND INFORMATION
Rights of the Parents
Absent agreement to limitations or court ordered limitations, pursuant to O.C.G.A. §19-9-1(b)(1)(D), both parents
are entitled to access to all of the child(ren)’s records and information, including, but not limited to, education,
health, extracurricular activities, and religious communications. Designation as a non-custodial parent does not affect
a parent’s right to equal access to these records.
The custodial parent shall promptly transmit to the non-custodial parent any information received concerning parent-
teacher meetings, school club meetings, school programs, athletic schedules and any other school activities in which
the child(ren) may be engaged or interested.
The custodial parent shall promptly, after receipt, furnish to the non-custodial parent a photo-copy of the child’s
grade cards or reports and copies of any other reports concerning the child’s status or progress.
The custodial parent shall when possible arrange appointments for parent-teacher conferences at a time when the
non-custodial parent can be present and whenever possible they shall be attended by both parents.
Limitation on access: __________________________________________________________
IV. MODIFICATION OF PLAN
Parties may, by mutual agreement, vary the parenting time/visitation; however, such agreement shall not be a
binding court order. Custody shall only by modified by court order. Should the parents disagree about this parenting
plan or wish to modify it, they must make a good faith effort to resolve the issue between them.
If either of the parties disagrees with the other’s compliance with the terms of this Order, the parties are directed
to appear before the Mediation Center in Chatham County (or before a private mediator if both parties agree)
for at least one session of good faith mediation to resolve their dispute, as a condition precedent to the filing of
any action to enforce the terms of this decree. Should a party fail to participate in scheduling and appearing
before the Mediation Center or a mutually agreed private mediator within thirty (30) days of the first written
request, the failure to cooperate will be reported to this Court and considered as evidence of willful intent to
violate the terms of this Order. This provision shall NOT apply to the following circumstances: contempt or
modification actions regarding inability to pay or failure to pay any support obligations under this order; the
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
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unauthorized denial of visitation or the unauthorized failure to return a child after a visitation; a parent is
incarcerated; or an emergency need involving the safety and well-being of minor child(ren).
V. SPECIAL CONSIDERATIONS
Attached as Exhibit A-1 is an Addendum, detailing any special circumstances involved in this case (e.g.,
health issues, educational issues, etc.).
During the time that either party has physical custody of the child, that parent shall not have residing in the
house, or staying overnight, anyone of the opposite sex not related by blood or marriage.
During the time that either party has physical custody of the child, that parent shall not drink any
alcohol.
Other:
VI. RULES OF CONDUCT
1. Neither party shall discuss with the minor child(ren) their past, present or future domestic relations litigation with
the exception of the custody schedule and these rules of conduct.
2. Neither party shall complain about, criticize, blame the other in the present of the minor child(ren), and shall
instruct others to refrain from such conduct in the presence of the minor child(ren).
3. Neither party shall accuse the other of being at fault in the presence of the minor child(ren).
4. Neither party shall make negative, critical and/or hurtful comments about the other party's family members in the
presence of the minor child(ren).
5. Neither party shall use the minor child(ren) to convey messages to the other parent.
6. The parents shall not hassle over visitation with the child. This undermines the parents' relationship with the child
and burdens the child with the guilt of responsibility for such hassles.
7. It is beneficial that the child experiences affectionate care from both parents. The visitation privileges exist
primarily for the child and not the parent.
8. The issue of visitation and child support are not related. The custodial parent shall not deny visitation to the non-
custodial parent to enforce the payment of child support. Such denial is a violation of this Order.
It is the intention of this Order to relieve the minor child(ren) of embroilment in his/her/their parents' controversies
and disputes. Such conduct is injurious to the health and well-being of the minor child(ren) and will not be tolerated
by the Court.
_____ Initials _____ Initials
The Mediation Center, 5105 Paulsen Street, Suite 125D, Savannah, Georgia 31405
(912) 354-6686 (office) (912) 354-8690
10
VII. PARENT’S CONSENT
Please review the following and initial:
We recognize that a close and continuing parent-child relationship and continuity in the child's life is in the child's
best interest.
__________(Mother) __________(Father)
We recognize that the parent with physical custody will make the day-to-day decisions and emergency decisions
while the child is residing with such parent.
__________(Mother) __________(Father)
We recognize that our child's needs will change and grow as the child matures; we have made a good faith effort to
take these changing needs into account so that the need for future modifications to the parenting plan are minimized.
__________(Mother) __________(Father)
We knowingly and voluntarily agree on the terms of this Parenting Plan. Each of us affirms that the
information we have provided in this Plan is true and correct.
_______________________________ ___ _____________________________________
Mother's Signature Father's Signature
ORDER
The Court has reviewed the foregoing Parenting Plan, and it is hereby made the order of this Court.
This Order entered on the ______ day of ____________________ 20___.
__________________________________________________________
JUDGE OF SUPERIOR COURT OF ___________ COUNTY,
GEORGIA
