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Fillable Printable Sample Blank Parenting Plan - Florida

Fillable Printable Sample Blank Parenting Plan - Florida

Sample Blank Parenting Plan - Florida

Sample Blank Parenting Plan - Florida

Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FOR COUNTY, FLORIDA
Case No.:
Division:
Petitioner,
and
Respondent.
/
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:
{Parent’s Name}_______________________________________________.
[ ] 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. PARENTS
Mother
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ______________________________________________________
E-Mail: _________________________________________________________________
Father
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ______________________________________________________
E-Mail: _________________________________________________________________
II. CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties:
(add additional lines as needed)
Name Date of Birth Sex
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
_______________________________________________________________________
_______________________________________________________________________
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 parents 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.
OR
[ ] Shared Parental Responsibility with Decision Making Authority
It is in the best interests of the child(ren) that the parents confer and attempt to agree
on the major decisions involving the child(ren). If the parents are unable to agree, the
authority for making major decisions regarding the child(ren) shall be as follows:
Education/Academic decisions [ ] Mother [ ] Father
Non-emergency health care [ ] Mother [ ] Father
___________________________ [ ] Mother [ ] Father
___________________________ [ ] Mother [ ] Father
___________________________ [ ] Mother [ ] Father
OR
[ ] Sole Parental Responsibility:
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
It is in the best interests of the child(ren) that the [ ] Mother [ ] Father shall have sole
authority to make major decisions for the child(ren.)
2. Day-to-Day Decisions
Each parent shall make decisions regarding day-to-day care and control of each child while
the child is with that parent. Regardless of the allocation of decision making in the
parenting plan, either parent may make emergency decisions affecting the health or safety
of the child(ren) when the child is residing with that parent. A parent who makes an
emergency decision shall share the decision with the other parent as soon as reasonably
possible.
3. Extra-curricular Activities ( Choose all that apply)
[ ] Either parent may register the child(ren) and allow them to participate in the activity of
the child(ren)’s choice.
[ ] The parents must mutually agree to all extra-curricular activities.
[ ] The parent 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 parent’s possession.
[ ] The costs of the extra-curricular activities shall be paid by:
Mother ______% Father __________ %
[ ] The uniforms and equipment required for the extra-curricular activities shall be paid by:
Mother _______ % Father ____________%
[ ] Other: _____________________________________________________ .
V. INFORMATION SHARING. Unless otherwise indicated or ordered by the Court:
Both parents shall have access to medical and school records pertaining to the child(ren) and
shall be permitted to independently consult with any and all professionals involved with the
child(ren). The parents 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 both parents have access to said records.
Each parent shall be responsible for obtaining records and reports directly from the school and
health care providers.
Both parents have equal rights to inspect and receive governmental agency and law
enforcement records concerning the child(ren).
Both parents shall have equal and independent authority to confer with the child(ren)’s
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
school, day care, health care providers, and other programs with regard to the child(ren)’s
educational, emotional, and social progress.
Both parents shall be listed as “emergency contacts” for the child(ren).
Each parent has a continuing responsibility to provide a residential, mailing, or contact address
and contact telephone number to the other parent. Each parent shall notify the other parent in
writing within 24 hours of any changes. Each parent shall notify the court in writing within seven
(7) days of any changes.
Other: _________________________________________________________________
________________________________________________________________.
VI. SCHEDULING
1. School Calendar
If necessary, on or before ______________ of each year, both parents should obtain a copy
of the school calendar for the next school year. The parents shall discuss the calendars and
the time-sharing schedule so that any differences or questions can be resolved.
The parents 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 start on the first day of
regularly scheduled classes after the holiday or break.
3. Schedule Changes (Choose all that apply)
[ ] A parent 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 parent requesting a change of schedule shall be responsible for any additional child
care, or transportation costs caused by the change.
[ ] Other ______________________________________________________.
VII. TIME-SHARING SCHEDULE
1. Weekday and Weekend Schedule
The following schedule shall apply beginning on ________________________ with the
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
[ ] Mother [ ] Father 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. Check box 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.
