Attorney or Party Without Attorney (Name & Address) Telephone No. Attorney for (Name) PLACER COUNTY SUPERIOR COURT 11546 "B" AVENUE AUBURN, CA 95603 PLAINTIFF or PETITIONER: DEFENDANT or RESPONDENT: COURT ORDER ON PARENTING AGREEMENT CASE NUMBER: DATE OF AGREEMENT: In accordance with Local Rule 10.6 (K), it is the responsibility of the parties to provide the court with an original & (2) copies and self addressed, stamped envelopes for each party and/or their attorney requesting a copy of this Court Order on Parenting Agreement. The parties hereby agree to and affirm the attached custody and visitation agreement and consent to an order being entered thereon in accordance with Family Code 3186. The parties also declare under penalty of perjury that the attached Mediation Agreement has not been altered in any way without permission of the other party. Petitioner's Signature Respondent's Signature Counsel for Petitioner Counsel for Respondent MEDIATOR TO SIGN BELOW IF PARTIES ATTENDED MEDIATION This Mediator hereby declares under penalty of perjury that the attached Mediation Agreement is an original and has not been altered without prior permission of the above named parties. Mediators Signature Date The parties to this agreement are hereby ordered to abide by the provisions of this agreement when signed by a Judge or Commissioner. This is a valid and enforceable order. Failure to comply may result in a contempt charge. This Order is effective when made. It is enforceable anywhere in California; by any Law Enforcement Agency that has received the Order is shown a copy of it. DATED: SIGNATURE OF JUDGE/COMMISSIONER American LegalNet, Inc. www.USCourtForms.com SUPERIOR COURT OF THE STATE OF CALIFORNIA In and For The County of Placer County Auburn, California PARENTING AGREEMENT And Case No. Petitioner Respondent CHILDREN: NAME AGE NAME AGE NAME AGE NAME AGE THE PARTIES HEREBY AGREE ON THE FOLLOWING: 1. 2. 3. Joint legal and physical custody. Sole legal and physical custody. Joint legal custody. A. B. Primary custodian is the: Secondary custodian is the: OTHER: 4. Mother's Father's parenting time is: Every other weekend from / Day AM/PM to / Time Every 1st, 3rd, and 5th weekend from / Day Every other Thursday AM/PM to Time Time / Day AM/PM to Monday Time AM/PM Day AM/PM Time AM/PM Time OTHER: PETITIONER'S SIGNATURE RESPONDENT'S SIGNATURE American LegalNet, Inc. www.USCourtForms.com 5. HOLIDAY SCHEDULE: Parties to alternate these holidays each year unless stated otherwise: THANKSGIVING: Starting with in . in . Parent Days & Times: CHRISTMAS: Starting with Parent A. First day of Winter Break to December 25 AM/PM TO December 26 Time B. Second half of Winter Break starting on December 25 AM/PM TO January 1 AM/PM Time December 26 Time AM/PM TO January 1 AM/PM Time C. AM/PM Time Time December TO December . Date Date D. Divide among parents. Specific date shall be mutually decided by November 1 of each year. OTHER: EASTER: Starting with in . Parent A. Friday AM/PM to Tuesday AM/PM. B. Tuesday AM/PM to Sunday AM/PM. OTHER: PETITIONER'S SIGNATURE RESPONDENT'S SIGNATURE American LegalNet, Inc. www.USCourtForms.com FOURTH OF JULY: Starting with in . Parent From / Day AM/PM to / Time AM/PM Day Time OTHER: BIRTHDAYS: Starting with in . Parent OTHER: All other holidays which fall on a Monday or Friday will extend the weekend with the scheduled parent. 6. VACATION: Starting with in . Parent A. Divided equally each year from / Day B. AM/PM to Time / Day AM/PM Time Two weeks uninterrupted parenting time with one month prior notice. OTHER: 7. FATHER'S DAY and MOTHER'S DAY will be spent with the parent in honor from: AM/PM to Time AM/PM Time OTHER: PETITIONER'S SIGNATURE RESPONDENT'S SIGNATURE American LegalNet, Inc. www.USCourtForms.com CHOOSE: 8. Each parent will offer the other the first right of refusal to parent the Child(ren), if away from the Child(ren) for more than hours. 9. Each parent will give a minimum of schedule is to occur. 10. Each party will provide the other with a current address and telephone number at all times. 11. Parties shall return to mediation at their own equally shared expense if circumstances change and/or this arrangement reflects that it is not in the best interests of the Child(ren). 12. Parties shall not be under the influence of illegal drugs while the Child(ren) is/are in their care. 13. Parties shall not be under the influence of alcohol while the Child(ren) is/are in their care. 14. If minor children are to be transported out of the State of California for more than 24 hours, each party must provide the other with prior notice to include dates, location of travel and telephone numbers. 15. Parties agree that they will provide each other a 45-day prior written notice if they intend on moving outside a 25 mile radius of their present residence. 16. All transportation for the exchange of the Child(ren) shall be shared equally. hours notice to the other if a change in the OTHER: PETITIONER'S SIGNATURE RESPONDENT'S SIGNATURE American LegalNet, Inc. www.USCourtForms.com