Fillable Printable Relocation or Long Distance Parenting Plan - Florida

Relocation or Long Distance Parenting Plan - Florida

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting

Plan (09/10)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.995(c), RELOCATION/LONG DISTANCE PARENTING PLAN

(09/10)

When should this form be used?

A Parenting Plan is required in all cases involving time-sharing with minor child(ren), even when time-

sharing is not in dispute. The Parenting Plan must be developed and agreed to by the parents and every

other person entitled to access or time-sharing with the child(ren) and approved by the court. “Other

Person” means an individual who is not the parent, but with whom the child resides pursuant to court

order, or who has the right of access to, time-sharing with or visitation with the child(ren). If the parties

cannot agree to a Parenting Plan or if the parents agreed to a Plan that is not approved by the court, a

Parenting Plan will be established by the court with or without the use of Parenting Plan

Recommendations.

This form or a similar form should be used in the development of a Parenting Plan when you are

planning to relocate your or the child(ren)’s principal residence more than 50 miles from the principal

place of residence:

 at the time of the last order either establishing or modifying time-sharing, or

 at the time of filing the pending action to either establish or modify time-sharing

This form should be typed or printed in black ink. If an agreement has been reached, both parties must

sign the Parenting Plan and have their signatures witnessed by a notary public or deputy clerk. After

completing this form, you should file the original with the clerk of the circuit court in the county where

the petition was filed and keep a copy for your records. You should then refer to the instructions for

your petition, answer, or answer and counterpetition concerning the procedures for setting a hearing or

trial (final hearing). If an agreed Parenting Plan is not filed by the parties, the Court shall establish a

Plan.

Where can I look for more information?

Before proceeding, you should read “General Information for Self-Represented Litigants” found at the

beginning of these forms. The words that are in “bold underline” in these instructions are defined

there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition

and/or answer that were filed in this case.

Special notes...

At a minimum, the Relocation/Long Distance Parenting Plan must describe in adequate detail:

 How the parties will share and be responsible for the daily tasks associated with the upbringing of

the child(ren),

 The time-sharing schedule that specifies the time that the minor child(ren) will spend with each

parent and every other person entitled to access or time-sharing,

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting

Plan (09/10)

 A designation of who will be responsible for any and all forms of health care, school-related matters,

including the address to be used for school-boundary determination and registration, other

activities,

 The methods and technologies that the parties will use to communicate with the child(ren), and

 Any transportation arrangements related to access or time-sharing.

The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the

Parenting Plan, all circumstances between the parties, including the parties’ historic relationship,

domestic violence, and other factors must be taken into consideration. Determination of the best

interests of the child(ren) shall be made by evaluating all of the factors affecting the welfare and interest

of the particular minor child(ren) and the circumstances of the family as listed in section 61.13(3),

Florida Statutes, including, but not limited to:

 The demonstrated capacity and disposition of each party to facilitate and encourage a close and

continuing parent-child relationship, to honor the time-sharing schedule, and to be reasonable

when changes are required;

 The anticipated division of parental responsibilities after the litigation, including the extent to which

parental responsibilities will be delegated to third parties;

 The demonstrated capacity and disposition of each party to determine, consider, and act upon the

needs of the child(ren) as opposed to the needs or desires of the parent;

 The length of time the child(ren) has lived in a stable, satisfactory environment and the desirability

of maintaining continuity;

 The geographic viability of the parenting plan, with special attention paid to the needs of school-age

children and the amount of time to be spent traveling to effectuate the parenting plan. This factor

does not create a presumption for or against relocation of either party with a child(ren);

 The moral fitness of the parties;

 The mental and physical health of the parties;

 The home, school, and community record of the child(ren);

 The reasonable preference of the child(ren), if the court deems the child(ren) to be of sufficient

intelligence, understanding, and experience to express a preference;

 The demonstrated knowledge, capacity, and disposition of each party to be informed of the

circumstances of the minor child(ren), including, but not limited to, the child(ren)’s friends, teachers,

medical care providers, daily activities, and favorite things;

