Parenting Plan Template - Colorado - Edit, Fill, Sign Online

JDF 1113 R7/06 PARENTING PLAN Page 1 of 7

District Court Juvenile Court

_________________________________________ County, Colorado

Court Address:

In re:

The Marriage of:

Parental Responsibilities concerning:

______________________________________________________

Petitioner:

and

Co-Petitioner/Respondent:

COURT USE ONLY

Attorney or Party Without Attorney (Name and Address):

Phone Number: E-mail:

FAX Number: Atty. Reg. #:

Case Number:

Division Courtroom

PARENTING PLAN

To promote the amicable settlement of disputes among parties, parties may enter into a written parenting plan

containing provisions for the allocation of parental responsibilities including decision-making and parenting time.

You must submit to the Court some form of written Parenting Plan addressing all of the issues which are

relevant to the facts of your case. If you do not, the Court must enter its own plan, and this may not be the plan

you think is in the best interests of you or your child(ren). When the Court either approves your plan, or enters its

own, the plan will become a Court Order.

You may use this form as a Parenting Plan to submit to the Court. This standard form does not include every

possible issue that may be relevant to the facts of your case. A section entitled "Other Terms" is available for you

to identify unique issues that you may have in your case. If you need more space than is provided, attach

additional pages to the form. Any additional pages must include notarized signatures.

This is a

Full Parenting Plan or a Partial Parenting Plan. If this is a partial plan, please complete and file

with the Court JDF 1129 – Pretrial Statement to identify issues that you have not agreed on. This is a required

form if you have any issues that you cannot agree on.

The Petitioner is the child(ren)’s:

Father Mother Other Party (state relationship to child(ren)

__________________________

The Co-Petitioner/Respondent is the child(ren)’s: Father Mother Other Party (state relationship to

child(ren)

________________________

The child(ren) are:

Full Name of Child

Present Address Sex Date of Birth

JDF 1113 R7/06 PARENTING PLAN Page 2 of 7

Section 1: Allocation of Parental Responsibilities (Decision-making)

1. The parties understand that day-to-day decisions such as minor training or correction, minor medical and

dental care, curfew, chores, allowance, clothing, hygiene, etc. will be made by the party who has the

child(ren) at the time such decisions are necessary.

2. Each party will inform the other party of any changes with their address and/or phone numbers in advance.

3. Both parties will provide the names, addresses, and telephone numbers of all medical, dental, and mental

health care providers. Either party may authorize emergency care, but if possible both parties agree to

contact the other party first.

4. Unless otherwise provided by the Court, state law provides that both parties have access to the records of the

child(ren) including school, medical, dental, and mental health records, pursuant to §14-10-123.8, C.R.S.

5. The child(ren) identified above have lived in Colorado for the last six months or since birth if under six months

of age.

Yes No If No, please explain: ___________________________________________________

We have identified below whether the major decisions (Education, Medical/Dental Mental Health, and Religious)

will be joint or will be made by one party.

Type of Major Decision-Making

Joint Father Mother Other Party

Educational

   

Medical/Dental/Mental Health

   

Religious

   

Other (please identify below):

   

Other (please identify below):

   

Other (please identify below):

   

Other (please identify below):

   

Section 2: Allocation of Parental Responsibilities (Parenting Time)

Parties are encouraged to create a Parenting Plan that meets the needs of the child(ren) and individual

needs of their family. If you have any unique issues, please identify them under “other” or provide an

attachment to this parenting plan. If a party fails to comply with a provision of this plan, child support is

not affected.

A. Parenting Time

The child(ren) named in this plan reside the majority of the time with: (check one)

Father Mother Other Party

When the child(ren) is/are not with the party listed above, parenting time will be exercised by the other party.

Drop off times and location shall be identified as necessary. If the table below does not accommodate your

schedule, please attach a calendar or other document.

JDF 1113 R7/06 PARENTING PLAN Page 3 of 7

Check the appropriate box “Father”, “Mother” or “Other” = “Other Party” for who will be caring for the

child(ren).

