Fillable Printable Shared Parenting Plan
Fillable Printable Shared Parenting Plan
Shared Parenting Plan
Supreme Court of Ohio
Uniform Domestic Relations Form – 17
SHARED PARENTING P LAN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 1 of 14
IN THE CO URT OF COM MON PLE AS
Division
COUNTY, OHIO
IN THE MATTER OF:
A Minor
:
Plaintiff/Petitioner
:
Case No.
:
Street Address
:
:
Judge
City, State and Zip Code
:
vs./and
:
Magistrate
:
:
Defendant/Petitioner
:
:
Street Address
:
:
City, State and Zip Code
:
:
Instructions: The Parenting Time Schedule mus t be attached to this Plan. Parents are urged to consult the Planning
for Parenting Time Guide: Ohio’s Gui de for Parents Living Apart available at
http://www.supremecourt.ohio.gov/Publications/JCS/parentingGuide.pdf.
SHARED PARENTING P LAN
We, the parents,
, “Father”, and
,“Mother”,
have
(number) child(ren) born from or adopted during the marriage or relationship.
Of the child(ren),
(number) is/are emancipated adult(s) and not under any disability,
and the following
(number) child(ren) are mi nor child(ren) and/or mentally or physically
disabled child(ren) incapable of supporting or maintaining themselves (name and date of birth of each
child):
The parents agree to the care, parenting, and control of their child(ren) as provided in this
Shared Parenting Plan.
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 2 of 14
FIRST: PARENTS’ RIGHTS
The parents s ha ll ha ve:
A.
The right to participate in major decisions concerning the child(ren)'s health, social situation,
morals, welfar e, educ a tio n, and economic environment.
B.
The right to reasonable telephone contact with the child(ren) w hen they are with the other parent.
C.
The right to participate in the selection of doctors, psychologists, psychiatrists, hospitals, and
other health care providers for the child(ren).
D.
The right to authorize medical, surgical, hospital, dental, institutional, psychological and psychiatric
care for the child(ren) and obtain a second opinion regarding medical conditions or treatment.
E.
The right to be notified in case of an injury to or illness of the child(ren).
F.
The right to be present with the child(ren) at medical, dental and other health-related
examinations and treatments, includi ng, but not limited to psyc hol og ical and ps ych iatric care.
G.
The right to inspect and receive the child(ren)’s medical and dental records and the right
to consult with any treating physician, dentist and/or other health care provider, including but not
limited to psychologists and psychiatrists.
H.
The right to consult with school officials concerning the child(ren)'s welfare and educational
status, and the right to inspect and receive the child(ren)’s student records to the extent per mitted
by law.
I.
The right to receive copies of all school reports, calendars of school events, notices of parent-
teacher conf erenc es , an d school pr ograms.
J.
The right to attend and participate in parent-teacher conferences, school trips, school programs,
and other scho ol ac ti vities in which parents are inv ited to part icip ate.
K.
The right to attend and participate with the child(ren) in athletic programs and other extracurricular
activities.
L.
The right to receive notice of the other parent’s intention to relocate.
SECOND: ALLOCATION OF PARENTAL RIGHTS A ND RESPONSIBILITIES
A.
General Responsibilities
Each parent shall take all measures necessary to foster respect and affection between the
child(ren) and the other parent. Neither parent shall do anything that may estrange the child(ren)
from the other parent, or impair the child(ren)’s high regard for the other parent.
B.
Medic al Res po nsib il ities
A parent shall notify the other parent promptly if a child experiences a serious injury, has a serious
or chronic illness, or receives treatment in an emergency room or hospital. A parent shall notify
the other parent of the emergency, the child's status, locale, and any other pertinent information
as soon as practical, but in any event wi thin 24 hours.
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 3 of 14
The parents shall consult with each other about the child(ren)’s medical care needs and each shall
immediately notify the other parent about all major non-emergency medical decisions before
authorizing a course of treatment. Parents have a right to know the necessity for treatment,
proposed cost, and proposed payment schedule. Each parent may also secure an independent
evaluation at his/her expense to determine the necessity for treatment. If the parties cannot agree
regarding a course of treatment, the Father’s Mother’s (select one) decision shall control.
The parents shall provide the other with the names and telephone numbers of all health care
providers for the child(ren).
C.
Both parents have shared parenting of the child(ren) as specified in this Plan. Each parent,
regardless of where an individual child is residing at a particular point in time, as specified in this
Plan, is the “residential parent”, “the residential parent and leg al cust odi an” , or the “custodial parent”
of that child.