 The demonstrated capacity and disposition of each party to provide a consistent routine for the

child(ren), such as discipline, and daily schedules for homework, meals, and bedtime;

 The demonstrated capacity of each party to communicate with and keep the other part(y)ies

informed of issues and activities regarding the minor child(ren), and the willingness of each party to

adopt a unified front on all major issues when dealing with the child(ren);

 Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child neglect,

regardless of whether a prior or pending action relating to those issues has been brought. If the

court accepts evidence of prior or pending actions regarding domestic violence, sexual violence,

child abuse, child abandonment, or child neglect, the court must specifically acknowledge in writing

that such evidence was considered when evaluating the best interests of the child(ren);

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting

Plan (09/10)

 Evidence that any party has knowingly provided false information to the court regarding any prior or

pending action regarding domestic violence, sexual violence, child abuse, child abandonment, or

child neglect;

 The particular parenting tasks customarily performed by each patty and the division of parental

responsibilities before the institution of litigation and during the pending litigation, including the

extent to which parenting responsibilities were undertaken by third parties;

 The demonstrated capacity and disposition of each party to participate and be involved in the

child(ren)’s school and extracurricular activities;

 The demonstrated capacity and disposition of each party to maintain an environment for the

child(ren) which is free from substance abuse;

 The capacity and disposition of each party to protect the child(ren) from the ongoing litigation as

demonstrated by not discussing the litigation with the child(ren), not sharing documents or

electronic media related to the litigation with the child(ren), and refraining from disparaging

comments about any other party to the child)ren); and

 The developmental stages and needs of the child(ren) and the demonstrated capacity and

disposition of each party to meet the child(ren)’s developmental needs.

This standard form does not include every possible issue that may be relevant to the facts of your case.

The Parenting Plan should be as detailed as possible to address the time-sharing schedule. Additional

provisions should be added to address all of the relevant factors. The parties should give special

consideration to the age and needs of each child.

In developing the Parenting Plan, you may wish to consult or review other materials which are available

at your local library, law library or through national and state family organizations.

Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill out

these forms, that person must give you a copy of a Disclosure from Nonlawyer, Florida Family Law Rules

of Procedure Form 12.900 (a), before he or she helps you. A nonlawyer helping you fill out these forms

also must put his or her name, address, and telephone number on the bottom of the last page of every

form he or she helps you complete.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,

IN AND FOR ______________________________ COUNTY, FLORIDA

Case No: __________________

Division: __________________

_________________________________,

Petitioner,

And

_________________________________,

Respondent.

RELOCATION/LONG-DISTANCE PARENTING PLAN

This parenting plan is: (Choose only one)

[ ] A Parenting Plan submitted to the court with the agreement of the parties.

[ ] A proposed Parenting Plan submitted by or on behalf of:

{Name of Parent or Other Person}____________________________________________.

[ ] A Parenting Plan established by the court.

This parenting plan is: (Choose only one)

[ ] A final Parenting Plan established by the court.

[ ] A temporary Parenting Plan established by the court.

[ ] A modification of a prior final Parenting Plan or prior final order.

I. PARTIES

Mother

Name:__________________________________________________________________

Address: ________________________________________________________________

Telephone Number: _______________________________________________________

E-Mail: _________________________________________________________________

Father

Name:__________________________________________________________________

Address: ________________________________________________________________

Telephone Number: _______________________________________________________

E-Mail: _________________________________________________________________

Other Person {If Applicable}

Name:___________________________________________________________________

Address:_________________________________________________________________

Telephone Number_________________________________________________________

E-mail:___________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

II. CHILDREN: This parenting plan is for the following child(ren):

{Add additional lines as needed}

Name(s) Birth Date(s)

___________________________________________________________________________

III. JURISDICTION

The United States is the country of habitual residence of the child(ren).

The State of Florida is the child(ren)’s home state for the purposes of the Uniform Child

Custody Jurisdiction and Enforcement Act.

