Fillable Printable Parenting Plan Template - Arizona
Fillable Printable Parenting Plan Template - Arizona
Parenting Plan Template - Arizona
Name:
Mailing Address:
Daytime Telephone
ATLAS #:
Representing Self, Without a Lawyer
IN T
HE SUPERIO R COURT OF ARIZONA, YAVAPAI COUNTY
Reg
arding the Matter of
Case No. 1300DO
Petitioner
PARENTING P LAN FOR:
and [ ] JOINT LEGAL DECISION-MAKING WITH
JOINT LEGAL DECISION-MAKING
AGREEMENT
or
[ ] SOLE LEGAL DECISION-MAKING
Respondent [ ] to Mother
[ ] to Father
INSTRUCTIONS
Thi
s document has 4 parts: PART 1) General Informat ion; PART 2) Legal Decision-Making and Parenting
Time; P A RT 3) Danger to Children Notification Statement; and PART 4) Joint Legal-Decision Making
Agreement. (Where this form refers to “children” it refers to any and all minor children that are common to the
parties, whether one or more.)
One o
r both parents must complete and sign the Plan as follows:
a. If both parents agree to joint legal decision-making, both parents must sign the Plan at the end of PART
2, at the end of PART 3, and at the end of PART 4;
b. If
both parents agree to legal decision-making and parenting time arrangements but not to joint legal
decision-making, both parents must sign the Plan at the end of PART 2 and at the end of PART 3;
c. If only one parent is submitting the Plan, that parent must sign at the end of PART 2 and at the end of
PART 3.
PART 1: GENERAL INFORMATION:
A. MIN
OR CHILDREN: This Plan concerns the following m inor children: (Use addit ional paper if
necessary)
CHILD’S NAME BIRTH D ATE
For Clerk’s Use Only
Page 1 of 8 DRDC72f
Superior Court of Ar
izona in Yavapai County
February 2016
Case No. 1300DO
B. THE FOLLOWING LEGAL DECISION-MAKING ARRANGEMENT IS REQUESTED: Choose ONE of the
options below (1, 2, 3, or 4). If you choose “sole legal decision-making”, (1 or 2), you have the option of
al
so requesting restrictions on the parenting time of the other party.
[ ] 1. SOLE LEGAL DECISION-MAKING BY AGREEMENT: The parents agree that sole legal
decision-making and primary physical residence of the child(ren) should be with the [ ] Mother
or [ ] Father. The parents agree that since each has a unique contribution to offer to the growth
and development of their minor children, each of them will continue to have a full and active role
in providing a sound moral, social, economic, and educational environment for the benefit of the
minor children as described in the following pages. OR,
[ ] 2. SOLE LEGAL DECISION-MAKING REQUESTED BY THE PARENT SUBMITTING THIS PL AN:
The parent s cannot agr ee t o th e terms of lega l d ecisio n -making and parenting time. The parent
submitting this Plan asks the court to order sole legal decision -making, parenting time and
determination of the primary physical residence for the child(ren) according to this Plan.
(Optional, if you marked 1 or 2 above)
[ ] RESTRICTED, SUPERVI S ED OR NO PARENTING TIM E: The parent submitting this Plan
asks the Court for an order restricting parenting time. The facts and information related to
this request are described in the Petition.
OR
[ ] 3. JOINT LEGAL DECISION-MAKING BY AGREEMENT: The parents agree to joint legal
decision-making and request the court to approve the joint legal decision-making arrangement as
described in this Plan. The primary residence of the child(ren) will be with the [ ] Mother or
[ ] Father. OR,
[ ] 4. JOINT LEGAL DECISION-MAKING RE QUESTED BY PARENT SUBMITTING THI S PLAN: The
parents cannot agree to the terms of legal d e ci si on-making and parenting time, or are unable to
submit this plan together at this time. My request for joint legal decision-making
is deferred for the
court’s determination.
PART 2: LEGAL DECISION-MAKING AND PARENTING TIME: Complete each section below. Be
specific about what you want the judge to approve in the court order.
A. (
School Year) WEEKDAY AND WEEKEND TIME-SHARING SCHEDULE:
[ ] The minor children will be in the care of Father as follows: (Explain).
[ ]
The minor children will be in the care of Mother as follows: (Explain).
