Florida Parenting Coordinator Form

 

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,
IN AND FORĀ COUNTY, FLORIDA

Case No.:

Division::
In re: The Marriage of:

Petitioner,

and

Respondent,
PARENTING PLAN
I, {full legal name} , the {Choose only one} , being sworn, certify that the following statements are true:
This parenting plan is: {Choose only one}

{Parent’s Name} .
This parenting plan is: {Choose only one}
I. PARENTS
Mother
I. PARENTS
Mother
Name:
Address:
Telephone Number:
E-Mail:
Address Unknown: {Please indicate here if mother’s address is unknown}
Address Confidential: {Please indicate here if mother’s address and phone numbers are
confidential pursuant to either a Final Judgment for Protection Against Domestic Violence,
confidential pursuant to either a Final Judgment for Protection Against Domestic Violence,
or other court order }
Father
Name:
Address:
Telephone Number:
E-Mail:
Address Unknown: {Please indicate here if father’s address is unknown}
Address Confidential: {Please indicate here if father’s address and phone numbers are
confidential pursuant to either a Final Judgment for Protection Against Domestic Violence,
confidential pursuant to either a Final Judgment for Protection Against Domestic Violence,
or other court order }.
II. CHILDREN: This parenting plan is for the following child(ren) born to, or adopted by the parties:
(add additional lines as needed)
Name
Birth date
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}
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
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 asfollows:

Education/Academic decisions
Non-emergency health care
Other: {Specify}


Mother Father
Mother Father
Mother Father
Mother Father
Mother Father
OR
It is in the best interests of the child(ren) that the Mother Father shall have sole authority tomakemajor decisionsforthe child(ren.) It is detrimentalto the child(ren) to have shared parental responsibility.
2. Day-to-Day Decisions
Unless otherwise specified in this plan, 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 {Indicate all that apply}
a.
b.
c.
d.
paid by: Mother % Father %
e.
paid by: Mother % Father %
f.
V. INFORMATION SHARING. Unless otherwise indicated or ordered by the Court:
V. Unless otherwise prohibited by law, each parent 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 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 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, and 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 withinseven (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 timesharing schedule so that any differences or questions can be resolved.
The parents shall follow the school calendar of: {Indicate all that apply}
a. the oldest child
b. the youngest child
c. County
d. 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 dayof regularly scheduled classes after the holiday or break.
3. Schedule Changes {Indicate all that apply}
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 dayof regularly scheduled classes after the holiday or break.
a. before the change is to occur.
b.
c. .
VII. TIME-SHARING SCHEDULE
1. Weekday and Weekend Schedule
The following schedule shall apply beginning on
with the Mother Father and continue as follows:
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}


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}


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
a.
b.
c.
Holidays
other’s Day
Father’s Day
President’s Day
M. L. King Day
Easter
Passover
Memorial Day Wkd
4th of July
Labor Day Wkd
Columbus Day Wkd
Halloween
Thanksgiving
Veteran’s Day
Hanukkah
Yom Kippur
Rosh Hashanah
Child(ren)’s Birthdays:
Even Years
Odd Years
Every Year
Begin/End Time
This holiday schedule may affect the regular Time-Sharing Schedule. Parents may wish to specify either or both of the following options:
d.
e.
3. Winter Break {Choose only one}
a. 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 alternate the arrangement each year.
b. The Mother Father shall have the child(ren) for the entire Winter Break during odd-numbered years even-numbered years every year.
c. The Other:
d. Specific Winter Holidays
If not addressed above, the specific Winter Holidays such as Christmas, New Year’s Eve, Hanukkah, Kwanzaa, etc. shall be shared asfollows:
4. Spring Break {Choose only one}
a.
b. odd-numbered years even numbered years.
c. The Father Mother shall have the child(ren) for the entire Spring Break every year.
d.
e.
5. Summer Break {Choose only one}
a.
b. The Mother Father shall have the entire Summer Break from after school is out until before schoolstarts.
c. During oddnumbered
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) .
d.
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.
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 OFCHILD(REN)
1. Transportation{Choose only one
a. The Mother Father shall provide all transportation.
b.
c.
d.
.
2. Exchange
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 ismore 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.
{Choose only one}:
a.
b. unless both parties agree in advance to a different meeting place.
c.
3. Transportation Costs {Choose only one}
a.
b. % of the transportation costs.
c. Other:
4. Foreign and Out-Of-State Travel {Indicate all that apply}
a. 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 reachedat least days before traveling.
b. days prior to traveling, the parent shall provide a detailed itinerary, including locations, and telephone numbers where the child(ren) andparent 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.
c.
d.
IX. EDUCATION
1. School designation.
2. {If Applicable} The following provisions are made regarding privateor home schooling:
3. Other.
X. DESIGNATION FOR OTHER LEGAL PURPOSES
X. The child(ren) named in this Parenting Plan are scheduled to reside the majority of the timewith 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. The child(ren) named in this Parenting Plan are scheduled to reside the majority of the timewith 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.
COMMUNICATION
1. Between Parents
1. 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.
1. 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: {Indicate all that apply}
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 toface contact.
The child(ren) may have telephone e-mail other electronic communication in the form of with the other parent:
{Choose only one}
a.
b. to .
c. during the hours of to .
d.
3. Costs of Electronic Communication shall be addressed as follows:
XII. CHILD CARE{Choose only one }
a.
b.
c. hours.
d.
XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN
Temporary changes to this Parenting Plan may be made informally without a written document; however, if the parties dispute the change, the Parenting Plan shall remain 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 settlement agreement. I am satisfied with this agreement and intend to be bound by it.
Dated:

Signature of Mother
Printed Name:
Address:
City,State,Zip:
Fax Number:
Designated E – mail Address(es):
STATE OF FLORIDA COUNTY OF
Sworn to or affirmed and signed before me on bY


NOTARY PUBLIC or DEPUTY CLERK


[Print, type, or stamp commissioned name of notary or
deputy clerk.]
Personally known
Produced identification
Type of identification produced
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this petition and that the punishment for knowingly making a false statement includes fines and/or imprisonment.
Dated:

Signature of Father
Printed Name:
Address:
City,State,Zip:
Fax Number:
Designated E – mail Address(es):
STATE OF FLORIDA COUNTY OF
Sworn to or affirmed and signed before me on bY


NOTARY PUBLIC or DEPUTY CLERK


[Print, type, or stamp commissioned name of notary or
deputy clerk.]
Personally known
Produced identification

Type of identification produced

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:[fill in all blanks]

 

This form was prepared for the: {choose only one} ( ) ( ) .This form was completed with the assistance of:
{name of individual}
{name of business}
{address}
{city} {state} {telephone number}

 

Contact Information

 

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