Fillable Printable Parenting Plan Form - District of Columbia
Fillable Printable Parenting Plan Form - District of Columbia
Parenting Plan Form - District of Columbia
SUPERIOR COURT OF THE DISTRICT OF COLUMBIA
FAMILY COURT
Domestic Relations Branch
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 1 of 9
PARENTING PLAN
THE PURPOSE OF A PARENTING PLAN IS TO HELP YOU THINK CAREFULLY ABOUT THE DETAILS OF
YOUR CUSTODY ORDER. YOU CAN DECIDE:
WHO WILL MAKE WHAT DECISIONS ABOUT THE CHILD(REN)?
WHO THE CHILD(REN) WILL STAY WITH AND WHEN?
WHAT FINANCIAL CONTRIBUTIONS SHOULD BE MADE TO SUPPORT THE CHILD(REN)?
IF YOU WANT, YOU CAN ASK THE JUDGE IN YOUR CASE TO INCORPORATE THIS PARENTING PLAN
INTO A COURT ORDER.
________________________________________
PRINT PLAINTIFF’S NAME
________________________________________
STREET ADDRESS
________________________________________
CITY, STATE AND ZIP CODE
SUBSTITUTE ADDRESS: CHECK BOX IF YOU
HAVE WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE
YOU FEAR HARASSMENT OR HARM.
PLAINTIFF,
v.
________________________________________
PRINT DEFENDANT’S NAME
________________________________________
STREET ADDRESS
________________________________________
CITY, STATE AND ZIP CODE
SUBSTITUTE ADDRESS: CHECK BOX IF YOU
HAVE WRITTEN SOMEONE ELSE’S ADDRESS BECAUSE
YOU FEAR HARASSMENT OR HARM.
DEFENDANT.
DR _____________________
Related Cases:
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 2 of 9
NOTE:
IF THE PARENTING ARRANGEMENTS ARE DIFFERENT FOR SOME OF YOUR CHILDREN,
YOU SHOULD WRITE UP A SEPARATE PARENTING PLAN FOR EACH CHILD.
THIS PARENTING PLAN INVOLVES THE FOLLOWING CHILD(REN):
Child’s Name
Age
Where does this child live?
IF YOU HAVE CHILDREN NOT ADDRESSED BY THIS PARENTING PLAN, NAME HERE:
Child’s Name
Age
Where does this child live?
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 3 of 9
LEGAL CUSTODY (who makes decisions about certain things)
Diet Both parents decide together Plaintiff Defendant
Religion Both parents decide together Plaintiff Defendant
Medical Care Both parents decide together Plaintiff Defendant
Mental Health Care Both parents decide together Plaintiff Defendant
Discipline Both parents decide together Plaintiff Defendant
Choice of School Both parents decide together Plaintiff Defendant
Choice of Study Both parents decide together Plaintiff Defendant
School Activities Both parents decide together Plaintiff Defendant
Sports Activities Both parents decide together Plaintiff Defendant
________________ Both parents decide together Plaintiff Defendant
________________ Both parents decide together Plaintiff Defendant
________________ Both parents decide together Plaintiff Defendant
What process will you use to make decisions?
FOR EXAMPLE – THE PARENT CONFRONTED WITH OR ANTICIPATING THE CHOICE WILL CALL THE OTHER PARENT WHEN
THE CHOICE PRESENTS ITSELF AND THE OTHER PARENT MUST AGREE OR DISAGREE WITHIN 24 HOURS OF ANY
DEADLINE OR IF IN LESS TIME, THEN BEFORE ANY DEADLINE)
If you cannot agree, which of you will make the final decision?
_____________________________________________________________________________
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 4 of 9
PHYSICAL CUSTODY (where the child(ren) live)
The child(ren)’s residence is with _________________________________________________
Describe which days and which times of day the child(ren) will be with each person:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
This schedule is every week every two weeks other _______________________
If not weekly, which of you has the child(ren) the rest of the time? _______________________
Drop-off
Where? ______________________________________________________________________
When? (time and day) ___________________________________________________________
Pick-up
Where? ______________________________________________________________________
When? (time and day) ___________________________________________________________
If one of you doesn’t show up, how long will the other wait? ____________________________
If there are extraordinary costs (taxi, train, plane, etc.) who will pay for which costs?
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 5 of 9
HOLIDAY VISITATION
HOLIDAY
Where will the child stay in…
Year A
Year B
Every Year
Martin Luther King Day
President’s Day
Easter
Memorial Day
4
th
of July
Labor Day
Yom Kippur
Rosh Hashanah
Thanksgiving
Vacation after Thanksgiving
Christmas Vacation
Christmas Day
Kwanza
New Year’s Eve/Day
Spring Vacation
Easter Sunday
Child’s Birthday
Mother’s Day
Father’s Day
Other holiday:
(Chanukah, Passover,
Ramadan, etc)
Summer Vacation:
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 6 of 9
SPECIAL ACTIVITIES OR SCHOOL ACTIVITIES
Name of Child
Activity
Will both of you attend?
If not, which of you will attend?
TEMPORARY CHANGES TO THIS PARENTING SCHEDULE
FROM TIME TO TIME, ONE OF YOU MIGHT WANT OR NEED TO REARRANGE THE PARENTING TIME SCHEDULE DUE TO
WORK, FAMILY OR OTHER EVENTS. YOU CAN ATTEMPT TO AGREE ON THESE CHANGES, IF YOU CANNOT AGREE, THE
PARENT RECEIVING THE REQUEST WILL MAKE THE FINAL DECISION.
The parent asking for the change will ask
in person by letter/email by phone ______________
no later than 12 hours 24 hours 1 week 1 month ______________
The parent being asked for a change will reply
in person by letter/email by phone ______________
no later than 12 hours 24 hours 1 week 1 month ______________
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 7 of 9
COMMUNICATION
May parents contact one another? ________________________________________________
When the child(ren) is/are with the one of you, how may they contact the other parent?
______________________________________________________________________________
______________________________________________________________________________
When and how may _____________ contact the child?_______________________________
______________________________________________________________________________
______________________________________________________________________________
When and how may _____________ contact the child, when the child is visiting? _________
______________________________________________________________________________
______________________________________________________________________________
CHILD(REN)’S EXPENSES
Expense
Mother - amount or %
Father – amount or %
Health Insurance Coverage
Medical Care (including co-pays)
Dental (braces, fillings, etc.)
Vision (eyeglasses, contacts, etc.)
Other Health Care
Mental Health Care
Education (tuition, books, fees, etc.)
Childcare (work-related)
Other (music lessons, sports equipment,
car insurance, etc.)
Other
Other
Other
Other
Unexpected Expenses not anticipated at
the time of this agreement
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 8 of 9
CHILD SUPPORT GUIDELINES
Child support will be paid by Plaintiff Defendant
Amount $_______________ every week every two weeks
once a month other _____________________
TAXES (who can take the income tax deduction for the child(ren) each year)
Plaintiff can take the deduction in Year A in Year B Every Year
Defendant can take the deduction in Year A in Year B Every Year
Other
COLLEGE (if you send your child(ren) to college)
Plaintiff will pay all college tuition, room and board, and books.
Defendant will pay all college tuition, room and board, and books.
Plaintiff and Defendant will share expenses for college tuition, room and board, and books.
Plaintiff will pay _____ % of the total expenses.
Defendant will pay _____ % of the total expenses.
* these must add up to 100%
Other
DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 9 of 9
OTHER (anything else you want to agree on)
______________________________ _____________________________
Date Signature of Mother
______________________________ _____________________________
Date Signature of Father
______________________________ _____________________________
Date Signature of Witness
