CC-1256 V3 STATE OF ILLINOIS IN THE CIRCUIT COURT OF THE 17 th JUDICIAL CIRCUIT COUNTY OF WINNEBAGO IN RE THE MARRIAGE OF: ) ) IN CHANCERY ) ) ) Case No. ) ) ) ) FILE STAMP Petitioner, vs. Respondent. TEMPORARY ORDER ALLOCATING PARENTAL RESPONSIBILITIES This Cause having come before the Court relating to the issues concerning parental responsibilities, Petitioner, pro se represented by attorney(s) ________________________________________ and Respondent, pro se represented by attorney(s) _____________________________________ the COURT HEREBY ORDERS AS FOLLOW: 1. Temporary Order Allocating Parental Responsibilities: The Court enters this Temporary order Allocating Parental Responsibilities without prejudice to either party pursuant to 750 ILCS 5/603.5. OR This Temporary Order Allocating Parental Responsibilities is entered pursuant to an agreement by the parties pursuant to 750 ILCS 5/603.5. The order is entered without prejudice to either party. 2. The Petitioner, __________________________________________ (name), is the child(ren)'s: Father Mother Other Party (state relationship to child(ren) ________________________ The Respondent, _________________________________________ (name), is the child(ren)'s: Father Mother Other Party (state relationship to child(ren) ________________________ 3. The Child(ren) of this relationship/ marriage are: Name of Child Sex Date of Birth Temporary Order Allocating Parental Responsibilities Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com CC-1256 V3 4. 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) Each Party shall inform the other party of any changes with their address and/or phone numbers in advance of them changing or within twenty four (24) hours of said change unless otherwise ordered by the Court. The Petitioner Respondent is not required to notify the other party under this paragraph because there is a history of domestic abuse or it is not in the child's or parent's best interests. c) Both Parties shall 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 shall 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. 5. For purposes of school attendance only, the child(ren)'s residence shall be with the: Petitioner Respondent Other Party 6. Significant Decision Making shall be allocated as follows: Type of Significant Decision Making Educational: Including day care and preschool Medical/Dental/Mental Health: Religious: Extracurricular and Recreational Activities: Other Joint Petitioner Respondent Other Party 7. Allocation of Parental Responsibilities (Parenting Time): a) Weekday and Weekend Schedule I. The child(ren) will be in the care of the Petitioner. List the days of the week and times. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ II. 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. ________________________________________________________________ ________________________________________________________________ Temporary Order Allocating Parental Responsibilities Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com III. CC-1256 V3 IV. Transportation and drop-off / pick-up arrangements will be as follows: Petitioner Respondent shall provide all transportation. OR 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: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ V. Restriction of parenting time: Not applicable The parenting time between the child(ren) and Petitioner Respondent is restricted as follows: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ Length of restriction: ________________________________________________________________ ________________________________________________________________ ______________________________________________________________ b) Summer Schedule The weekday and weekend schedule above will apply for all 12 calendar months with no specific changes during the summer. OR During the summer months, the child(ren) will be in the care of the Petitioner. List the days of the week and times. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ____________________________________________________________________ During the summer months, the child(ren) will be in the care of the Respondent. List the days of the week and times. ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Temporary Order Allocating Parental Responsibilities Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com CC-1256 V3 During the summer