This Parenting Plan is a child custody determination for the purposes of the Uniform Child

Custody Jurisdiction and Enforcement Act, the International Child Abduction Remedies Act,

42 U.S.C. Sections 11601 et seq., the Parental Kidnapping Prevention Act, and the

Convention on the Civil Aspects of International Child Abduction enacted at the Hague on

October 25, 1980, and for all other state and federal laws.

Other: _____________________________________________________________________.

IV. PARENTAL RESPONSIBILITY AND DECISION MAKING

1. Parental Responsibility (Choose only one)

[ ] Shared Parental Responsibility.

It is in the best interests of the child(ren) that the parties confer and jointly

make all major decisions affecting the welfare of the child(ren). Major decisions

include, but are not limited to, decisions about the child(ren)’s education,

healthcare, and other responsibilities unique to this family.

[ ] Shared Parental Responsibility with Decision Making Authority

It is in the best interests of the child(ren) that the parties confer and attempt to

agree on the major decisions involving the child(ren). If the parties are unable

to agree, the authority for making major decisions regarding the child(ren) shall

be as follows:

Education/Academic decisions [ ] Mother [ ] Father [ ] Other Person

Non-emergency health care [ ] Mother [ ] Father [ ] Other Person

___________________________ [ ] Mother [ ] Father [ ] Other Person

__________________________ _ [ ] Mother [ ] Father [ ] Other Person

___________________________ [ ] Mother [ ] Father [ ] Other Person

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

[ ] Sole Parental Responsibility:

It is in the best interests of the child(ren) that the [ ] Mother [ ] Father [ ]

Other Person shall have sole authority to make major decisions for the

child(ren.) It is detrimental to the child(ren) for the parties to share decision

making.

2. Day-to-Day Decisions

Unless otherwise specified in this plan, each party shall make decisions regarding day-

to-day care and control of each child, including the performance of daily tasks, while the

child is with that party. Regardless of the allocation of decision making in the Parenting

Plan, any party may make emergency decisions affecting the health or safety of the

child(ren) when the child is residing with that party. A party who makes an emergency

decision shall share the decision with the other party as soon as reasonably possible.

3. Extracurricular Activities ( Choose all that apply)

[ ] Any party may register the child(ren) and allow them to participate in the

activity of the child(ren)’s choice.

[ ] The parties must mutually agree to all extracurricular activities.

[ ] The party with the minor child(ren) shall transport the minor child(ren) to

and/or from all mutually agreed upon extra-curricular activities, providing all

necessary uniforms and equipment within the party’s possession.

[ ] The costs of the extracurricular activities shall be paid by:

Mother _______% Father ________ %

[ ] The uniforms and equipment required for the extracurricular activities shall be

paid by:

Mother _______ % Father _________%

[ ] Other: _____________________________________________________ .

V. INFORMATION SHARING. Unless Otherwise Indicated or Ordered by the Court:

1. Unless otherwise prohibited by law, the parties shall have access to medical and school

records, and information pertaining to the child(ren), and shall be permitted to

independently consult with any and all professionals involved with the child(ren). The

parties shall cooperate with each other in sharing information related to the health,

education, and welfare of the child(ren) and they shall sign any necessary

documentation ensuring that all parties have access to said records.

2. Each party shall be responsible for obtaining records and reports directly from the

school and health care providers.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

3. The parties have equal rights to inspect and receive governmental agency and law

enforcement records concerning the child(ren).

4. The parties shall have equal and independent authority to confer with the child(ren)’s

school, day care, health care providers, and other programs with regard to the

child(ren)’s educational, emotional, and social progress.

5. The parties shall be listed as “emergency contacts” for the child(ren).

6. Each party has a continuing responsibility to provide a residential and mailing address,

and contact telephone number (s) to the other parties. Each party shall notify the other

parties in writing within 24 hours of any changes. Each party shall notify the court in

writing within seven (7) days of any changes.

7. Other: _________________________________________________________________

_______________________________________________________________________.

VI. SCHEDULING

1. School Calendar

If necessary, on or before ______________ of each year, the parties should obtain a

copy of the school calendar for the next school year. The parties shall discuss the

calendars and the time-sharing schedule so that any differences or questions can be

resolved.