D.
Parenting Time Schedule
Unless otherwise agreed, the parents shall have parenting time with the child(ren) according to the
attached Parenting Time Schedule, which shows the times that the child(ren) shall be with each
parent on w eek da ys, weekends, holidays, and vacation times.
(The Parenting Time Schedule must be attached to this Plan.)
E.
School Designation
Father shall be designated as the residential parent for school attendance and enrollment
purposes of the following child(ren):
Mother shall be designated as the residential parent for school attendance and enrollment
purposes of the following child(ren):
In the event that a change in schools is being considered, after consultation with the other parent:
Father is authorized to change school placement of the foll owing child(ren):
Mother is authorized to change school placement of the following child(ren):
Without a written agreement or court order, neither parent is authorized to change school
placement of the following child(ren):
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 4 of 14
F.
Other orders:
G.
Pub lic Benefits
Father shall be designated as the residential parent for receipt of public benefits purposes of the
following child(ren):
Mother shall be designated as the residential parent for rec eipt of public benefits purposes of the
following child(ren):
H.
This designation of a particular parent as the residential parent for the purposes of determining
the school attendance and enrollment of the child(ren) or the receipt of public benefits of the
child(ren) does not affect the designation of each parent as the “residential parent,”
“residential parent and legal custodian,” or the “custodial parent of the child(ren)”.
I.
Transportation (select one):
Each parent shall be responsible for providing transportation for the child(ren) at the beginning
of his/her parenting period. Each parent shall be responsible for providing transportation for the
child(ren) to and from scho ol and activities during his/her parenting period.
We agree to the f o l lo w in g a rrangements for providing transportation for our child(ren) at the
beginning, during, or end of a parenting period:
J.
Current Address and Telephone Number
Father’s current home address and telephone number, including cellular telephone number:
Mother’s current home address and telephone number, including cellular telephone number:
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 5 of 14
K.
Relocation Notice
Pursuant to section 3109.051(G) of the Revised Code:
If either of the residential parents intends to move to a residence other than the residence specified
in the court order, the parent shall file a notice of intent to relocate with this Court. Except as
provided in divisions (G)(2), (3), and (4) of section 3109.051 of the Revised Code, the Court
shall send a copy of the notice to the other parent. Upon receipt of the notice, the Court, on its ow n
motion or the motion of the nonmoving parent, may schedule a hearing with notice to both
parents to determine w hether it is in the best interests of the child(ren) to revise the parenting
time schedule for the child(ren).
Each residential parent shall inform in writing the Court and the other parent of changes in address
and telephone, including cellular tel eph one number , unless otherwise provided by court order.
The relocation notice must be filed with the Cour t grant ing the al loc at ion of parental rights and
responsibilities (name and address of Court):
L.
Re cords Access Notice
Pursuant to sections 3109.051(H) and 3319.321(B)(5)(a) of the Revi sed Code:
Subject to sections 3125.16 and 3319.321(F) of the Revised Code, each parent is entitled to
access to any record that is related to the child(ren), under the same terms and conditions as the
other parent unless otherwise restricted. Any keeper of a record who knowingly fails to comply
with any record order is in contempt of court.
Restrictions or limitations:
None
Restrictions or limitations to records access are as follows:
M.
Da y Care Acces s Notice
Pursuant to section 3109.051(I) of the Revised Code:
In accordance with section 5104.11 of the Revised Code, each parent is entitled to access
to any day care center that is or will be attended by the child(ren) unless otherwise restricted.
Restrictions or limitations:
None
Restrictions or limitations to day care access are as follows:
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 6 of 14
N.
School Activities Access Notice
Pursuant to section 3109.051(J) of the Revised Code:
Subject to section 3319.321(F), each parent is entitled to access to any student activity that is
related to the child(ren) and to which the residential parent is legally provided access, under
the same terms and conditions as the residential parent. Any school employee or official w ho
knowi ngly fails to comply with this school activities access order is in contempt of court.
Restrictions or limitations:
None
Restrictions or limitations to school activities access are as follows:
THIRD: HEALTH INSURANCE COVERAGE.
As required by law, the parties have completed a Child Support Worksheet, which is attached to
and incorporated in this Agreement.
Select one:
A.
Health Insurance Coverage Available to at Least One Parent
1.
