SHORT TITLE CASE NUMBER ATTACHED DECLARATION IN SUPPORT OF REQUEST FOR CHILD CUSTODY / VISITATION ORDERS The following information is submitted in support of my request for child custody and/or visitation orders: 1. Primary caretaker information a. The primary caretaker of the child(ren) is: b. The person who takes the child(ren) to the doctor and dentist is: c. The person who transports and attends the extracurricular activities of the child(ren) is: d. The person who helps/supervises the child(ren) with daily homework is: e. The person who attends school events with the child(ren) and meets with teachers is: 2. Distance between homes and availability of transportation a. The distance between the homes of the parties is: 0 to 10 miles 10 to 30 miles 30 to 60 miles b. I have the following transportation available: over 60 miles unknown. unknown. unknown. . . . . . private vehicle public transportation c. The other party has the following transportation available: 3. Work schedule of parties NAME MONDAY Work Schedule Each Day TUESDAY WEDNESDAY private vehicle public transportation THURSDAY FRIDAY SATURDAY SUNDAY NAME MONDAY Work Schedule Each Day TUESDAY WEDNESDAY THURSDAY FRIDAY SATURDAY SUNDAY 4. Current or planned childcare arrangements Before school: After school: During work hours: 5. Schools and/or school issues Attendance issues. Homework issues. Special needs. IEP (Individualized education plan). Explanation: SDSC FLF-011 (New 6/10) ATTACHED DECLARATION IN SUPPORT OF REQUEST FOR CHILD CUSTODY / VISITATION ORDERS Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SHORT TITLE CASE NUMBER 6. Special medical needs or conditions of the child(ren) 7. Other issues The other parent has a history of substance abuse, domestic violence, or poor parenting skills. The other parent has no relationship with our child(ren) and does not visit or call our child(ren). The other parent has not followed the current custody/visitation order. Other: 8. Material change of circumstance (for modification of orders only) A material change of circumstance affecting the best interests of the child(ren) has occurred since the last order was made. Describe the change(s): . 9. Proposed parenting plan My proposed parenting plan is: This plan is in the best interest of the child(ren) because: Additional facts contained on attached JC form #MC-031. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Type or Print Name Signature of Declarant SDSC FLF-011 (New 6/10) ATTACHED DECLARATION IN SUPPORT OF REQUEST FOR CHILD CUSTODY / VISITATION ORDERS Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com