Name of Person Filing: ________________________________________ Mailing Address: ________________________________________ City, State, Zip Code: ________________________________________ Daytime Phone Number: ________________________________________ Evening Phone Number: ________________________________________ ATLAS Number (If Applicable):_____________________________________ State Bar Number (If Applicable):___________________________________ Self Representing: Petitioner Respondent FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number:_________________________ (Name of Petitioner) PARENTING PLAN FOR: AND JOINT CUSTODY WITH JOINT CUSTODY AGREEMENT OR SOLE CUSTODY (Name of Respondent) Mother Father INSTRUCTIONS This document has 3 parts: PART 1) General Information; PART 2) Custody and Parenting Time; PART 3) Joint Custody Agreement. One or both parents must complete and sign the Plan as Follows: a. If both parents agree to joint custody: Both parents must sign the Plan at the end of PART 2 and at the end of PART 3; b. If both parents agree to custody and parenting time arrangements but not to joint custody: Both parents must sign the Plan at the end of PART 2; c. If only one parent is submitting the Plan: that parent must sign at the end of PART 2. PART 1: GENERAL INFORMATION A. MINOR CHILDREN. This plan concerns the following minor children: (Use additional paper if necessary) ______________________________________ _______________________________________ ______________________________________ _______________________________________ ______________________________________ _______________________________________ ______________________________________ _______________________________________ B. CUSTODY ARRANGEMENTS REQUESTED IN THIS PLAN: The following custody arrangement is requested: (Check the box(es) that apply.) JOINT LEGAL CUSTODY DETERMINATION DEFERRED: The parent’s request for joint legal custody is deferred to the court for determination. OR, 11/4/09 Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No.__________________________ JOINT LEGAL CUSTODY AGREEMENT: The parents agree to joint legal custody and request the court to approve the joint legal custody arrangement as described in this Plan, OR Mother or Father will be the primary custodial parent. SOLE LEGAL CUSTODY AGREEMENT: The parents agree that Mother or Father will be the parent with sole legal custody and shall be the primary custodial parent. The parents agree that since each has a unique contribution to offer to the growth and development of their minor child(ren), each of them will continue to have a full and active role in providing a sound moral, social, economic, and educational environment for the benefit of the minor child(ren), as described in the following pages. OR, SOLE LEGAL CUSTODY REQUESTED BY THE PARENT SUBMITTING THIS PLAN: The parents cannot agree to the terms of custody and parenting time. The parent submitting this Plan asks the court to order custody and parenting time according to this Plan. RESTRICTED, SUPERVISED, OR NO PARENTING TIME: The parent submitting this Plan asks the court for an order restricting parenting time. The facts and information related to this request are described in the Petition.. PART 2: CUSTODY AND PARENTING TIME. Complete each section below. Be specific about what you want the judge to approve in the court order. A. WEEKDAY AND WEEKEND SCHEDULE: The time-sharing schedule will be as follows: The children will be in the care of Father as follows: (Explain). ________________________________________________________________________________ The children will be in the care of Mother as follows: (Explain). ________________________________________________________________________________ Other custody arrangements are as follows: (Explain). ________________________________________________________________________________ Transportation will be provided as follows: (Explain). Mother or Father will pick the minor children up at ____________________ o’clock. Mother or Father will drop the minor children off at ____________________ o’clock. Parents may change their time-share arrangements by mutual agreement with at least ___________ days notice in advance to the other parent. B. SUMMER MONTHS OR SCHOOL BREAK LONGER THAT 4 DAYS: The weekday and weekend schedule described above will apply for all 12 calendar months EXCEPT: During summer months or school breaks that last longer than 4 days, no changes shall be made. OR During summer months or school breaks that last longer than 4 days, the minor child(ren) will be in the care of Father: (Explain) ________________________________________________________________________________ During summer months or school breaks that last longer than 4 days, the minor child(ren) will be in the care of Mother: (Explain) ________________________________________________________________________________ Each parent is entitled to a ___________ week period of vacation time with the minor child(ren). The parents will work out the details of the vacation at least __________ days in advance. Should either parent travel out of the area with the minor child(ren), each parent will keep the other parent informed of travel plans, address(es), and telephone number(s) at which that parent and the minor child(ren) can be reached. Neither parent shall travel with the minor child(ren) outside Arizona for longer than __________ days without the prior written consent of the other parent or order of the court. C. HOLIDAY SCHEDULE: The holiday schedule takes priority over the regular time-sharing schedule as described above. Check the box(es) that apply and indicate the years of the holiday access/Parenting time schedule. Holiday Even Years Odd Years New Year’s Eve New Year’s Day 11/4/09 Mother Mother Father Father Mother Mother Father Father Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________ Spring Vacation Easter 4th of July Halloween Veteran’s Day Thanksgiving Hanukkah Christmas Eve Christmas Day Winter Break Child’s Birthday Mother Mother Mother Mother Mother Mother Mother Mother Mother Mother Mother Father Father Father Father Father Father Father Father Father Father Father Mother Mother Mother Mother Mother Mother Mother Mother Mother Mother Mother Father Father Father Father Father Father Father Father Father Father Father Mother’s Day will be celebrated with the Mother every year. Father’s Day will be celebrated with the Father every year. Each parent may have the child(ren) on his or her birthday. Three-day weekends which include Martin Luther King Day, Presidents’ Day, Memorial Day, Labor Day, Columbus Day, the child(ren) will remain in the care of the parent who has the child(ren) for the weekend. Other Holidays (Describe the other holidays and the arrangement.) ________________________________________________________________________________ Each parent may have telephone contact with the minor child(ren) during the child(ren)’s normal waking hours. Other (Explain) ________________________________________________________________________________ D. PARENTAL ACCESS TO RECORDS AND INFORMATION: Under Arizona law (A.R.S. 25-403), unless otherwise provided by court order or law, on reasonable request, both parents are entitled to have equal access to documents and other information concerning the minor child(ren)’s education and physical, mental, moral and emotional health including medical, school, police, court and other records. A person who does not comply with a reasonable request for these records shall reimburse the requesting parent for court costs and attorney fees incurred by that parent to make the other parent obey this request. A parent who attempts to restrict the release of documents or information by the custodian of the records without a prior court order is subject to legal sanctions. E. EDUCATIONAL ARRANGEMENTS: Both parents have the right to participate in school conferences, events and activities, and the right to consult with teachers and other school personnel. Both parents will make major educational decisions together. If the parents do not reach an agreement, then the final decision making regarding educational decisions shall be with Mother OR Father after consultation with ___________________________________. F. MEDICAL AND DENTAL ARRANGEMENTS: Both parents have the right to authorize emergency medical treatment, if needed, and the right to consult with physicians and other medical practitioners. Both parents agree to advise the other parent immediately of any emergency medical/dental care sought for the minor child(ren), to cooperate on health matters concerning the child(ren) and to keep one another reasonably informed. Both parents agree to keep each other informed as to names, addresses and telephone numbers of all medical/dental care providers. Both parents will make major medical decisions together, except for emergency situations as noted above. If the parents do not agree, then the final decision regarding medical issues will be with: Mother OR Father after consultation with _____________________________________. 