Fillable Printable Parenting Plan Template - Colorado
Fillable Printable Parenting Plan Template - Colorado
Parenting Plan Template - Colorado
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 (Identify)
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
F M O F M O F M O
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
