Name: Mailing Address: Daytime Telephone ATLAS #: Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the Matter of DO Petitioner CUSTODY AND/OR PARENTING PLAN and [ ] [ ] Proposed/Separate Joint Respondent GENERAL INFORMATION: A. CHILD(REN): This Plan concerns the following child(ren): (Use additional paper if necessary) CHILD’S NAME B. BIRTH DATE CUSTODY AND PARENTING TIME (formerly called “Visitation”) REQUESTED IN THIS PLAN: (Check the box(es) that apply.) [ ] [ ] SOLE 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. [ ] C. JOINT CUSTODY: The parents/parties agree to joint custody and this Parenting Plan and find it in the best interest(s) of the child(ren) to award physical custody to [ ] Mother [ ] Father [ ] Other . RESTRICTED, SUPERVISED OR NO PARENTING TIME: The parent submitting this Plan asks the Court for an order restricting parenting time. CUSTODY AND PARENTING TIME: Complete each section below. Be specific about what you want the judge to approve in the court order. 1. WEEKDAY AND WEEKEND SCHEDULE: Superior Court of Arizona in Yavapai County September 2007 Page 1 of 6 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com [ ] The child(ren) will be in the care of Father as follows: (Explain). [ ] The child(ren) will be in the care of Mother as follows: (Explain). [ ] Other custody arrangements are as follows: (Explain). [ ] Transportation will be provided as follows: [ ] Mother or [ ] Father will pick the child(ren) up at [ ] Mother or [ ] Father will drop the child(ren) off at o’clock a.m./p.m. o’clock a.m./p.m. [ ] Parents may change their time-share arrangements by mutual agreement and with at least days notice in advance to the other parent. 2. SUMMER MONTHS OR SCHOOL BREAK LONGER THAN 4 DAYS: The weekday and weekend schedule described above will apply for all 12 calendar months AND [ ] During the summer months or school breaks that last longer than 4 days, no changes shall be made. OR [ ] During the summer months or school breaks that last longer than 4 days, the child(ren) will be in the care of FATHER. (Explain.) OR [ ] During the summer months or school breaks that last longer than 4 days, the child(ren) will be in the care of MOTHER. (Explain.) [ ] Each parent is entitled to a week period of vacation time with the child(ren). The parents agree to work out the details of the vacation at least days in advance. [ ] Parents agree that should either of them travel out of the area with the child(ren), each parent will keep the other informed of travel plans, address(es), and telephone number(s) at which that parent and the child(ren) can be reached. Superior Court of Arizona in Yavapai County September 2007 Page 2 of 6 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com [ ] Neither parent shall travel with the child(ren) outside Arizona for longer than without the prior written consent of the other parent or order of the court. 3. HOLIDAY SCHEDULE: days 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 [ ] Mother [ ] Father [ ] Mother [ ] Father New Year’s Day [ ] Mother [ ] Father [ ] Mother [ ] Father Spring Break [ ] Mother [ ] Father [ ] Mother [ ] Father 4th of July [ ] Mother [ ] Father [ ] Mother [ ] Father Halloween [ ] Mother [ ] Father [ ] Mother [ ] Father Thanksgiving [ ] Mother [ ] Father [ ] Mother [ ] Father Winter Break [ ] Mother [ ] Father [ ] Mother [ ] Father Hanukkah [ ] Mother [ ] Father [ ] Mother [ ] Father Christmas Eve [ ] Mother [ ] Father [ ] Mother [ ] Father Christmas Day [ ] Mother [ ] Father [ ] Mother [ ] Father Child(ren)'s Birthdays [ ] Mother [ ] Father [ ] Mother [ ] 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, President’s Day, Memorial Day, Labor Day, Columbus Day, Veteran’s 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.) [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] 4. TELEPHONE ACCESS: [ ] [ ] Each parent may have telephone contact with the child(ren) during the child(ren)'s normal waking hours. Other (Explain) 5. PARENTAL ACCESS TO RECORDS AND INFORMATION: Under Arizona law, both parents are entitled to have equal access to documents and other information concerning the 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. 6. EDUCATIONAL ARRANGEMENTS: Superior Court of Arizona in Yavapai County September 2007 Page 3 of 6 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com [ ] 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 both parents do not agree regarding the educational decisions, then [ ] If the parents do not agree, then the final decision making regarding educational decisions shall be with [ ] mother [ ] father after consultation with the other parent. 