Fillable Printable Sample Parenting Plan Form - Texas
Fillable Printable Sample Parenting Plan Form - Texas
Sample Parenting Plan Form - Texas
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In the 219th Judicial District Court
of the State of Texas
Scott J. Becker, Judge Presiding
No.21
9 - ________________ - ____
In The Matter Of The Marriage Of / In The Interest Of
_______________________________
And
______________________________
PARENTING PLAN
This form may be used for several purposes. Please indicate below how this form is being
used:
A. This is a temporary plan permanent plan.
B. There are are not any remaining disputed issues concerning the
parenting plan. If disputed issues remain, please indicate the section number of
the disputed issue(s):
C. This is the parenting plan requested by _______________________________
If the opposing party does not agree with this plan , he/she should file a separate one
with the Court.
This form does not include every possible issue you may want to address. An "Other
Terms" section has been provided for items you would like to add. If you need more space
than is provided, attach additional pages to the form. If the form includes issues that do not
apply to your situation, write "Not Applicable" or "N/A" in that section. However, you must
submit to the Court some form of written Permanent Parenting Plan addressing all of the
issues which are relevan t 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.
SECTION 1. INFORMATION ABOUT THE CHILD(REN)
Name Present Address Sex Date of Birth
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SECTION 2. DECISION-MAKING
This parenting plan form reflects decision-making on major issues other than parenting time.
In this plan, major decision-making does not include day-to-day decisions, which may be
made by the current residential parent without the need to consult with the other parent,
unless you make such decisions a part of your plan. Day-to-day decisions include, but are not
limited to, minor training or correction, minor medical and dental care, curfew, chores,
allowance, day-to-day decisions about clothing or hygiene during the time the child is with
you.
The division of decision-making allows you to make several choices. You may decide that one
parent should make all of the major decisions alone, OR you may decide that you and the other
parent will make all major decisions together. The third option is to decide the major areas of
decis ion-making and to de cid e which parent will have the responsibility for which decision.
SELECT ONLY ONE OF THE THREE FOLLOWING OPTIONS:
Option One MAJOR DECISION-MAKING BY ONE PARENT ONLY
The Mother Father (check one) will make all of the major decisions regarding the
child(ren). You have now selected a decision-making plan. Go directly to complete Sections 3 -7
starting on page 4
Option Two ALL MAJOR DECISION-MAKING BY BOTH PARENTS
Both parties will make ALL major decisions regarding the child(ren) together. If the parents
cannot reach an agreement on a decision, then they shall use the dispute resolution procedures
in this parenting plan (Section 6). You have now selected a decision-making plan. Go dire ctly to
complete Sections 3 -7 starting on page 4
Option Three MAJOR DECISION-MAKING DIVIDED BETWEEN THE PARENTS
Complete A, B, C, D and E below before proceeding to compl ete Sections 3- 7
A. EDUCATIONAL DECISION-MAKING (includes daycare unless specifically
excluded)
The parents will make all major educational decisions together. If the parents do not reach an
agreement, then they shall use the dispute resolution procedure in this parenting plan.(Section 6)
The current enrollment of the children shall not be changed withou t joint agreement. The child(ren)
are currently enrolled as follows:
The Mother Father (check one) shall have the final decision-making responsibility
regarding all major education decisions. However, if such decision involves additional
expenses, the parties shall agree on the division of those expenses or, if they cannot agree,
shall use the dispute resolution procedure in this plan. (Section 6)
Both parents may participate in school conferences, events, and activities, and may consult
with teachers and other school personnel. For purposes of school attendance only, the child(ren)'s
legal residence will be with the Mother Father (check one).
Other arrangements as to edu cational decision-ma kin g:
The parents have no agreement on this issue.
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B. MEDICAL, DENTAL AND MENTAL HEALTH DECISION-MAKING
The parents will make the final decision regarding major medical/dental decisions for
the child(ren) together. If the parents do not reach an agreement, then they shall use the
dispute resolution procedures in this parentin g plan. (Sec tion 6)
The Mother Father (check one) shall have the final decision-making responsibility
regarding major medical/dental decisions for the child(ren). However, if such decision
involves additional expenses, the parties shall agree on the division of those expenses or, if
they cannot agree , shall use the dispute resolution procedure in this plan. (Section 6)
Both parents agree that, under emergency circumstances, it is sufficient for either party
to s i gn legal releases to get medical tr eatment or to take other necessary measures.
In the event of a dispute about the necessity of or type of medical treatment for the minor
child(ren), the parent in possession of the child shall be allowed to obtain necessary medical
treatment for the minor child(ren).
Both parents agree to advise/inform the other parent immediately regarding:
emergency medical/dental care sought for the child(ren)
names, addresses, and telephone numbers o f all medica l/mental health care practitioners
any health matter pertaining to the child(ren).