Private health insurance coverage is accessible and reasonable in cost through a group policy,
contract, or plan to: Father Mother Both parents. Father Mother B oth paren ts
shall provide private health insurance coverage for the benefit of the child(ren).
2.
If both parents are ordered to provide private health insurance coverage for the benefit of the
child(ren), Father’s Mother’s health insurance plan shall be considered the primary health
insurance plan for the child(ren).
3.
The parent required to provide private health insurance coverage shall provide proof of insurance
to the
County Child Support Enforcement Agency (CSEA)
and the other parent.
4.
Both parents shall cooperate in the preparation of insurance forms to obtain reimbursement or
payment of expenses, as applicable. A copy of medi cal bills must be submitted to the party
holding the insurance and responsible for payment or the other parent within 30 days of receipt.
5.
Should the health insurance coverage be cancelled for any reason, the parent ordered to
maintain insurance shall immediately notify the other parent and take immediate steps to obtain
replacement coverage. Unless the cancellation was intentional, the uncovered expenses shall be
paid as provided above. If the cancellation was intentionally c aus ed b y the parent or dered to
maintain insurance coverage, that parent shall be responsible for all medical expenses that
would have been covered had the insurance been in effect.
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 7 of 14
B.
Health Insurance Coverage Unavailable to Either Parent
1.
Private health insurance coverage is not accessible and reasonable in cost through a group
policy, contract, or plan to either parent.
2.
If private health insurance coverage becomes available to either parent at reasonable cost,
he/she wi ll im mediately obt ain the insurance, not ify the other paren t and the
County CSEA, and submit to the other parent proof of insurance, insurance forms, and an
insurance card. The CSEA shall determine whether the cost of the insurance is of sufficient
amount to justify an administrative review of the amount of child support payable. In the event
an administrative review is warranted, one shall be conducted.
C.
Division of Uninsured Expenses
1.
The cost of any uninsured medical expenses, incurred by or on behalf of the child(ren) not paid by
a health insurance plan and exceeding $100 per child per year, including co-payments and
deductibles, shall be paid by the parents as follows:
% by Father
% by Mother.
The first $100 per child per year shall be paid by Mother for the following child(ren):
The first $100 per child per year shall be paid by Father for the following child(ren):
Other orders regarding payment of uninsured medical expenses:
2.
The parent incurring the expenses shall provide the other parent the original or copies of all
medical bill s, and Explanation of Benefits (EOB), if available, within 30 days of the date on the bill
or EOB, wh iche ver is lat er, abs ent ex traor d inary circumstances. The other parent shall, within 30
days of receipt of the bill, reimburse the parent incurring the expenses or pay directly to the health
care provider that parent’s percentage share of the bill as shown above.
D.
Other Important Information about Medical Records and Expenses
1.
Each party shall have access to all medical records of the child(ren) as provided by law.
2.
The term “medical expense” or “medical records” shall include but not be limited to medi cal,
dent al, ortho don tic, optical, surgical, hospital, major me dical, psychological, psychiatric,
outpatient, doctor, therapy, counseling, prosthetic, and/or all other expenses/records including
preventative health care expenses/records related to the treatment of the human body and mind.
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 8 of 14
FOURTH: CHILD SUPPORT
As required by law, the parties have completed a Child Support Worksheet, which is attached to
and incorporated in this Agreement.
A.
Child Sup por t with Private Health Insurance Coverage
When private health insurance coverage is being provided for the child(ren), Father
Mother, Obligor, shall pay child support in the amount of
$
per child per month,
for
(number) child(ren) for a total of
$
per month.
B.
Child Sup por t with out Pr ivate Health Insurance Coverage
When private health insurance coverage is not available for the benefit of the child(ren),
Father Mother, the Obligor, shall pay child support in the amount of
$
per
child per month and
$
per child per month as cash medical support.
The total of child support and cash medical support for
(number) child(ren)
is
$
per month.
C.
Child Sup por t Payment
The child support payment (including cash medical support, if any) plus a 2% processing charge
shall commence on
and shall be paid to the Ohio Child Support Payment
Center, P. O. Box 182372, Columbus, Ohio 43218-2372, as administered through the
County Child Support Enforcement Agency (CSEA) by income withholding at
Obligor’s place of employment or from nonexempt funds on deposit at a financial institution.
D.