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Superior Court of Ar
izona in Yavapai County
February 2016
Case No. 1300DO
[ ] Other legal dec is io n -making arrangements are as follows: (Explain).
[ ]
T r ansportation will be provided as follows:
[ ] Mother or [ ] Father will pick the children up at o’clock a.m./p.m.
[ ] Mother or [ ] Father will drop the children off at o’clock a.m./p.m.
Parents may change their time-share arrangements by mutual agreement and with at least
days
notice in advance to the other parent.
B. SUMMER MONTHS OR SCHOOL BREAK LONGER THAN 4 DAYS: The weekday and weekend
schedule described above will apply for all 12 calendar months EXCEPT:
[ ] During the summer months or school breaks that last longer than 4 days, no changes shall be
made.
OR
[ ] During the summer months or school breaks that last longer than 4 days, the children will be in the
care of FATHER. (Explain.)
OR
[ ] During the summer months or school breaks that last longer than 4 days, the children will be in the
care of MOTHER. (Explain.)
[ ] Each parent is entitled to a week period of vacation time with the children. The
parents agree to work out the details of the vacation at least
days in advance.
C.
TRAVEL:
[
] Should either parent travel out of the area with the minor children, each parent will keep the other
parent informed of travel plans, address(es), and telephone number(s) at which that parent and the
minor children can be reached.
[ ] Neither parent shall travel with the children outside Arizona for longer than days
without the prior written consent of the other parent or order of the court.
D. HOLIDAY SCHEDULE: The holiday schedule takes priority over the regular time-sharing schedule as
described above. Check the box(es) that apply and indicate the years of the holiday access/parenting
time schedule.
Holiday Even Years Odd Years
[ ] New Year's Eve [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] New Year’s Day [ ] Mother [ ] Father [ ] Mother [ ] Father
Page 3 of 8 DRDC72f
S
uperior Court of Arizona in Yavapai County
February 2016
Case No. 1300DO
[ ] Spring Vacation [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Easter [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] 4th of July [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Halloween [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Veteran’s Day [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Thanksgiving [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Hanukkah [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Chri stmas E ve [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Christmas Day [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Winte r Break [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Children’s Birthdays [ ] Mother [ ] Father [ ] Mother [ ] Father
[ ] Mot her's Day will be celebrated with the Mother every year.
[ ] Father' s Day will be celebrated with the Father every year.
[ ] Each parent may have the children on his or her birthday.
[ ] Three-day weekends which include Martin Luther King Day, President’s Day, Memorial Day, Labor
Day, Columbus Day, the children will remain in the care of the parent who has the minor children for
the weekend.
[ ] Ot her Holidays (Describe the other holidays and the arrangement.)
[ ] Each par
ent may have telephone contact with the minor children during the children's normal
waking hours, OR
[ ] Other (Explain)
E. PARENTAL ACCESS TO RECORDS AND INFORM ATION: Under Arizona law (A.R.S.§ 25-403),
unless otherwise provided by court order or law, on reasonable request, both parents are entitled to
have equal access to documents and other information concerning the minor children’s education and
phy
sical, mental, moral and emotional health including medical, school, police, court and other records.
A person who does not comply with a reasonable request f or these records shall reimburse the
requesting parent for court costs and attorney fees incurred by that parent to make the other parent obey
this request. A parent who attempts to restrict the release of documents or information by the custodian
of the records without a prior court order is subject to legal sanctions.
F. EDUC
ATIONAL ARRANGEM ENTS:
[ ] Both parents have the right to participate in school conferences, events and activities, and the right
to consult with teachers and other school personnel.
[ ] Both par ents will make major educational decisions together.
(optional) [ ] If both parents do not reach an agreement, then
,
OR
[ ] Major educ
ational decisions will be made by [ ] Mother, OR [ ] Father after consulting the other
parent.
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S
uperior Court of Arizona in Yavapai County
February 2016
Case No. 1300DO
Superior Court of Arizona in Yavapai County Page 5 of 8 DRDC72f
February 2016
G. MEDIC AL AND DENT AL ARRANGEMENTS:
[ ] Both parents have the right to authorize emergency medical treatment, if needed, and the right to
consult with physicians and other medical practitioners. Both parents agree to advise the other
parent immediately of any emergency medical/dental care sought fo r the children, to cooperate on
health matters concerning the children and to keep one another reasonably informed. Both parents
agree to keep each other informed as to names, addresses and telephone numbers of all
medical/dental care providers.