7. 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 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 (explain) [ ] The final decision regarding medical issues will be with [ ] mother [ ] father after consultation with the other parent. 8. RELIGIOUS EDUCATION ARRANGEMENTS: [ ] Each parent may take the child(ren) to a church or place of worship of his or her choice during the time that the child(ren) is/are in his or her care. [ ] Both parents agree that the child(ren) may be instructed in the [ ] Both Parents agree that religious arrangements are not applicable to this Plan. faith. 9. 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 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 child(ren)'s access to the other parent. [ ] ASK OTHER PARENT IF HE OR SHE WANTS TO TAKE CARE OF CHILD(REN). Each Superior Court of Arizona in Yavapai County September 2007 Page 4 of 6 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com parent agrees to consider the other parent as care-provider for the child(ren) before making other arrangements. [ ] OBTAIN WRITTEN CONSENT BEFORE MOVING. Neither parent will move with the child(ren) out of the [ ] Prescott [ ] Tri-City [ ] Verde Valley [ ] Northern Arizona [ ] State of Arizona area without prior written consent of the other parent, or a court ordered Parenting Plan. [ ] COMMUNICATE. Each parent agrees 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 parenting time changes. [ ] PRAISE OTHER PARENT. Each parent agrees to encourage love and respect between the child(ren) and the other parent, and neither parent shall do anything that may undermine the other parent's relationship with the 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 child(ren) and to amicably resolve such disputes as may arise. [ ] 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 before the move or the minimum Yavapai County Access Guidelines until other arrangements can be worked out. NOTIFY OTHER PARENT OF PROBLEMS WITH TIME-SHARING AHEAD OF TIME. If either parent is unable to follow through with the timesharing arrangements involving the child(ren), that parent will notify the other parent as soon as possible. CONCILIATION/MEDIATION. If the parents wish to make a legal change to the existing court ordered Parenting Plan, they will try to work out a new Parenting Plan with a private mediator before starting any court action. 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 this Parenting Plan, or act in such a way that is inconsistent with the terms of this agreement. [ ] [ ] 10. REVIEW. The parents agree to review the terms of their joint custody agreement and make any necessary or desired changes every months from the date of this document. If they are unable to reach a mutual agreement regarding an issue they may request mediation through a private mediator of their choice. The parties understand that joint custody does not necessarily mean equal parenting time. SUPERVISED OR NO PARENTING TIME. [ ] Supervised parenting time between the child(ren) and the [ ] Petitioner [ ] Respondent. OR Name of the person who will supervise: Superior Court of Arizona in Yavapai County September 2007 Page 5 of 6 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com The cost of supervised parent/child access will be paid by [ ] the parent being supervised, [ ] the parent having custody, [ ] shared equally by the parties. [ ] No parenting time rights to the parent not having custody. Date Signature OATH AND VERIFICATION BY PETITIONER: I, the Petitioner, being duly sworn, state that I have read this Plan and everything stated in this agreement is true and correct to the best of my knowledge, information, and belief. Petitioner SUBSCRIBED AND SWORN to before me this day of , 20 , . by Notary Public My Commission Expires: OATH AND VERIFICATION BY RESPONDENT: I, the Respondent, being duly sworn, state that I have read this Plan and everything stated in this agreement is true and correct to the best of my knowledge, information, and belief. Respondent SUBSCRIBED AND SWORN to before me this by My Commission Expires: Superior Court of Arizona in Yavapai County September 2007 day of , 20 , . Notary Public Page 6 of 6 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com