Superior Court of Washington County of In re the Custody of: No. Child(ren), Petitioner(s), and Residential Schedule [ ] Proposed (PRS) [ ] Temporary (TRS) [ ] Final Order (RS) Respondent(s). This residential schedule is: [] [] [] [] the final residential schedule signed by the court pursuant to a nonparental custody decree signed by the court on this date or dated _____________________________________. the final residential schedule signed by the court pursuant to an order signed by the court on this date or dated ____________________________, which modifies a previous residential schedule or custody decree. a temporary residential schedule signed by the court. proposed by (name) ______________________________ . It is Ordered, Adjudged and Decreed: I. General Information This residential schedule applies to the following children: Name Age Residential Schedule (PRS, TRS, RS) - Page 1 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com II. Basis for Restrictions Under certain circumstances, as outlined below, the court may limit or prohibit a person’s contact with the child(ren) and the right to make decisions for the child(ren). 2.1 Limiting Conduct of ________________________________ (RCW 26.10.160) [] [] Does not apply. ______________________________’s residential time with the children shall be limited or restrained completely because [ ] __________________________ [ ] a person residing with ___________________________ has engaged in the conduct which follows: [] [] [] [] [] [] 2.2 Willful abandonment that continues for an extended period of time or substantial refusal to perform parenting functions (this applies only to parents, not to a person who resides with a parent). Physical, sexual or a pattern of emotional abuse of a child. A history of acts of domestic violence as defined in RCW 26.50.010(1) or an assault or sexual assault which causes grievous bodily harm or the fear of such harm. A conviction as an adult or adjudication as a juvenile of a sex offense involving a minor. A finding that the person is a sexual predator. Other: Limiting Conduct of _______________________________ (RCW 26.10.160) [] [] Does not apply. ______________________________’s residential time with the children shall be limited or restrained completely because [ ] __________________________ [ ] a person residing with _____________________________ has engaged in the conduct which follows: [] [] [] [] [] [] Willful abandonment that continues for an extended period of time or substantial refusal to perform parenting functions (this applies only to parents, not to a person who resides with a parent). Physical, sexual or a pattern of emotional abuse of a child. A history of acts of domestic violence as defined in RCW 26.50.010(1) or an assault or sexual assault which causes grievous bodily harm or the fear of such harm. A conviction as an adult or adjudication as a juvenile of a sex offense involving a minor. A finding that the person is a sexual predator. Other: III. Residential Schedule Residential Schedule (PRS, TRS, RS) - Page 2 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com These provisions set forth where the child(ren) shall reside each day of the year and what contact the child(ren) shall have with each party. 3.1 Schedule for Children Under School Age [] [] There are no children under school age. Prior to enrollment in school, the child(ren) shall reside with (nonparental custodian) _____________________________________________, except for the following days and times when the child(ren) will visit the following parties: ____________________________________ from: (day and time)__________________ to (day and time) ___________________ [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: _____________________________________ from: (day and time) __________________ to (day and time) ___________________ [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: 3.2 School Schedule Upon enrollment in school, the child(ren) shall reside with (nonparental custodian) _____________________________ ____________________, except for the following days and times when the child(ren) will visit the following parties: __________________________________________ from: (day and time) __________________ to (day and time) ___________________ [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: __________________________________________ from: (day and time) __________________ to (day and time) ___________________ [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: [] 3.3 The school schedule will start when each child begins [ ] kindergarten [ ] first grade [ ] other: Schedule for Winter Vacation Residential Schedule (PRS, TRS, RS) - Page 3 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com The child(ren) shall reside with (nonparental custodian) _________________________________ during winter vacation, except for the following days and times when the child(ren) will visit the following parties: _________________________________________________: _________________________________________________: 3.4 Schedule for Other School Breaks The child(ren) shall reside with (nonparental custodian) _________________________________ during other school breaks, except for the following days and times when the child(ren) will visit the following parties: _________________________________________________: _________________________________________________: 3.5 Summer Schedule Upon completion of the school year, the child(ren) shall reside with (nonparental custodian) ____________________________________________________ , except for the following days and times when the child(ren) will visit the following parties: [] [] Same as school year schedule. Other: _________________________________________________: _________________________________________________: 3.6 Vacations Residential Schedule (PRS, TRS, RS) - Page 4 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com [] [] 3.7 Does not apply. The schedule for vacation is as follows: Schedule for Holidays The residential schedule for the child(ren) for the holidays listed below is as follows: New Year’s Day Martin Luther King Day Presidents’ Day Memorial Day July 4th Labor Day Veterans’ Day Thanksgiving Day Christmas Eve Christmas Day [] [] Holidays which fall on a Friday or a Monday shall include Saturday and Sunday. [] 3.8 For purposes of this residential schedule, a holiday shall begin and end as follows (set forth times): Other: Schedule for Special Occasions The residential schedule for the child(ren) for the following special occasions (for example, birthdays) is as follows: Special occasion: Mother’s Day Father’s Day [] Other: Residential Schedule (PRS, TRS, RS) - Page 5 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com 3.9 Priorities Under the Residential Schedule [] [] Does not apply because the parents have no visitation or restricted visitation. Paragraphs 3.3 - 3.8, have priority over paragraphs 3.1 and 3.2, in the following order: [] Rank the order of priority, with 1 being given the highest priority: ____winter vacation (3.3) ____school breaks (3.4) ____summer schedule (3.5) [] 3.10 ____holidays (3.7) ____special occasions (3.8) ____vacation with parents (3.6) Other: Restrictions [] [] [] 3.11 Does not apply because there are no limiting factors in paragraphs 2.1 or 2.2. ______________________________________’s residential time with the children shall be limited because there are limiting factors in paragraphs 2.1 and 2.2. The following restrictions shall apply: ______________________________________’s residential time with the children shall be limited because there are limiting factors in paragraphs 2.1 and 2.2. The following restrictions shall apply: Transportation Arrangements Transportation costs are included in the Child Support Worksheets and/or the Order of Child Support and should not be included here. Transportation arrangements for the child(ren) shall be as follows: 3.12 Other Residential Schedule (PRS, TRS, RS) - Page 6 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com 3.13 Summary of RCW 26.09.430 - .480, Regarding Relocation of a Child This is a summary only. For the full text, please see RCW 26.09.430 through 26.09.480. If the person with whom the child resides a majority of the time plans to move, that person shall give notice to every person entitled to court ordered time with the child. If the move is outside the child’s school district, the relocating person must give notice by personal service or by mail requiring a return receipt. This notice must be at least 60 days before the intended move. If the relocating person could not have known about the move in time to give 60 days’ notice, that person must give notice within five days after learning of the move. The notice must contain the information required in RCW 26.09.440. See also form DRPSCU 07.0500, (Notice of Intended Relocation of a Child.). If the move is within the same school district, the relocating person must provide actual notice by any reasonable means. A person entitled to time with the child may not object to the move but may ask for modification under RCW 26.09.260. Notice may be delayed for 21 days if the relocating person is entering a domestic violence shelter or is moving to avoid a clear, immediate and unreasonable risk to health and safety. If information is protected under a court order or the address confidentiality program, it may be withheld from the notice. A relocating person may ask the court to waive any notice requirements that may put the health and safety of a person or a child at risk. Failure to give the required notice may be grounds for sanctions, including contempt. If no objection is filed within 30 days after service of the notice of intended relocation, the relocation will be permitted and the proposed revised residential schedule may be confirmed. A person entitled to time with a child under a court order can file an objection to the child’s relocation whether or not he or she received proper notice. An objection may be filed by using the mandatory pattern form WPF DRPSCU 07.0700, [Objection to Relocation/Petition for Modification of Custody Decree/parenting Plan/Residential Schedule]. The objection must be served on all persons entitled to time with the child. The relocating person shall not move the child during the time for objection unless: (a) the delayed notice provisions apply; or (b) a court order allows the move. If the objecting person schedules a hearing for a date within 15 days of timely service of the objection, the relocating person shall not move the child before the hearing unless there is a clear, immediate and unreasonable risk to the health or safety of a person or a child. IV. Other Provisions [ ] There are no other provisions. [ ] There are the following other provisions: Residential Schedule (PRS, TRS, RS) - Page 7 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com V. Declaration for Proposed Residential Schedule [] [] Does not apply. (Only sign if this is a proposed residential schedule.) I declare under penalty of perjury under the laws of the state of Washington that this residential schedule has been proposed in good faith and that the statements in Part II of this Schedule are true and correct. Signature Date and Place (City and State) of Signature Signature Date and Place (City and State) of Signature VI. Order by the Court It is ordered, adjudged and decreed that the residential schedule set forth above is adopted and approved as an order of this court. Warning: Violation of residential provisions of this order with actual knowledge of its terms is punishable by contempt of court and may be a criminal offense under RCW 9A.40.060(2) or RCW 9A.40.070(2). Violation of this order may subject a violator to arrest. If a party fails to comply with a provision of this plan, the other parties’ obligations under the plan are not affected. Dated: Judge/Commissioner Presented by: Approved for entry: Signature of Party or Lawyer/WSBA No. Signature of Party or Lawyer/WSBA No. Print Name Print Name Signature of Party or Lawyer/WSBA No. Signature of Party or Lawyer/WSBA No. Print Name Print Name Residential Schedule (PRS, TRS, RS) - Page 8 of 9 WPF CU 01.0450 Mandatory (6/2008) - RCW 26.10.160, 26.10.040 American LegalNet, Inc. www.FormsWorkflow.com