The parties shall follow the school calendar of: (Choose all that apply)

[ ] the oldest child

[ ] the youngest child

[ ] the school calendar for ______________ County

[ ] the school calendar for _________________ School

2. Academic Break Definition

When defining academic break periods, the period shall begin at the end of the last

scheduled day of classes before the holiday or break and shall end on the first day of

regularly scheduled classes after the holiday or break.

3. Schedule Changes (Choose all that apply)

[ ] A party making a request for a schedule change will make the request as soon as

possible, but in any event, except in cases of emergency, no less than

_____________________________________ before the change is to occur.

[ ] A party requesting a change of schedule shall be responsible for any additional

child care, or transportation costs caused by the change.

[ ] Other ______________________________________________________.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

VII. TIME-SHARING SCHEDULE

1. Weekday and Weekend Schedule

The following schedule shall apply beginning on ________________________ with the

[ ] Mother [ ] Father [ ] {If Applicable} Other Person and continue as follows:

A. The child(ren) shall spend time with the Mother on the following dates and times:

WEEKENDS: [ ] Every [ ] Every Other [ ] Other {Specify} _____________

From ____________________________to __________________________

WEEKDAYS: {Specify days} _______________________________________

From _____________________________ to _________________________

OTHER: {Specify} _______________________________________________

______________________________________________________________

B. The child(ren) shall spend time with the Father on the following dates and times:

WEEKENDS: [ ] Every [ ] Every Other [ ] Other {Specify} ______________

From____________________________ to ___________________________

WEEKDAYS: {Specify days} ________________________________________

From _____________________________ to __________________________

OTHER: {Specify _________________________________________________

_______________________________________________________________

C. The child(ren) shall spend time with the Other Person {If Applicable} on the

following dates and times:

WEEKENDS: [ ] Every [ ] Every Other [ ] Other {Specify} ____________

From _____________________________to __________________________

WEEKDAYS: {Specify Days}________________________________________

From _____________________________to __________________________

OTHER: {Specify} ________________________________________________

______________________________________________________________

D. Please indicate if there is a different time sharing schedule for any child. Complete

a separate Attachment for each child for whom there is a different time sharing

schedule.

[ ] There is a different time-sharing schedule for the following child(ren) in

Attachment _____.

______________________________, and _________________________.

{Name of Child} {Name of Child}

2. Holiday Schedule (Choose only one)

[ ] No holiday time sharing shall apply. The regular time-sharing schedule set forth

above shall apply.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

[ ] Holiday time-sharing shall be as the parties agree.

[ ] Holiday time-sharing shall be in accordance with the following schedule. The

Holiday schedule will take priority over the regular weekday, weekend, and

summer schedules. Fill in the blanks with Mother, Father, or

{If Applicable} Other Person to indicate where the child(ren) will be for the

holidays. Provide the beginning and ending times. If a holiday is not specified as

even, odd, or every year with one party, then the child(ren) will remain with the

other party in accordance with the regular schedule

Holidays Even Years Odd Years Every Year Begin/End Time

Mother’s Day __________ _________ __________ _________________

Father’s Day __________ _________ __________ _________________

President’s Day __________ _________ __________ _________________

Martin Luther King Day __________ _________ __________ _________________

Easter __________ _________ __________ _________________

Passover __________ _________ __________ _________________

Memorial Day Weekend __________ _________ __________ _________________

of July __________ _________ __________ _________________

Labor Day Weekend __________ _________ __________ _________________

Columbus Day Weekend _________ _________ __________ _________________

Halloween __________ _________ __________ _________________

Thanksgiving __________ _________ __________ _________________

Veteran’s Day __________ _________ __________ _________________

Hanukkah __________ _________ __________ _________________

Yom Kippur __________ _________ __________ _________________

Rosh Hashanah __________ _________ __________ _________________

Child(ren)’s Birthdays __________ _________ __________ _________________

_______________ __________ _________ __________ _________________

This holiday schedule may affect the regular time-sharing schedule. Parties may wish to

specify one or more of the following options:

[ ] When the parties are using an alternating weekend plan and the holiday

schedule would result in one party having the child(ren) for three weekends in a

row, the parties will exchange the following weekend, so that each has two

weekends in a row before the regular alternating weekend pattern resumes.