[ ] 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 or Father 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 parent, then the child(ren) will remain with the parent in
accordance with the regular schedule
Holidays Even Years Odd Years Every Year Begin/End Time
Mother’s Day __________ _________ __________ _________________
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
Father’s day __________ _________ __________ _________________
President’s Day __________ _________ __________ _________________
Martin Luther King Day __________ _________ __________ _________________
Easter __________ _________ __________ _________________
Passover __________ _________ __________ _________________
Memorial Day Weekend __________ _________ __________ _________________
4
th
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. Parents may wish to specify
one or more of the following options:
[ ] When the parents are using an alternating weekend plan and the holiday schedule
would result in one parent having the child(ren) for three weekends in a row, the
parents will exchange the following weekend, so that each has two weekends in a row
before the regular alternating weekend pattern resumes.
[ ] If a parent 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. Entire Winter Break (Choose only one)
[ ] The [ ] Mother [ ] Father 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 parent will have the children for the second
portion of the Winter Break. The parties shall alternative the arrangement each year.
[ ] The [ ] Mother [ ] Father shall have the child(ren) for the entire Winter Break during
[ ] odd-numbered years [ ] even-numbered years [ ] every year.
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
[ ] Other: ______________________________________________________________
______________________________________________________________
______________________________________________________________.
B. Specific Winter Holidays
If not addressed above, the specific Winter Holidays such as Christmas, New Year’s Eve,
Hanukkah, Kwanzaa, etc. and shall be shared as follows:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________.
4. Spring Break (Choose only one)
[ ] The parents shall follow the regular schedule.
[ ] The parents shall alternate the entire Spring Break with the Mother having the
child(ren) during the [ ]odd-numbered years [ ]even numbered years.
[ ] The [ ] Father [ ] Mother 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
parent whose regularly scheduled weekend falls on the first half and the second half
going to the parent 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 shall have the entire Summer Break from __________ after
school is out until _______________ before school starts.
[ ] The parents shall equally divide the Summer Break. During [ ] odd-numbered years
[ ] even numbered years, the [ ] Mother [ ] Father shall have the children from
________ after school is out until ________. The other parent shall have the child(ren)
for the second one-half of the summer break. The parents shall alternate the first and
second one-halves each year unless otherwise agreed. During the extended periods of
time-sharing, the other parent shall have the child(ren)
______________________________.
[ ] Other:__________________________________________________________________
_______________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
6. Number of Overnights:
Based upon the time-sharing schedule, the Mother has a total of _____ overnights per year
and the Father has a total of _____ overnights per year. Note: The two numbers must
equal 365.
7. [ ] If not set forth above, the parties shall have time-sharing in accordance with the
schedule which is attached and incorporated herein.
VIII. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
1. Transportation (Choose only one)
[ ] The [ ] Mother [ ] Father shall provide all transportation.
[ ] The parent beginning their time-sharing shall provide transportation for the child(ren).
[ ] The parent ending their time-sharing shall provide transportation for the child(ren).
[ ] Other: _________________________________________________________________.
2. Exchange (Choose only one)
Both parents shall have the child(ren) ready on time with sufficient clothing packed and
ready at the agreed upon time of exchange. If a parent is more than ______ minutes late
without contacting the other parent to make other arrangements, the parent with the
child(ren) may proceed with other plans and activities.
[ ] Exchanges shall be at Mother’s and Father’s homes unless both parents agree to a
different meeting place.
[ ] Exchanges shall occur at __________________________________________________
____________________________________________________________ unless both
parties agree in advance to a different meeting place.
[ ] Other: ________________________________________________________________.
3. Transportation Costs (Choose only one)
[ ] Transportation costs are included in the Child Support Worksheets and/or the Order for
Child Support and should not be included here.
[ ] The Mother shall pay ______% and the Father shall pay ______ % of the transportation
costs.
[ ] Other: __________________________________________________________________.
