Name: Mailing Address: Daytime Telephone ATLAS #: Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the Matter of Case No. Petitioner PARENTING PLAN FOR: and [ ] JOINT CUSTODY WITH JOINT CUSTODY AGREEMENT or [ ] SOLE CUSTODY [ ] to Mother [ ] to Father Respondent INSTRUCTIONS This document has 4 parts: PART 1) General Information; PART 2) Custody and Parenting Time; PART 3) Danger to Children Notification Statement; and PART 4) Joint Custody Agreement. (Where this form refers to “children” it refers to any and all minor children that are common to the parties, whether one or more.) 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 at the end of PART 3, and at the end of PART 4; 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 and at the end of PART 3; c. If only one parent is submitting the Plan, that parent must sign at the end of PART 2 and at the end of PART 3. . PART 1: GENERAL INFORMATION: A. MINOR CHILDREN: This Plan concerns the following minor children: (Use additional paper if necessary) CHILD’S NAME Superior Court of Arizona in Yavapai County July 2010 BIRTH DATE Page 1 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com B. Case No. THE FOLLOWING CUSTODY ARRANGEMENT IS REQUESTED: Choose ONE of the options below, (1, 2, 3, or 4). If you chose “sole custody”, (1 or 2), you have the option of also requesting restrictions on the parenting time of the other party. [ ] 1. SOLE LEGAL CUSTODY BY AGREEMENT: The parents agree that sole legal custody and primary physical custody should be granted to the [ ] Mother or [ ] Father. The parents agree that since each has a unique contribution to offer to the growth and development of their minor children, 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 children as described in the following pages. OR, [ ] 2. 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 sole custody and parenting time according to this Plan. (Optional, if you marked 1 or 2 above) [ ] [ ] [ ] PART 2: 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. OR 3. JOINT LEGAL CUSTODY BY AGREEMENT: The parents agree to joint legal custody and request the court to approve the joint legal custody arrangement as described in this Plan. The primary custodial parent will be the [ ] Mother or [ ] Father 4. JOINT LEGAL CUSTODY REQUESTED BY PARENT SUBMITTING THIS PLAN: The parents cannot agree to the terms of custody and parenting time, or are unable to submit this plan together at this time. My request for joint legal custody is deferred for the court’s determination., OR CUSTODY AND PARENTING TIME: Complete each section below. Be specific about what you want the judge to approve in the court order. A. (School Year) WEEKDAY AND WEEKEND TIME-SHARING SCHEDULE: [ ] The minor children will be in the care of Father as follows: (Explain). [ ] The minor children will be in the care of Mother as follows: (Explain). [ ] Other custody arrangements are as follows: (Explain). Superior Court of Arizona in Yavapai County July 2010 Page 2 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com Case No. [ ] Transportation will be provided as follows: [ ] Mother or [ ] Father will pick the children up at o’clock a.m./p.m. o’clock a.m./p.m. [ ] Mother or [ ] Father will drop the children off at Parents may change their time-share arrangements by mutual agreement and with at least days notice in advance to the other parent. B. SUMMER MONTHS OR SCHOOL BREAK LONGER THAN 4 DAYS: The weekday and weekend schedule described above will apply for all 12 calendar months EXCEPT: [ ] 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 children will be in the care of FATHER. (Explain.) OR [ ] During the summer months or school breaks that last longer than 4 days, the children will be in the care of MOTHER. (Explain.) [ ] Each parent is entitled to a week period of vacation time with the children. The parents agree to work out the details of the vacation at least days in advance. C. TRAVEL: [ ] Should either parent travel out of the area with the minor children, each parent will keep the other parent informed of travel plans, address(es), and telephone number(s) at which that parent and the minor children can be reached. [ ] Neither parent shall travel with the children outside Arizona for longer than without the prior written consent of the other parent or order of the court. D. [ [ [ [ ] ] ] ] days 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 [ ] Mother [ ] Father [ ] Mother [ ] Father New Year’s Day [ ] Mother [ ] Father [ ] Mother [ ] Father Spring Vacation [ ] Mother [ ] Father [ ] Mother [ ] Father Easter [ ] Mother [ ] Father [ ] Mother [ ] Father Superior Court of Arizona in Yavapai County July 2010 Page 3 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com Case No. [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] 4th of July Halloween Veteran’s Day Thanksgiving Hanukkah Christmas Eve Christmas Day Winter Break Children's Birthdays [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] Mother Mother Mother Mother Mother Mother Mother Mother Mother [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] Father Father Father Father Father Father Father Father Father [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] Mother Mother Mother Mother Mother Mother Mother Mother Mother [ [ [ [ [ [ [ [ [ ] 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 children on his or her birthday. [ ] Three-day weekends which include Martin Luther King Day, President’s Day, Memorial Day, Labor Day, Columbus Day, the children will remain in the care of the parent who has the minor children for the weekend. [ ] Other Holidays (Describe the other holidays and the arrangement.) [ ] [ ] Each parent may have telephone contact with the minor children during the children's normal waking hours, OR Other (Explain) E. PARENTAL ACCESS TO RECORDS AND INFORMATION: Under Arizona law (A.R.S.§ 25-403), unless otherwise provide by court order or law, on reasonable request, both parents are entitled to have equal access to documents and other information concerning the minor children’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. F. 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. (optional) [ ] If both parents do not reach an agreement, then , OR [ ] Major educational decisions will be made by [ ] Mother, OR [ ] Father after consulting the other parent. Superior Court of Arizona in Yavapai County July 2010 Page 4 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com Case No. G. 