[ ] If a party has the child(ren) on a weekend immediately before or after an

unspecified holiday or non-school day, they shall have the child(ren) for the

holiday or non-school day.

3. Winter Break

A. Winter Break (Choose only one)

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

[ ] The [ ] Mother [ ] Father [ ] {If Applicable} Other Person shall have the

child(ren) from the day and time school is dismissed until December ____ at

____ a.m./p. m in [ ] odd-numbered years [ ] even-numbered years [ ]

every year. The other party will have the child(ren) for the second portion

of the Winter Break. The parties shall alternate the arrangement each year.

[ ] The [ ] Mother [ ] Father [ ] {If Applicable} Other Person shall have the

child(ren) for the entire Winter Break during [ ] odd-numbered years

[ ] even-numbered years [ ] every year

[ ] Other:_________________________________________________________

______________________________________________________________

B. Specific Winter Holidays

If not addressed above, the specific Winter Holidays such as Christmas, New Year’s

Eve, Hanukkah, Kwanzaa, etc. shall be shared as follows:

____________________________________________________________________

____________________________________________________________________.

4. Spring Break (Choose only one)

[ ] The parties shall follow the regular schedule.

[ ] The parties shall alternate the entire Spring Break with the [ ] Mother

[ ] Father [ ] {If Applicable} Other Person having the child(ren) during the

[ ] odd-numbered [ ] even-numbered years

[ ] The [ ] Father [ ] Mother [ ] {If Applicable} Other Person shall have the

child(ren) for the entire Spring Break every year.

[ ] The Spring Break will be evenly divided. The first half of the Spring Break will go

to the party whose regularly scheduled weekend falls on the first half and the

second half going to the party whose weekend falls during the second half.

[ ] Other: __________________________________________________________.

5. Summer Break (Choose only one)

[ ] The parents shall follow the regular schedule through the summer.

[ ] The [ ] Mother [ ] Father [ ] {If Applicable} Other Person shall have the entire

Summer Break from _____________________________after school is out until

____________________ before school starts.

[ ] The parties shall equally divide the Summer Break as follows:

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan

(09/10)

_________________________________________________________________

[ ] Other: ___________________________________________________________

_________________________________________________________________.

6. Number of Overnights:

Based upon the time-sharing schedule, the Mother has a total of _____ overnights per

year, the Father has a total of ____ overnights per year and {If Applicable} the Other

Person has a total of _____ overnights per year. Note: The total of these numbers must

equal 365.

7. [ ] If not set forth above, the parties shall have time-sharing in accordance with the

schedule which is attached as Attachment ______and incorporated herein.

VIII. TRANSPORTATION AND EXCHANGE OF CHILD(REN)

The parties shall have the child(ren) ready on time with sufficient clothing packed and ready

at the agreed upon time of exchange. All necessary information and medicines will

accompany the child(ren).

The parties shall exchange travel information and finalize travel plans at least ______days in

advance of the date of travel. Except in cases of emergency, any party requesting a change

of travel plans after the date of finalization shall be solely responsible for any additional

costs.

1. Automobile Transportation and Exchange (Choose only one)

If a party is more than _____minutes late without contacting the other party to make

other arrangements, the party with the child(ren) may proceed with other plans and

activities.

[ ] The [ ] Mother [ ] Father [ ] {If Applicable} Other Person shall provide all

transportation.

[ ] The [ ] Mother [ ] Father [ ] {If Applicable} Other Person shall pick up the

child(ren) at the beginning of the visit and the other party shall pick up the

child(ren) at the end of the visit. The exchange shall take place:

[ ] At the parties’ homes unless otherwise agreed

[ ] At the following location unless the parties agree in advance to a different

location:_________________________________________________________.

[ ] The parties shall meet at the following central

location:__________________________________________________________

_________________________________________________________.