4. Foreign and Out-Of-State Travel (Choose only one)
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
[ ] Either parent may travel with the child(ren) during his/her time-sharing. The parent
traveling with the child(ren) shall give the other parent at least ____ days written notice
before traveling out of state unless there is an emergency, and shall provide the other
parent with a detailed itinerary, including locations and telephone numbers where the
child(ren) and parent can be reached at least ____ days before traveling.
[ ] Either parent may travel out of the country with the child(ren) during his/her time-
sharing. At least ___ days prior to traveling, the parent shall provide a detailed itinerary,
including locations, and telephone numbers where the child(ren) and parent may be
reached during the trip. Each parent agrees to provide whatever documentation is
necessary for the other parent to take the child(ren) out of the country.
[ ] If a parent wishes to travel out of the country with the child(ren), he/she shall provide
the following security for the return of the child _____________________________
_____________________________________________________________________.
[ ] Other ________________________________________________________________.
IX. EDUCATION
1. School designation. For purposes of school boundary determination and
registration, the
[ ] Mother’s * + Father’s address shall be designated.
2. (If Applicable) The following provisions are made regarding private or home
schooling:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________.
3. Other.
________________________________________________________________
________________________________________________________________
________________________________________________________________.
X. DESIGNATION FOR OTHER LEGAL PURPOSES
The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time with
the [ ] Mother [ ] Father. This majority designation is SOLELY for purposes of all other state
and federal laws which require such a designation. This designation does not affect either
parent’s rights and responsibilities under this parenting plan.
XI. COMMUNICATION
1. Between Parents
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
All communications regarding the child(ren) shall be between the parents. The parents shall
not use the child(ren) as messengers to convey information, ask questions, or set up
schedule changes.
The parents shall communicate with each other by: (Choose all that apply)
[ ] in person
[ ] by telephone
[ ] by letter
[ ] by e-mail
[ ] Other:__________________________________________________________________.
2. Between Parent and Child(ren)
Both parents shall keep contact information current. Telephone or other electronic
communication between the child(ren) and the other parent shall not be monitored by or
interrupted by the other parent. “Electronic communication” includes telephones,
electronic mail or e-mail, webcams, video-conferencing equipment and software or other
wired or wireless technologies or other means of communication to supplement face to face
contact.
The child(ren) may have [ ] telephone [ ] e-mail [ ] other electronic communication in the
form of ___________________________________ with the other parent: (Choose only one)
[ ] Anytime
[ ] Every day during the hours of ____________________ to ______________________.
[ ] On the following days____________________________________________________
during the hours of __________________________ to _________________________.
[ ] Other: ________________________________________________________________.
3. Costs of Electronic Communication shall be addressed as follows:
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________.
XII. CHILD CARE (Choose only one)
{ } Each parent may select appropriate child care providers
[ ] All child care providers must be agreed upon by both parents.
[ ] Each parent must offer the other parent the opportunity to care for the child(ren)
before using a child care provider for any period exceeding _______ hours.
[ ] Other ________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (03/09)
XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN
This Parenting Plan may be modified or varied on a temporary basis when both parents agree in
writing. When the parents do not agree, the Parenting Plan remains in effect until further order
of the court.
Any substantial changes to the Parenting Plan must be sought through the filing of a
supplemental petition for modification.
XIV. RELOCATION
Any relocation of the child(ren) is subject to and must be sought in compliance with section
61.13001, Florida Statutes.
XV. DISPUTES OR CONFLICT RESOLUTION
Parents shall attempt to cooperatively resolve any disputes which may arise over the terms of
the Parenting Plan. The parents may wish to use mediation or other dispute resolution methods
and assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court
action.
XVI. OTHER PROVISIONS
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________.
SIGNATURE OF PARENTS
I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this
Plan and intend to be bound by it.
Dated: _____________________________________________
Signature of Mother Printed Name: ___________________________
Address:
City, State, Zip:
Telephone Number:
Fax Number:
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