Other arrangements as to medical and/or dental decision-making:
The parents have no agreement on these issues.
C. RELIGIOUS DECISION-MAKING
The parents will make all major religious decisions for the child(ren) together. If the
parents do not reach an agreement, then they shall use the dispute resolution procedures in
this parenting plan.
The Mother Father (check one) will have the authority to make decisions concerning
th e re lig ious practices o f the child(r en) .
Other agreements regarding religious decisions:
The parents have no agreement on this issue.
D. EXTRACURRICULAR AND RECREATIONAL ACTIVITIES
The parents will make the final decision regarding extracurricular and recreational
a c t iv i t i e s together.
The Mother Father (check one) will have the right to make all decisions concerning
extracurricular and recreational activities for the child(ren). However, if such decision involves
additional expenses, the parties shall agree on the division of those expenses or, if they
cannot agree, shall use the dispute res olution pr oce dure in th is parenting plan. ( Section 6)
Each parent has final decision-making authority for activities that occur only during that
parent's parenting time and shall be solely responsible for transportation for and expenses of
participation in those ac tivities that occur on ly during tha t pare nt's paren ting time .
Each parent has final decision-making authority to enroll the child in _____ (number)
activities. Both parents will keep the other informed about the scheduled activities and will
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ensure that the child attend the ac tivities.
Other agreements regarding extracu rricu lar and recreationa l activities:
The parents have no agreement on this issue.
E. OTHER SIGNIFICANT DECISIONS (General Welfare, Driving, Car, Car Insurance,
College, etc.)
You may use this section to document any agreements made between the parties that are
no t required by law to be ad dressed 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 b y the court and made a part of
t h e f i n a l d e c r e e o f dissolution , become enforceable b y the court.
Choose one of the following to indicate how significant decisions other than those specified
in t h i s plan will be made:
The parents will make the final decision regarding other significant decisions
invo lving th e child(ren) together. If the parents do not reach an agreement, than they shall
use the dispute resolution procedure in this parenting plan.
The Mother Father (check one) shall have the final decision-making responsibility
regarding other significan t decisions regarding the child(ren).
The parents have no agreement on this issue.
Significant decisions to be made by th e par ties are: (attach extra sheets as necessary)
SECTION 3. FINANCIAL SUPPORT FOR CHILD(REN):
A. CHILD SUPPORT:
The
Mother Father will pay child support, in accordance with the Texas
Family Code Child Support Guidelines, in the amount of $__________________
per month Beginning the _____ day of _____________, 20___.
Deviations:
_______________________________________________________
A ‘Wage Withholding Order’ shall be i ssued in every case.
The parties affirmatively acknowledge that Court approval m ust be obtained before child support
can be reduced or modified, unless such payments are automatically reduced or terminated
under the terms of the Parenting Plan.
*ATTACH SWORN STATEMENT OF INCOME IF THIS IS A PROPOSED PLAN.
You should furnish information sufficient to accurately identify your income; and produce
complete unredacted copies of income tax returns for the past two years, a financial statement,
and pay stubs for the past three months.
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B. TAX DEDUCTION:
The
Mother Father shall receive the tax deduction for the child(ren), so
long as the child support is current on the 15
th
day of January of each year in:
alternate years starting ___________
each year
other: _________________________________________________________
There is no agreement. Federal regulations shall apply.
C. TAX RETURN NOTICE:
The parent(s) paying child support shall send to the other parent by or before
April 15 of every year [OR August 15, if an extension is sought], a copy of their
respective W-2(s), 1099(s), and the first two (2) pa ges of their tax return.
D. HEALTH INSURANCE:
The
Mother Father will maintain major medical/dental/hospital insurance
on the minor child(ren) and he/she shall provide proof of continuing coverage
annually.
Uncovered medical expenses, which include deductibles or co-payments,
eyeglasses, contact lens, routine annual physicals, will be paid by the:
Mother Father OR divided equally by the parties.
Other:
After insurance has paid its portion, the parent receiving the bill will send the bill
and Explanation of Benefits to the other parent within 10 days of the receipt of
the Explanation of Benefits. The other parent will pay his/her share within thirty
(30) days of receipt of the bill and Explanation of Benefits.
E. LIFE INSURANCE [OPTIONAL FOR PARENT NOT PAYING CHILD
SUPPORT]:
Father shall insure his own life in the minimum amount of $_____________,
whole or term.
Mother shall insure her ow n life in the minimum amount of $____________,
whole or term.
The policy(ies) shall name:
the other parent.
Other parent as trustee of the funds to serve without bond or accounting, as
beneficiary for the support of the children.