[
] Both parents will make major medical decisions together, except for emergency situations as noted
above.
(Optional) [ ] If the parents do not reach an agreement, then:
,
OR
Major medical/dental decisions will be made by [ ] Mother OR [ ] Father, after consulting with the
other parent.
H. RELI GIOUS EDUC ATION ARRANGEMENTS:
[ ] Each parent may take the children to a church or place of worship of his or her choice during the
time that the children is/are in his or her care.
[ ] Both parents agree that the children may be instructed in the faith.
[
] Both Parents agree that religious arrangements are not applicable to this Plan.
I. A
DDI TION AL ARRANGEMENTS AND COMMENTS:
[ ] NOTI FY OTHER PARENT OF ADDRESS CHANGE. Each parent will inform the other parent of
any change of address and/or phone number in advance or within days of the change.
[ ] NOTI FY OTHER PARENT OF EM E RGENCY. Both parents agree that each parent will promptly
inform the other parent of any emergency or other important event that involves the children.
[
] TALK TO OTHER PAR ENT ABOUT EXTR A ACTIVITI ES. Each parent will consult and agree with
the other parent regarding any extra activity that affects the children's access to the other parent.
[
] ASK OTHER PARENT IF HE OR SHE WANTS TO T AKE CARE OF CHILDREN. Each parent
agrees to consider the other parent as care-provider for the children before making other
arrangements.
[
] RELOCATION OF CHILD. Under Arizona law (ARS §25-408) if by written agreement or court order,
both parents are entitled to Joint Legal Decision-Making or parenting time and both parents reside
in the state, at least 45 days’ advance written notice shall be provided to the other parent before a
parent may do either of the following:
1. Relocate the child outside the state.
2. Relocate the child more than 100 miles within the state.
Under Arizona law (ARS §25-403.01 C) an order for sole legal decision-making does not allow the
parent designated as sole legal decision-maker to alter unilaterally a court-ordered parenting time
plan.
[
] PERSONAL CARE ARRANGEMENTS.
[ ] Each parent may during his/her scheduled parenting time, make routine personal care decisions
for our children.
[ ] Other:
Case No. 1300DO
Superior Court of Arizona in Yavapai County Page 6 of 8 DRDC72f
February 2016
[ ] COMMUNICATE. Each parent agrees that all communications regarding the children will be
between the parents and that they will not use the children to convey information or to set up
parenting time changes.
[ ] PRAISE OTHER PARENT. Each par ent agrees to encourage love and respect between the
children and the other parent, and neither parent shall do anything that may undermine the other
parent's relationship with the children.
[
] COOPERATE AND WORK TOGETHER. Both parents agree to exert their best efforts to work
cooperatively in future plans consistent with the best interests of the children and to amicably
resolve such disputes as may arise.
[
] PARENTING PLAN. Both parents agree that if either parent moves out of the area and returns
later, they will use the most recent “Parenting Plan/Access Agreement” in place before the move
or the minimum Yavapai County Access Guidelines until other arrangements can be worked out.
[
] MEDIATION. If the parents are unable to reach a mutual agreement regarding a legal change to
their parenting orders, they may request mediation through the court or a private mediator of their
choice.
N
OTICE: DO NOT DEVIATE FROM PLAN UNTIL DI SPUTE IS RESO L VED.
Both parents are advised that while a dispute is being resolved, neither parent shall deviate from this
Parenting Plan, or act in such a way that is inconsistent with the terms of this agreement.
Once this Plan has been made an order of the Court, if either parent disobeys the court order related to
parenting time with the minor children, the other parent may submit court papers to request enforcement.
(See Self-Service Center)
J
. SIGNATURE OF ONE OR BOTH PAREN TS – as instructed on page 1.
Signature of Mother: Date:
Signature of Father: Date:
Case No. 1300DO
Superior Court of Arizona in Yavapai County Page 7 of 8 DRDC72f
February 2016
PART 3: STATEMENT REGARDING CONTACT WITH SE X OFFENDERS AND PERSONS
CONVICTED OF DANGEROUS CRIMES AGAINST CHILDREN.
Accordi ng t o A.R.S. § 25-403.05 (B), a child’s parent or legal deci sion-maker must immediately
notify the other parent or l egal decision-maker if the person knows that a convicted or registered
sex offender or someone who has been convicted of a dangerous crime against children may
have access to the child.
