STATE OF HAWAII FAMILY COURT _______ Circuit CASE NUMBER PROPOSED PARENTING PLAN FC- G CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI‘I, ____________________________________________ (Name: First Middle Last) G Mother G Father PLAINTIFF(S)/PETITIONER(S), vs. ____________________________________________ (Name: First Middle Last) G Mother G Father G Caretaker NO. ________ This document was prepared by: [ ] Plaintiff/Petitioner [ ] Defendant/Respondent [ ] Caretaker/Other* [ ] Attorney for: [ ]Petitioner/Plaintiff [ ]Defendant/Respondent _______________________________________________ Name _______________________________________________ Address ____________________________________________ (Name: First Middle Last) G Mother G Father G Caretaker _______________________________________________ City, State, Zip Code _______________________________________________ Telephone Number G and CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI‘I, * Relationship of Caretaker/Other to the child(ren): _______________________________________________ DEFENDANT(S)/RESPONDENT(S). I will be relocating to _________________________________ on or about _________________. [If you are relocating, file one plan for before relocation and another plan for after relocation.] G This is the plan for before relocation. G This is the plan for after relocation. 1. Child(ren): G See attached sheet for additional children. Is CPS* Full Name Birth Date Gender School/Grade Involved? Child 1 / / GM GF GYes GNo Child 2 / / GM GF GYes GNo Child 3 / / GM GF GYes GNo / / GM GF GYes GNo Child 4 / / GM GF GYes GNo Child 5 Child 6 / / GM GF GYes GNo *CPS stands for Child Protective Services 2. Legal Custody should be awarded to (person(s) making the major decisions, such as, school enrollment, medical, driver’s license): G Mother G Father G Jointly to both Mother and Father G Caretaker 3. Physical Custody should be awarded to (the child(ren) will primarily live with this person): G Mother G Father G Jointly to both Mother and Father G Caretaker (State Parenting Time Below*) * Joint custody with the child(ren) will be shared between Mother and Father as follows (even if you are suggesting joint custody, you can also use the checklists in Sections 5 and 6.): ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ FOR COURT USE ONLY Effective 12/19/05 Page 1 of 4 PROPOSED PARENTING PLAN American LegalNet, Inc. www.FormsWorkflow.com 4. Special Concerns: (i.e. breastfeeding infant, special needs of child(ren) or disability of either parent: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 5. Visitation Schedule: G Father GMother (check one) shall have visitation, which shall commence on (fill in date), as follows: G Reasonable visitation as agreed to by the parties. G Every other weekend G Every weekend from (day of the week) at ________ GA.M. GP.M. to (day of the week)______________________ at GA.M. GP.M. G Midweek dinner visits on (days of the week) from P.M. to _______P.M. (Note: For Friday and Monday holidays, the child(ren) will stay with the parent who has the child(ren) for that weekend.) Summer Vacation: G Should be split as agreed to by Father and Mother. G Father and Mother shall each have one-half of the summer vacation with alternate weekends to the other parent. The child(ren) should be returned to the custodial parent at least one (1) week prior to the start of school. G Other: __________________________________________________________________________ . Christmas and New Year Vacation: G Should be split as agreed to by Father and Mother G Father and Mother shall each have one-half of the Christmas/New Year vacation. G Other: __________________________________________________________________________ . Intersession Vacations (Spring Break and Fall Break): G Each intersession break should be split as agreed to by Father and Mother. G Each intersession break should be alternated yearly between by Father and Mother. G Father and Mother shall each have one-half of each intersession break. G Other: __________________________________________________________________________ . Child(ren)’s Birthday(s): G The child(ren)’s birthday(s) should be celebrated as agreed to by Father and Mother. G A child’s birthday will be spent with the parent who has the child on that day. G [ ]Father [ ]Mother should have the child(ren) on the child(ren)’s birthday on even-numbered years. The other parent should have the child(ren) on the child(ren)’s birthday on odd-numbered years. G Father and Mother will share the child(ren) for at least half the day on the child(ren)’s birthday. G Other: __________________________________________________________________________ . Extensive Visitation (if applicable) should be as follows: _____________________________________ ____________________________________________________________________________________ . Out-of-State visitation (if applicable) should be as follows: ___________________________________ ____________________________________________________________________________________ . Effective 12/19/05 Page 2 of 4 PROPOSED PARENTING PLAN American LegalNet, Inc. www.FormsWorkflow.com 6. Detailed Holiday Schedule: Some cases work better if more details are listed. Use this as a checklist. You do not have to fill in everything. Anything that is left blank means that the child will spend the day with the parent who has the child on that day. (Note: For Friday and Monday holidays, the child(ren) will stay with the parent who has the child(ren) for that weekend.) Check “M” for Mother and “F” for Father. An example is shaded in gray. Holiday Time (Put a.m. or p.m.) Every Year Even Years GM GF :M GF GM :F New Year’s Eve GM GF GM GF GM GF New Year’s Day GM GF GM GF GM GF GM GF GM GF Example Holiday 9 a.m. to 7 p.m. Martin Luther King, Jr. Day MONDAY HOLIDAY (see above note) President’s Day Odd Years MONDAY HOLIDAY (see above note) Prince Kuhio Day (March 26th) GM GF Good Friday FRIDAY HOLIDAY (see above note) Memorial Day MONDAY HOLIDAY (see above note) King Kamehameha Day (June 11th) GM GF GM GF GM GF Independence Day (July 4th) GM GF GM GF GM GF Statehood Day (Admissions Day) FRIDAY HOLIDAY (see above note) Labor Day MONDAY HOLIDAY (see above note) Veterans’ Day (November 11th) GM GF GM GF GM GF Thanksgiving Day GM GF GM GF GM GF Christmas Eve GM GF GM GF GM GF Christmas Day GM GF GM GF GM GF Mother’s Day GM GF GM GF GM GF Father’s Day GM GF GM GF GM GF Mother’s Birthday GM GF GM GF GM GF Father’s Birthday GM GF GM GF GM GF Halloween (October 31st) GM GF GM GF GM GF Other: GM GF GM GF GM GF Other: GM GF GM GF GM GF 7. Childcare: These are the arrangements for childcare when I am at work (if you have agreed to joint custody, also state the arrangements of the other parent): ____________________________________________________________ ________________________________________________________________________________________ 8. Parents covering each other: G If we cannot care for the child(ren) during a time assigned to us, we will ask the other parent to take care of the child(ren) before we ask anybody else. G It will be up to each parent who they ask for help during their assigned times. Effective 12/19/05 Page 3 of 4 PROPOSED PARENTING PLAN American LegalNet, Inc. www.FormsWorkflow.com 9. Transportation: G The parents will agree to who can transport the child(ren). G Only the following people can help the parents with transportation: ____________________________ __________________________________________________________________________________ 10. Communication and Information Sharing: G The parent without the child(ren) can call the child(ren) (check only one): G At reasonable hours OR G Everyday from a.m./p.m. to a.m./p.m. G E-Mail at this email address: ____________________ G Other: _________________________ G Parents will share information with each other G Parents must get information from the source (e.g., Dr., school) 11. Supervised Visitation/No Visitation: G Father G Mother G Will have supervised visitation with the child(ren): G at PACT Visitation Center G Under the supervision of __________________________________ G Will have no visitation. (State the reason why supervised or suspended visitation is necessary) ___________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 12. Modifications to the visitation schedule: G Any additional visitation or changes to the visitation schedule can be agreed upon by the parents/caretaker with at least 24-hour notice. G If the non-custodial parent fails to arrive at the appointed time, then the custodial parent/caretaker will wait for minutes before considering the visitation cancelled. G Other: ___________________________________________________________________________ _________________________________________________________________________________ G No modifications allowed except by a court order. 13. Mediation and Solving Disagreements: G The parties should mediate any unresolved issues or future disagreements at: G The Mediation Center of the Pacific G Other: _________________________________________ G Mediation is inappropriate because: G Domestic Violence/TRO G Other: ___________________ G Before going to court, the parents will ask the following person to help them solve disagreements: ________________________________________________________________________________ (list name, relationship, address, phone no.) 14. Counseling: List present counselors for: Mother: _____________________ Father: _____________________ Child(ren): _____________________ Under penalty of perjury, I/we declare that this plan is proposed in good faith and is in the best interest of the child(ren) listed in Section 1. __________________________________________ Print Attorney’s Name __________________________________________ Party’s Signature Date __________________________________________ Attorney’s Signature Date __________________________________________ Party’s Signature Date Effective 12/19/05 Page 4 of 4 PROPOSED PARENTING PLAN American LegalNet, Inc. www.FormsWorkflow.com