Deviation of Child Support Amount
The child support amount agreed upon is different than the amount calculated on the attached
Child Support Worksheet because the amount calculated on the Worksheet would be unjust or
inappropriate and would not be in the best interests of the child(ren) for the following reason(s)
as provided in R.C. 3119.22, 3119.23, 3119.24 and shall be adjusted as follow s:
Special and unusual needs of the child(ren) as follows:
Extraordinary obligations for child(ren) or obligations for handicapped child(ren) who is/are not
stepchild(ren) and who are not offspring from the marriage or relationship that is the basis of the
immediate child support determination as follows:
Other court-ordered payments as follows:
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 9 of 14
The Obligor obtained additional employment after a child support order was issued to support a
second family as follows:
Extended parenting time or extraordinary costs associated with parenting time, provided that this
division does not authorize and shall not be construed as authorizing any deviation from the schedule
and the applicable worksheet, through the line establi shing the actual annual obligation, or any
escrowing, impoundment, or withholding of child support because of a denial of or interference with a
right of parenting time granted by court order as follows:
The financial resources and the earning ability of the child(ren) as follows:
Disparity in income between parents or households as follows:
Benefits that either parent receives from remarriage or sharing living expenses with another
person as follows:
The amount of federal, state, and local taxes actually paid or estimated to be paid by a parent
or both of the parents as follows:
Significant, in-kind contributions from a parent, including, but not limited to, direct payment for
lessons, sports equipment, schooling, or clothing as follows:
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 10 of 14
The relative financial resources, other assets and resources, and needs of each parent as
follows:
The standard of living and circumstances of each parent and the standard of living the child(ren)
would have enjoyed had the marriage continued or had the parents been married as follows:
The physical and emotional condition and needs of the child(ren) as follows:
The need and capacity of the child(ren) for an education and the educational opportunities
that would have been available to the child(ren) had the circumstances requiring a court order
for support not arisen as follows:
The responsibility of each parent for the support of others as follows:
Any other relevant factor:
E.
Duration of Child Support.
The child support order will terminate upon the child’s 18
th
birthday unless one of the following
circumstances applies:
• The child is mentally or physically disabled and incapable of supporting or maintaining himself
or herself.
• The parents have agreed to continue child support beyond the date it would otherwise terminate,
as set out below.
• The child continuously attends a recognized and accredited high school on a full-time basis so
long as the child has not as yet reached the age of 19 years old. (Under these circumstances,
child support will end at the time the child ceases to attend a recognized and accredited high
school on a full-time basis or when he or she reaches the age of 19, whichever occurs first.)
Supreme Court of Ohio
Uniform Dom estic Relations Form – 17
SHARE D PARENTING PL AN
Approved under Ohio Civil Rule 84 and Ohio Juvenile Rule 46
Effecti ve Date: 7/1/2013
Page 11 of 14
This Support Order will remain in effect during seasonal vacation periods until the order terminates.
The parents agree that child support will extend beyond the time when it would otherwise end.
The terms and conditions of that agreement are as follows:
The parents have (a) chi ld( r en) who is/are mental l y or ph ysic al ly disabl ed and incapab le of
supporting or maintaining themselves. The name of the child(ren) and the nature of the mental or
physical disabili ty are as follows:
F.
Important Child Support Orders and Information
Obligee must immediately notify and Obligor may notify the CSEA of any reason for which the
support order should terminate. A willful failure to notify the CSEA as required is contempt of court.
The following are reasons for termination of the Order:
• Child’s attainment of the age of majority if the child no longer attends an accredited high school
on a full-time basis and the support order does not provide for the duty of support to continue
past the age of majority
• Child stops attending an accredited high school on a full-time basis after attaining the age of
majority
• Child’s deat h
• Child’s marriage
• Child’s emanc ipation
• Child’s enlistment in the Armed Services
• Child’s dep ortation
• Change of legal custody of the child
All support payments must be made through the CSEA or the office of child support in the Ohio
Department of Job and Family Servi ces (Child Support Payment Central). Any payment of money
not made through the CSEA will be presumed to be a gift, unless the payment is made to discharge
an obligation other than support.
All support under this Order shall be withheld or deducted from the income or assets of the Obligor
purs uant to a withh old in g or deduct ion not ice or appro pr iate order iss ued in ac cor danc e with
Chapters 3119., 3121., 3123., and 3125. of the Revi sed Code or a withdrawal directive issued
pursuant to sections 3123.24 to 3123.38 of the Revised Code and shall be forwarded to the Obli gee
in accordance with Chapters 3119., 3121., 3123., and 3125. of the Revised Code.
The Obligor and/or Obligee required under this Order to provide private health insurance coverage