A
ccording to A.R.S. § 13-705 (P) (1), “Dangerous crime against children” means any of the following that
is committed against a minor who is under fifteen years of age:
(a) Second degree murder.
(b) Aggravated assault resulting in serious physical injury or involving the discharge, use or threatening
exhibition of a deadly weapon or dangerous instrument.
(c) Sexual assault.
(d) Molestation of a child.
(e) Sexual conduct with a minor.
(f) Commercial sexual exploitation of a minor.
(g) Sexual exploitation of a minor.
(h) Child abuse as prescribed in section 13-3623, subsection A, paragraph 1.
(i) Kidnapping.
(j) Sexual abuse.
(k) Taking a child for the purpose of prostitution as prescribed in section 13-3206.
(l) Child prost it ution as prescribed in section 13-3212.
(m) Involving or using minors in drug offenses.
(n) Cont inuous sexual abuse of a child.
(o) At t empt ed first degree murder.
(p) Sex trafficking .
(q) Manufac t ur ing methamphetamine under circumstances that cause physical injury to a minor.
(r) Bestiality as prescribed in section 13-1411, subsection A, paragraph 2.
(s) Lur ing a minor for sexual exploitation.
(t) Aggravated luring a minor for sexual exploitation.
(u) Unla wf ul age misrepresentation.
(v) Unlawful mutilation.
The parent or legal decision-maker must provide notice by first class mail, return receipt
requested, by electronic means to an electronic mail address that the recipient provided to the
parent or legal decision-maker for notification purposes or by another form of communication
accepted by the court.
PART 3: SIGN ATURE OF ONE OR BO TH P ARTIES – as instructed on page 1.
I
(We) have read, understand and agree to abide by the notification requirements of A.R.S. 25-403.05 (B)
concerning notification of other parent or legal decision-maker if someone convicted of a dangerous crime
against children may have access to the child.
Signature of Mother: Date:
Signature of Father: Date:
Case No. 1300DO
PART 4: JOINT LEGAL DECISION-MAKING AGREEMENT (IF APPLICABLE):
A. D
OMESTIC VIOL ENCE: Arizona Law (A.R.S. § 25-403.03) states that joint leg al d e c is ion -making shall
not be awarded if there has been a history of “significant domestic violence”.
[ ] Domest ic Violence has not occurred between the parties, OR
[ ] Domest ic Violence has occurred, but it has not been “significant” or has been committed by both
parties.*
B. DUI o r
DRUG CONVICTION(S):
[ ] Neither party has been convicted of driving under the influence or a drug offense within the past 12
months, OR
[ ] One of the parties HAS been convicted of driving under the influence or a drug offense within the
past 12 months, but the parties feel Joint Legal Decision-Making is in the best interests of the
children. *
* IF
THERE HAS BEEN DOMESTIC VIO LENCE OR A DUI OR DRUG CO NVICTION:
Attach an extra page explaining why Joint Legal Decision-Making is still in the best interest of
the children.
C. J
OINT LEGAL DECISION-MAKING AGREEMENT: If the parents have agreed to joint legal decision-
making, the following will apply, subject to approval by the Judge.
1. REVIEW PARENT ING PLAN . The parents agree to review the terms of their joint legal decision-
making agreement and make any necessary or desired changes every
months
from the date of this document.
2. CRITERIA. Our joint legal decision-making agreement meets the criteria required by Arizona law
(A.R.S. § 25-403.02), as listed below:
a. T he best interests of the minor children are served;
b. Each parent’s rights and responsibilities for personal care of the minor children and for
decisions in education, health care and religious training are designated in this P lan ;
c. A schedule of the physical residence of the minor children, including holidays and school
vacations is included in the Plan;
d. T he Plan includes a procedure for periodic review;
e. T he Plan includes a procedure by which proposed changes, disputes and alleged breaches
may be mediated or resolved;
f. The parties understand that joint legal decis io n -making does not necessarily mean equal
parenting time.
D. S
IGNATURES OF BOTH PARENTS REQUES TING JOINT LEG AL DECISION-MAKING – as
instructed on page 1.
Signature of Mother: Date:
Signature of Father: Date:
Page 8 of 8 DRDC72f Superior Court of Arizona in Yavapai County
February 2016
