SUPERIOR COURT OF THE DISTRICT OF COLUMBIA FAMILY COURT Domestic Relations Branch ________________________________________ PRINT PLAINTIFF'S NAME ________________________________________ STREET ADDRESS ________________________________________ CITY, STATE AND ZIP CODE SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE WRITTEN SOMEONE ELSE'S ADDRESS BECAUSE YOU FEAR HARASSMENT OR HARM. DR _____________________ v. PLAINTIFF, Related Cases: ________________________________________ PRINT DEFENDANT'S NAME ________________________________________ STREET ADDRESS ________________________________________ CITY, STATE AND ZIP CODE SUBSTITUTE ADDRESS: CHECK BOX IF YOU HAVE WRITTEN SOMEONE ELSE'S ADDRESS BECAUSE YOU FEAR HARASSMENT OR HARM. DEFENDANT. PARENTING PLAN THE PURPOSE OF A PARENTING PLAN IS TO YOUR CUSTODY ORDER. YOU CAN DECIDE: HELP YOU THINK CAREFULLY ABOUT THE DETAILS OF WHO WILL MAKE WHAT DECISIONS ABOUT THE CHILD(REN)? WHO THE CHILD(REN) WILL STAY WITH AND WHEN? WHAT FINANCIAL CONTRIBUTIONS SHOULD BE MADE TO SUPPORT THE CHILD(REN)? IF YOU WANT, YOU CAN ASK THE JUDGE IN YOUR CASE TO INCORPORATE THIS PARENTING PLAN INTO A COURT ORDER. DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 1 of 9 American LegalNet, Inc. www.FormsWorkFlow.com NOTE: IF THE PARENTING ARRANGEMENTS ARE DIFFERENT FOR SOME OF YOUR CHILDREN, YOU SHOULD WRITE UP A SEPARATE PARENTING PLAN FOR EACH CHILD. THIS PARENTING PLAN INVOLVES THE FOLLOWING CHILD(REN): Child's Name Age Where does this child live? IF YOU HAVE CHILDREN NOT ADDRESSED BY THIS PARENTING PLAN, NAME HERE: Child's Name Age Where does this child live? DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 2 of 9 American LegalNet, Inc. www.FormsWorkFlow.com LEGAL CUSTODY (who makes decisions about certain things) Diet Religion Medical Care Mental Health Care Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Both parents decide together Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Plaintiff Defendant Discipline Choice of School Choice of Study School Activities Sports Activities ________________ ________________ ________________ What process will you use to make decisions? FOR EXAMPLE ­ THE PARENT CONFRONTED WITH OR ANTICIPATING THE CHOICE WILL CALL THE OTHER PARENT WHEN THE CHOICE PRESENTS ITSELF AND THE OTHER PARENT MUST AGREE OR DISAGREE WITHIN DEADLINE OR IF IN LESS TIME, THEN BEFORE ANY DEADLINE) 24 HOURS OF ANY If you cannot agree, which of you will make the final decision? _____________________________________________________________________________ DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 3 of 9 American LegalNet, Inc. www.FormsWorkFlow.com PHYSICAL CUSTODY (where the child(ren) live) The child(ren)'s residence is with _________________________________________________ Describe which days and which times of day the child(ren) will be with each person: Sunday Monday Tuesday Wednesday Thursday Friday Saturday This schedule is every week every two weeks other _______________________ If not weekly, which of you has the child(ren) the rest of the time? _______________________ Drop-off Where? ______________________________________________________________________ When? (time and day) ___________________________________________________________ Pick-up Where? ______________________________________________________________________ When? (time and day) ___________________________________________________________ If one of you doesn't show up, how long will the other wait? ____________________________ If there are extraordinary costs (taxi, train, plane, etc.) who will pay for which costs? DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 4 of 9 American LegalNet, Inc. www.FormsWorkFlow.com HOLIDAY VISITATION HOLIDAY Martin Luther King Day President's Day Easter Memorial Day 4th of July Labor Day Yom Kippur Rosh Hashanah Thanksgiving Vacation after Thanksgiving Christmas Vacation Christmas Day Kwanza New Year's Eve/Day Spring Vacation Easter Sunday Child's Birthday Mother's Day Father's Day Other holiday: (Chanukah, Passover, Ramadan, etc) Where will the child stay in... Year A Year B Every Year Summer Vacation: DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 5 of 9 American LegalNet, Inc. www.FormsWorkFlow.com SPECIAL ACTIVITIES OR SCHOOL ACTIVITIES Name of Child Activity If not, which of you will attend? Will both of you attend? TEMPORARY CHANGES TO THIS PARENTING SCHEDULE PARENT RECEIVING THE REQUEST WILL MAKE THE FINAL DECISION. FROM TIME TO TIME, ONE OF YOU MIGHT WANT OR NEED TO REARRANGE THE PARENTING TIME SCHEDULE DUE TO WORK, FAMILY OR OTHER EVENTS. YOU CAN ATTEMPT TO AGREE ON THESE CHANGES, IF YOU CANNOT AGREE, THE The parent asking for the change will ask in person by letter/email no later than 12 hours 24 hours by phone ______________ ______________ 1 week 1 month The parent being asked for a change will reply in person by letter/email no later than 12 hours 24 hours by phone ______________ ______________ 1 week 1 month DC Bar Pro Bono Program (revised 10-2011) Parenting Plan Page 6 of 9 American LegalNet, Inc. www.FormsWorkFlow.com COMMUNICATION May parents contact one another? ________________________________________________ When the child(ren) is/are with the one of you, how may they contact the other parent? ______________________________________________________________________________ ______________________________________________________________________________ When and how may _____________ contact the child?_______________________________ ______________________________________________________________________________ ______________________________________________________________________________ When and how may _____________ contact the child, when the child is visiting? _________ ______________________________________________________________________________ ______________________________________________________________________________ CHILD(REN)'S EXPENSES Expense Health Insurance Coverage Medical Care (including co-pays) Dental (braces, f