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Week 1

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Week 2

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Father

Mother

Other

Drop off Time:

Indicate a.m.

or p.m.

Drop off

location:

 Other: _________________________________________________________________________________

_______________________________________________________________________________________

B. Travel and Vacation Plans

 The parties agree that should either of them require out-of-state or any type of overnight travel with the

child(ren), each party will inform the other party of such travel and vacation plans, including notice and contact

information.

 Other: _________________________________________________________________________________

_______________________________________________________________________________________

C. Holidays and Special Occasions

The following schedule will take priority over the regular weekday and weekend schedule in Section A. Please

check all that apply and indicate the time and place of exchange, which party the child(ren) will spend time with,

and the schedule, i.e. even/odd/all years, alternating events, etc. Identify any unique situations under “Other”.

Event Name of party spending

time with child(ren)

Odd

years

Even

years

All

Years

Time & Place of

exchange

 Spring Break

 Mother’s Day

 Memorial Day

 Father’s Day

JDF 1113 R7/06 PARENTING PLAN Page 4 of 7

Event Name of party spending

time with child(ren)

Odd

years

Even

years

All

Years

Time & Place of

exchange

 July 4

th

 Labor Day

 Thanksgiving Break

 Winter Break

 Summer Break

 Children’s Birthdays

 Other (Identify)

 Other parenting time arrangements:

_______________________________________________________________________________________

Section 3: Relocation

Relocation refers to moving the child(ren)’s residence so that the geographic ties between the child(ren) and the

other parent are substantially changed requiring a modification of allocation of parental responsibilities (decision-

making and parenting time). The parties understand that after the Decree or Order is issued, if a party wants to

relocate, he/she must file a Motion with the Court, pursuant to §14-10-129, C.R.S. and obtain court permission to

relocate.

The

Father Mother Other Party is planning to relocate with the child(ren) to

____________________________________ (identify city/state) on ______________________ (date) and we

have agreed to the following terms:

__________________________________________________________________________________________

JDF 1113 R7/06 PARENTING PLAN Page 5 of 7

Section 4: Financial Obligations for the Benefit of the Child(ren)

A. Child Support

 Child Support Payment Agreement:

1. The Father Mother shall pay child support to the Father Mother Other Party in the sum of $

____________ per month beginning on ___________________________ (date).

2. Child support payments shall be paid: (check one)

 To the Family Support Registry (FSR), P. O. Box 2171, Denver, CO 80201-2171.

 Directly to the Father Mother Other Party

3. Child support payments shall be paid: (check one)

weekly bi-weekly twice a month monthly Other: _________________________________

 Child Support shall be paid per a previously issued Administrative Order in _________________________

(case number) issued on _______________________ (date) in ____________________________ (County).

 The attached Child Support Worksheet reflects an amount of child support of $_____________ per month.

 The amount of child support agreed to by the parties is based upon the Child Support Worksheet.

or

 The amount of child support agreed to by the parties is not based upon the Child Support Worksheet.

Please identify the amount and the reasons why you agree to deviate from the amount identified in the

Child Support Worksheet. (The Court must approve any deviation from the guideline amount and

will do so only for compelling reasons.)

____________________________________________________________________________________

It is the responsibility of the Obligee (the person receiving the payment) to complete the appropriate

forms to activate an income assignment, pursuant to §14-14-111.5(3)(a)(II), C.R.S. Please see JDF 1801 –

Instructions, if applicable.