Other: ________________________________________________________
F. ORTHODONTIC CARE:
If available to either parent through their work, the
Mother Father will
maintain orthodontic care on the minor child(ren). Uncovered orthodontic
expenses will be paid by:
Mother Father divided equally by the parties.
SECTION 4. PARENTINGTIME
A. WEEKDAY AND WEEKEND SCHEDULE
The Mother Father (check one) will have possession of the child at all times except as
agreed between the parties and failing agreement, the other parent shall have possession of
the child(ren) dur ing the following per iods of paren ting time .
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Option One 1st, 3
rd
and 5
th
Fridays from after school 6:00 p.m. (check one)
until Sunday at 6:00 p.m. Monday at school (check one) and
Thursdays from after school 6:00 p.m. (check one)
until Thursday at 8:00 p.m. Friday at school (check one)
Option Two – (write your agreemen t or proposal here)
B. SUMMER SCHEDULE
The weekday and weekend schedule above will apply for all 12 calendar months, with
no s p e ci f i c changes during summer.
During the summer months, the child(ren) will be in care of the Father (list days of the
week and times):
During the summer months, the child(ren) will be in care of the Mother (list days of the
week and times):
During the summer months, the Mother Father (check one) will have the month of July;
the other parent will have all other summer days.
Other:
C. EXCHANGES.
Pick up at the beginning of possession shall be at Mother's Father's home.
Delivery at the end of possession shall be at Mother's Father's home.
Exchanges shall be at _________________________________
Exchanges shall occur on time. Each parent shall be on time for the drop off and pick up of the
child/ren and shall have the child/ren ready. 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 for the child/ren.
Each parent shall give the other parent information about the child/ren's homework, school
projects, appointments and activities that need attention while the child/ren is with the other
parent.
Each parent will talk to the other parent about the child/ren's sleep and eating schedule, any
medications or health matters and thei r general condition before exchanges.
When exchanging the child/ren the parents shall not discuss other issues nor fight, be
sarcastic or demonstrate anger during the exchange.
Other:
_____________________________________________________________________________
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D. RE-INVOLVING A PARENT.
Mother Father has not had frequent contact with our child(ren) for approximately
, and wishes to begin more
actively participating in our child(ren)'s life. To make this transition work for all of us,
we agree: (check all that apply)
We shall both seek counseling to assist us in helping the child(ren) with this
transition and to receive advice about how to make the transitio n work.
We shall begin contact with the child(ren) by having the following schedule of
contacts:
After the above schedule of contacts has been kept for (time),
we shall increase the time the child(ren) spend with the other parent to the
following schedule:
Other:
E. CHILD(REN)'S TRAVEL
The parents agree that should either of them travel away from home with the child(ren),
each parent will keep the other parent informed of travel plans, address(es), and telephone
number(s) where that p arent and th e child(r en) can be re ached.
The parents have additional travel agreements regarding the children as follows:
The parents have no agree ment on this issue .
F. AIRPLANE TRAVEL.
When the parents live in different communities where transportation will be by
airplane, the parents agree to assist their child(ren) by considering jet lag, settling
in times, and "best option in light of the price" schedules appropriate to our
child(ren)'s age and needs.
The parents shall split the cost of the travel for summer visitation as follows:
Mother will pay _____%, Father will pay _______%
Father Mother shall
purchase the ticket and the other parent shall reimburse within 30 days.
Transportation for other visits shall be paid by the away parent that does not live
in the same community as the child(ren).
Dad Mom shall purchase all roundtrip tickets for all trips and the other
parent shall reimburse half of the cost of the child(re n)'s ticket within 30 days.
The costs of roundtrip tickets shall b e paid by each parent as follows:
Summer Dad Mom
Spring Break Dad Mom
Winter Break/Christmas Dad Mom
Other: Dad Mom
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Iif a parent cannot financially pay for transportation, then the other parent has the
option of paying for the transportation for the visit to take place.
The child(ren) may miss school half-day 1 day 2 days, if they are
otherwise doing well in school, in order to accommodate travel arrangements and
be with the other parent for the following visitations:
Summer Spring Break
Winter Break
Other:
Other:
The parents will consult with each other about whether an escort is appropriate
for the child(ren) when they are going to be making an airplane trip and comply
with commercial airline regulation s.
G. HOLIDAYS, VACATIONS, SPECIAL OCCASIONS, AND RELIGIOUS EVENTS
The following schedule will take priority over the regular weekday, weekend, and summer
schedules discussed above. 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 .
Event Name of party spending
time with child(ren)
Odd
numbered
years
Even
numbered
years
Ail Years Time & Place of exchange
New Year's Eve
New Year's Day
Spring Vacation
Mother's Day
Memorial Day
Fathers Day
July 4th
Labor Day
Thanksgiving Break
Thanksgiving Day
Winter Break
Family Birthdays
Children's Parties
Religious Events
Holiday Events
The parents have no agreement on this issue.