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 children, to cooperate on health matters concerning the children 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. (Optional) [ ] If the parents do not reach an agreement, then: , OR Major medical/dental decisions will be made by [ ] Mother OR [ ] Father, after consulting with the other parent. H. [ ] RELIGIOUS EDUCATION ARRANGEMENTS: Each parent may take the children to a church or place of worship of his or her choice during the time that the children is/are in his or her care. [ ] Both parents agree that the children may be instructed in the [ ] Both Parents agree that religious arrangements are not applicable to this Plan. faith. I. 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 children. [ ] TALK TO OTHER PARENT ABOUT EXTRA ACTIVITIES. Each parent will consult and agree with the other parent regarding any extra activity that affects the children's access to the other parent. [ ] ASK OTHER PARENT IF HE OR SHE WANTS TO TAKE CARE OF CHILDREN. Each parent agrees to consider the other parent as care-provider for the children before making other arrangements. [ ] OBTAIN WRITTEN CONSENT BEFORE MOVING: Neither parent will move with the minor children 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. (A.R.S. 25-408 (B)) . [ ] COMMUNICATE. Each parent agrees that all communications regarding the children will be between the parents and that they will not use the children to convey information or to set up parenting time changes. Superior Court of Arizona in Yavapai County July 2010 Page 5 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com Case No. [ ] PRAISE OTHER PARENT. Each parent agrees to encourage love and respect between the children and the other parent, and neither parent shall do anything that may undermine the other parent's relationship with the children. [ ] 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 children 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” in place before the move or the minimum Yavapai 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. NOTICE: 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. 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 children, the other parent may submit court papers to request enforcement. (See Self-Service Center) J. SIGNATURE OF ONE OR BOTH PARENTS – as instructed on page 1. Signature of Mother: Date: Signature of Father: Date: Superior Court of Arizona in Yavapai County July 2010 Page 6 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com Case No. PART 3: STATEMENT REGARDING CONTACT WITH SEX OFFENDERS AND PERSONS CONVICTED OF DANGEROUS CRIMES AGAINST CHILDREN. According to A.R.S. § 25-403.05, a child’s parent or custodian must immediately notify the other parent or custodian if the person knows that a convicted or registered sex offender or someone who has been convicted of a dangerous crime against children may have access to the child. According to A.R.S. § 13-705 (P) (1), “Dangerous crime against children” means any of the following that is committed against a minor who is under fifteen years of age: (a) Second degree murder. (b) Aggravated assault resulting in serious physical injury or involving the discharge, use or threatening exhibition of a deadly weapon or dangerous instrument. (c) Sexual assault. (d) Molestation of a child. (e) Sexual conduct with a minor. (f) Commercial sexual exploitation of a minor. (g) Sexual exploitation of a minor. (h) Child abuse as prescribed in section 13-3623, subsection A, paragraph 1. (i) Kidnapping. (j) Sexual abuse. (k) Taking a child for the purpose of prostitution as prescribed in section 13-3206. (l) Child prostitution as prescribed in section 13-3212. (m) Involving or using minors in drug offenses. (n) Continuous sexual abuse of a child. (o) Attempted first degree murder. (p) Sex trafficking. (q) Manufacturing methamphetamine under circumstances that cause physical injury to a minor. (r) Bestiality as prescribed in section 13-1411, subsection A, paragraph 2. (s) Luring a minor for sexual exploitation. (t) Aggravated luring a minor for sexual exploitation. (u)Unlawful age misrepresentation. The parent or custodian must provide notice by first class mail, return receipt requested, by electronic means to an electronic mail address that the recipient provided to the parent or custodian for notification purposes or by another form of communication accepted by the court. PART 3: SIGNATURE OF ONE OR BOTH PARTIES – as instructed on page 1. I (We) have read, understand and agree to abide by the notification requirements of A.R.S. 25-403.05 (B) concerning notification of other parent or custodian if someone convicted of a dangerous crime against children may have access to the child. Signature of Mother: Date: ________________ Signature of Father: Superior Court of Arizona in Yavapai County July 2010 Date: _________ Page 7 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com Case No. PART 4: JOINT CUSTODY AGREEMENT (IF APPLICABLE): A. 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”. [ ] [ ] B. 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.* DUI or DRUG CONVICTION(S): [ ] Neither party has been convicted of driving under the influence or a drug offense within the past 12 months, OR [ ] One of the parties HAS been convicted of driving under the influence or a drug offense within the past 12 months, but the parties feel Joint Custody is in the best interests of the children. * * IF THERE HAS BEEN DOMESTIC VIOLENCE OR A DUI OR DRUG CONVICTION: Attach an extra page explaining why Joint Custody is still in the best interest of the children. C. 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 their 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. § 25-403.02), as listed below: a. The best interests of the minor children are served; b. Each parent’s rights and responsibilities for personal care of the minor children 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 children, including holidays and school vacations is 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. D. SIGNATURES OF BOTH PARENTS REQUESTING JOINT CUSTODY – as instructed on page 1. Signature of Mother: Date: Signature of Father: Date: Superior Court of Arizona in Yavapai County July 2010 Page 8 of 8 DRDC72f American LegalNet, Inc. www.FormsWorkFlow.com