B. Medical, Dental, Vision, and Mental Health Insurance and Extraordinary/Out-of

Pocket Medical Expenses

 Father shall provide medical dental vision mental health insurance for the child(ren). If not all

children, please identify the names of the children the Father will be providing insurance for:

_________________________________________

and/or

 Mother shall provide medical dental vision mental health insurance for the child(ren). If not all

children, please identify the names of the children the Mother will be providing insurance for:

_________________________________________

and/or

 ________________________________ (name of party) shall provide medical dental vision mental

health insurance for the child(ren). If not all children, please identify the names of the children that this party

will be providing insurance for: _________________________________________

 Extraordinary Medical Expenses are defined as uninsured expenses, including co-payments and deductible

amounts in excess of $250.00 per child per calendar year. Note: The first $250.00 is the responsibility of the

person receiving the child support. The parties agree that extraordinary medical, dental, vision, or mental

JDF 1113 R7/06 PARENTING PLAN Page 6 of 7

health expenses for the child(ren) shall be divided with the Father paying ___________ %, the Mother paying

____________%, and the Other Party paying _____________%.



Other: _______________________________________________________________________________

_____________________________________________________________________________________

A “Notice to Employer to Deduct for Health Insurance” (JDF 1809) can be completed by the Obligee

(person receiving) and served upon the Obligor (person paying) and Obligor’s employer.

C. Extraordinary Expenses (Post-Secondary education, school/sport activities, etc.)

You may use this section to document any agreements made between the parties that are not required by law to

be addressed such as post-secondary education, automobile access or insurance, or any other agreements

affecting the general welfare of the child(ren). NOTE: Agreements made under this provision, if approved by

the Court and made a part of the Decree or Order, become enforceable by the Court.

 The parties agree to the following:

_______________________________________________________________________________________

Section 5: Child Tax Deduction

Only one party may claim a deduction for each child on his/her income tax return. Both parties agree to prepare

appropriate IRS forms, for example, Form 8332 “Release of Claim to Exemption for Child of Divorced or

Separated Parents” IRS link to forms: http://www.irs.gov/formspubs/index.html

The dependency exemptions(s), pursuant to §14-10-115(14.5), C.R.S., shall be as follows:

“F” = Father “M” = Mother “O” = Other party

Full Name of Child

Deduction to be

claimed every year

by:

Deduction to be

claimed during odd

years

Deduction to be

claimed during even

years

F M O F M O F M O

 Other: _________________________________________________________________________________

_______________________________________________________________________________________

Section 6: Other Terms

If the parties cannot reach an agreement in the future on any issues involving the child(ren), they agree to enter

into

mediation arbitration at their own cost. Yes, we agree. No, we do not agree.

JDF 1113 R7/06 PARENTING PLAN Page 7 of 7

 Identify below any issues not already identified in this agreement.

_______________________________________________________________________________________

Minor changes may be made at any time if both parties agree to the changes. A written

agreement to modify child support, the primary caretaking party, or other substantial changes

to the parenting plan should be filed with the Court along with a proposed order for the Court to

approve the modification.

Please re-read this document carefully to make sure it accurately reflects your entire agreement. Items

agreed upon outside of this document may not be enforceable.

Your signature below indicates that you have read, understand, and agree with all terms of this

agreement. This document should be signed in the presence of a notary public or court clerk.

___________________________________ ____________________________________________

Petitioner’s Signature Date Co-Petitioner’s Respondent’s Signature Date

___________________________________ ____________________________________________

Signature of Attorney, if applicable Date Signature of Attorney, if applicable Date

___________________________________ ____________________________________________

Petitioner’s Address Co-Petitioner/Respondent’s Address

___________________________________ ____________________________________________

City, State, Zip Code City, State, Zip Code

___________________________________ ____________________________________________

(Area Code) Home Telephone Number (Area Code) Home Telephone Number

___________________________________ ____________________________________________

(Area Code) Work Telephone Number (Area Code) Work Telephone Number

Subscribed and affirmed, or sworn to before me Subscribed and affirmed, or sworn to before me

in the County of ________________________, in the County of _________________________,

State of ____________________, this _______ State of ____________________, this ________

day of ________________, 20 ____. day of ________________, 20 ____.

My Commission Expires: _________________ My Commission Expires: ___________________

_____________________________________ ________________________________________

Notary Public/Clerk Notary Public/Clerk

Fillable Printable Parenting Plan Template - Colorado

Fillable Printable Parenting Plan Template - Colorado

Parenting Plan Template - Colorado