CC-1252 V6 STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 17 th JUDICIAL CIRCUIT COUNTY OF WINNEBAGO ) ) IN CHANCERY ) ) ) Case No. ) ) ) ) FILE STAMP Petitioner, vs. Respondent. PARENTING PLAN [EVERY SECTION MUST BE COMPLETED UNLESS EXEMPTIONS UNDER PARAGRAPH 2 & 3 APPLY] 1. Parenting Plan: Parenting Plan prepared by Petitioner Respondent Other Party:__________________. The Parties are unable to arrive at a Joint Parenting Plan. Full Joint Parenting Plan (The parties agree to everything and the plan is signed by both parties.) Partial Joint Parenting Plan (We agree to some things and the plan is signed by both parties.) 2. The personal identifying information regarding the Petitioner Respondent Other Party in subsections 4, 5, 7(b) and 15 is not required to be provided because there is a history of domestic violence or abuse. 3. The Court has found that the Petitioner Respondent Other Party is not required to provide the personal identifying information stated in subsections 4, 5, 7(b) and 15 because disclosure is not in the best interests of the child(ren) or party. 4. The Petitioner, _________________________________________(name), is the child(ren)'s: Father Mother Other Party (state relationship to child(ren): ______________________ The Petitioner's Address is: _____________________________________________________ ____________________________________________________________________________ The Petitioner's Telephone Number is: ____________________________________________ The Petitioner's Employer is: ___________________________________________________ The Petitioner's Employer Address is: ____________________________________________ ____________________________________________________________________________ The Petitioner's Employer Telephone Number is: ___________________________________ 5. The Respondent, ______________________________________(name), is the child(ren)'s: Father Mother Other Party (state relationship to child(ren): ______________________ The Respondent's Address is: ___________________________________________________ ____________________________________________________________________________ The Respondent's Telephone Number is: __________________________________________ Parenting Plan Form Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com CC-1252 V6 The Respondent's Employer is: __________________________________________________ The Respondent's Employer Address is: ___________________________________________ ____________________________________________________________________________ The Respondent's Employer Telephone Number is: __________________________________ 6. The children of this relationship / marriage are: Name of Child Sex Date of Birth 7. Parental Conduct: a) The Parties understand that day-to-day decisions such as minor training or correction, minor medical and dental care, chores, allowances, clothing, hygiene, etc. will be made by the party who has the child(ren) at the time such decisions are necessary. b) The Petitioner Respondent parties shall provide to the other party at least sixty (60) days prior written notice of the intention to change his or her residence. At minimum, the party changing his or her residence shall provide the intended date of the change of residence and the address of the new residence. If the sixty (60) day notice is impracticable, written notice shall be given at the earliest practical date. c) Both Parties will provide the names, addresses, and telephone numbers of all medical, dental, and mental health care providers. Either party may authorize emergency care, but if possible, both parties agree to contact the other party first. d) Unless otherwise ordered by the Court for good cause shown, state law provides that both parties have access to the records of the child(ren) including school, medical, dental, and mental health records, pursuant to 750 ILCS 5/602.11. e) Travel and Vacation Notice Unless otherwise ordered by the Court for good cause shown, if either party requires out of state or any type of overnight travel with the child(ren), each party will inform the other party of such travel and vacation plans, including notice and contact information. 8. Significant Decision Making shall be allocated as follows: Type of Significant Decision Joint Petitioner Making Educational: Including day care and preschool Medical/Dental/Mental Health: Religious: Extracurricular and Recreational Activities: Other Respondent Other Party Parenting Plan Form Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com CC-1252 V6 9. Allocation of Parental Responsibilities (Parenting Time): a) Weekday and Weekend Schedule during the School Year I. The child(ren) will be in the care of the Petitioner. List the days of the week and times. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ The child(ren) will be in the care of the Respondent. List the days of the week and times. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ The child(ren) will be in the care of Other Party. List the days of the week and times. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Transportation and drop-off / pick-up arrangements will be as follows: Petitioner Respondent shall provide all transportation. Or II. III. IV. Party starting parenting time shall provide transportation. OR Party ending parenting time shall provide transportation. AND The parties shall meet at the following location: ________________________________________________________________ ________________________________________________________________ Other Transportation Arrangements: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ V. Restriction of parenting time: Not applicable The parenting time between the child(ren) and Petitioner Respondent is restricted as follows: ________________________________________________________________ ________________________________________________________________