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H. STANDARD PARENTING O RDERS:
Unless stated otherwise be l ow, both parents are entitled to the following rights:
1. To unimpeded telephone conversations with the child at least once each we ek at
reasonable times and for a reasonable duration;
2. To send mail to the child which the other parent shall not open and will not
censor;
3. To receive notice and relevant information as soon as practical (but within 24
hours) in the event of hospitalization, major illness, or death of the child;
4. To receive directly from the school, upon written request, which includes a
current mailing address and upon payment of rea son able costs of duplicating,
copies of the child’s repo rt cards, attendance re cords, names of teachers, class
schedules, standardized test scores, and any other records customarily made
available to parents;
5. Unless otherwise provided by law, the right to receive copies of the child’s
medical, health or other treatment records directly from the physician or health
care provider who provided such treatment or health care upon written req ue st
which contains a current mailing addre ss and u pon payment of reasonable costs
of duplication.
6. To be free of derogatory remarks made about such parent or such parent’s family
by the other parent to or in the presence of the child;
7. To be given at least forty-eight (48) hours notice, whenever possible, of all extra
curricular activities, and the opportunity to participate or ob serve, including, but
not limited to the following:
(i) School activities
(ii) Athletic activities
(iii) Church activities, and
(iv) Other activities as to which parental participation or observation
would be appropriate.
8. To receive from the other parent, in the event the other parent leaves the state
with the minor child(ren) for more than two (2) days, an itinerary includi ng
telephone numbers for use in the event of an emerge ncy.
9. Access and participation in education, including the right of access to the minor
child or children for lunch and other activities, on the same basis that is provided
to all parents, provided the participation or access is reasonable and does not
interfere with day-to-day operations or with the child’ s edu cational performance.
The following exceptions to the above standard o rd ers should apply:
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I. DOMICILE RESTRICTION
At the time of this agreement, the Mother Father neither parent is planning to relocate.
The children’s current residence is:
The domicile of children shall not be changed from Collin County or ___________ without the
written consent of both parents.
The parents have agreed on domicile and relo cation plan s for the child(ren) as follows:
The parents have not agreed on domicile restriction and relocation plans, and request that the
Court make that determination.
If the parents do not have a written agreement or Court Order, the child(ren) may not
move out of Co llin County, Texas unt il further order of t he Court. If Collin County is not
their current residence, the children may not be moved from their present residence
until further order of t he Cou rt.
J . ADDITIONAL ARRANGEMENTS (Check all that apply and fill in appropriate information.)
Each parent will inform the other parent of any changes of business or residential address
and / or phone number in advance
OR
within
__
_ days ___ weeks of the change.
Both parents will consult with one another in advance of any change to the schedule
tha t w oul d af fec t either p arent's access to the children. Without a signed agreement by both
parents, wi th copies to each, no such change which violates the Court O rder will be honored
by the Court.
Both parents agree that all communications regarding the child(ren) will be between the
parents and that they will not use the child(ren) to convey information or to set up visitation
changes.
Both parents agree that they will not belittle or criticize the other parent in front of the
child(ren).
SECTION 5. OTHER TERMS
Add any other items regarding the child(ren) you would like to include in your parenting
plan.
(Use additional sheets if necessary).
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SECTION 6. FUTURE CONFLICT RESOLUTION
If the parents cannot reach an agreement in the future on any issue involving the parenting
plan, they agree do not agree to enter into mediation arbitration.
If the paren ts ag ree, mediation and / or arbitration will b e con ducted by _______________________ .If that
mediator/arbitrator is unavailable, and the parents cannot agree on another mediator/arbitrator,
they will use__________________________. Any al t e r na t ive d i spute r e so l ution s h al l be pai d
____ % by _______________________________________________ (n a m e o f p a rty) and
____ % by________________________________________________ (name of party).
If the mediation fails, the final decision will be made by the Court.
SECTION 7. VERIFICATION AND ACKNOWLEDGEMENT
Your signature below Indicates that you have read and agree with everything in this plan. If
both parties agree to this plan, both parties must sign the same plan document. This
document must be signed in th e presence o f a Notary Public.
I swear/affirm under oath that I have read the foregoing document and that the information
and attachments provided, including income information, set forth therein is true, correct and
complete to the best of my knowledge .
______________________ ___ _____
Petitioner’s Signature Date
Subscribed and affirmed, or sworn to before me
Th i s _ _ _ d ay o f ____________ . 20 _______ .
My commission expires:
Notary Public/Clerk
______________________ ___ _____
Respondent’s Signature Date
Subscribed and affirmed, or sworn to before me
Th i s _ _ _ d a y of ___________ . 20 _______ .
My commission expires:
Notary Public/Clerk