11/4/09 Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________ G. RELIGIOUS EDUCATION ARRANGEMENTS: Each parent may take the minor child(ren) to a church or place of worship of his or her choice during the time that the minor child(ren) is/are in his or her care. Both parents agree that the minor child(ren) may be instructed in the _________________________ faith. Both parents agree that religious arrangements are not applicable to this plan. H. ADDITIONAL ARRANGEMENTS AND COMMENTS: NOTIFY OTHER PARENT OF ADDRESS CHANGE. Each parent will inform the other parent of any change of address and/or phone number in advance OR within ___________ days of the change. NOTIFY OTHER PARENT OF EMERGENCY. Both parents agree that each parent will promptly inform the other parent of any emergency or other important event that involves the minor child(ren). TALK TO OTHER PARENT ABOUT EXTRA ACTIVITIES. Each parent will consult and agree with the other parent regarding any extra activity that affects the minor child(ren)’s access to the other parent. ASK OTHER PARENT IF HE/SHE WANTS TO TAKE CARE OF CHILD(REN). Each parent agrees to consider the other parent as care-provider for the minor child(ren) before making other arrangements. OBTAIN WRITTEN CONSENT BEFORE MOVING. Neither parent will move with the minor child(ren) out of Mohave County without prior written consent of the other parent, or a Court ordered Parenting Plan. COMMUNICATE. Each parent agrees that all communications regarding the minor child(ren) will be between the parents and that they will not use the minor child(ren) to convey information or to set up parenting time changes. PRAISE OTHER PARENT. Each parent agrees to encourage love and respect between the minor child(ren) and the other parent, and neither parent shall do anything that may hurt the other parent’s relationship with the minor child(ren) COOPERATE AND WORK TOGETHER. Both parents agree to exert their best efforts to work cooperatively in future plans consistent with the best interests of the minor child(ren) and to amicably resolve such disputes as may arise. NOTIFY OTHER PARENT OF PROBLEMS WITH TIME-SHARING AHEAD OF TIME. If either parent is unable to follow through with the time-sharing arrangements involving the minor child(ren), that parent will notify the other parent as soon as possible. PARENTING PLAN. Both parents agree that if either parent moves out of the area and returns later, they will use the most recent “Parenting Plan/Access Agreement” in place before the move or the Mohave County Access Guidelines until other arrangements can be worked out. MEDIATION. If the parents are unable to reach a mutual agreement regarding a legal change to their parenting orders, they may request mediation through the court or a private mediator of their choice. DO NOT DEVIATE FROM PLAN UNTIL DISPUTE IS RESOLVED. Both parents are advised that while a dispute is being resolved, neither parent shall deviate from the Parenting Plan, or act in such a way that is inconsistent with the terms of this agreement. NOTICE TO PARENTS: Once this Plan has been made an order of the court, if either parent disobeys the court order related to parenting time with the minor child(ren), the other parent may submit court papers to request enforcement. See court materials for help. I. SIGNATURE OF BOTH PARTIES Signature of Mother: _________________________________ Date:_____________________ Signature of Father: _________________________________ Date:_____________________ 11/4/09 Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No._________________________ PART 3: JOINT CUSTODY AGREEMENT (IF APPLICABLE): A. JOINT CUSTODY AGREEMENT: If the parents have agreed to joint custody, the following will apply, subject to approval by the judge: 1. REVIEW PARENTING PLAN. The parents agree to review the terms of the joint custody agreement and make any necessary or desired changes every __________ months from the date of this document. 2. CRITERIA. Our joint custody agreement meets the criteria required by Arizona law (A.R.S. 25-403) a. The best interests of the minor child(ren) are served; b. Each parent’s rights and responsibilities for personal care of the minor child(ren) and for decisions in education, health care and religious training are designated in this Plan; c. A schedule of the physical residence of the minor child(ren), including holidays and school vacations are included in the Plan; d. The Plan includes a procedure for periodic review; e. The Plan includes a procedure by which proposed changes, disputes and alleged breaches may be mediated or resolved. f. The parties understand that joint custody does not necessarily mean equal parenting time. § B. DOMESTIC VIOLENCE: Arizona Law (A.R.S. 25-403.03) states that joint custody shall NOT be awarded if there has been a history of “significant domestic violence.” Domestic Violence has not occurred between the parties, OR Domestic violence has occurred but it has not been “significant” or has been committed by both parties. If “yes” to this box, attach an extra page explaining why joint custody is still in the best interest of the minor child(ren) even though domestic violence has occurred. C. SIGNATURE OF BOTH PARENTS REQUESTING JOINT CUSTODY Signature of Mother: ___________________________________ Date:__________________ Signature of Father: ___________________________________ Date:__________________ 11/4/09 Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com