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FORM 12.984(b): INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES (Florida)

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Instructions for Florida Family Law Rules of Procedure Form 12.984(b), Response by Parenting
Coordinator (07/14)
INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES OF PROCEDURE
FORM 12.984(b)
RESPONSE BY PARENTING COORDINATOR (07/14)
When should this form be used?
A person appointed as a parenting coordinator must accept or decline the appointment under
Florida Family Law Rule of Procedure 12.742(e). If you accept the appointment, you must
complete paragraphs 1(a) and 2 and sign it. If you decline the appointment, you must complete
only paragraph 1(b) and sign the form. This form should be typed or printed in black ink.
Important Consideration Before Responding.
A Qualified Parenting Coordinator or other licensed mental health professional under Chapter
490 or 491, Florida Statutes, shall abide by the ethical and other professional standards imposed
by his or her licensing authority, certification board, or both, as applicable.
A person who is not a Qualified Parenting Coordinator or a licensed mental health professional
under Chapter 490 or 491, Florida Statutes, shall not accept an appointment to serve as
parenting coordinator in a matter that presents an apparent or undisclosed conflict of interest.
A conflict of interest arises when any relationship between the parenting coordinator and either
party compromises or appears to compromise the parenting coordinator’s ability to serve. The
burden of disclosure of any potential conflict of interest rests on the parenting coordinator.
Disclosure shall be made as soon as practical after the parenting coordinator becomes aware of
the potential conflict of interest. If a parenting coordinator makes an appropriate disclosure of
a conflict of interest or a potential conflict of interest, he or she may serve if all parties agree.
However, if a conflict of interest substantially impairs a parenting coordinator's ability to serve,
the parenting coordinator shall decline the appointment or withdraw regardless of the express
agreement of the parties.
A parenting coordinator shall not provide any services to either party that would impair the
parenting coordinator's ability to be neutral.
What should I do next?
After completing and signing this form, you must file the original with the clerk of the circuit
court in the county in which the action is pending and keep a copy for your records.
You must mail or hand-deliver a copy of this form to the attorney(s) for the parents or, if not
represented by an attorney, to the parents.
Where can I look for more information?
Before proceeding, you should read “General Information for Self-Represented Litigants”
found at the beginning of these forms. For more information, see section 61.125; Florida
Statutes, Florida Family Law Rule of Procedure 12.742, Rules for Qualified and Court Appointed
Parenting Coordinators and the Order of Referral to Parenting Coordinator, Florida Family Law
Rules of Procedure Form 12.984(a).
Instructions for Florida Family Law Rules of Procedure Form 12.984(b), Response by Parenting
Coordinator (07/14)
Special notes
Remember, a person who is NOT an attorney is called a nonlawyer. If a nonlawyer helps you fill
out these forms, that person must give you a copy of Disclosure from Nonlawyer, Florida Family
Law Rules of Procedure Form 12.900(a), before he or she helps you. A nonlawyer helping you fill
out these forms also must put his or her name, address, and telephone number on the bottom
of the last page of every form he or she helps you complete.
Florida Family Law Rules of Procedure Form 12.984(b), Response by Parenting Coordinator (07/14)
IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
RESPONSE BY PARENTING COORDINATOR
I, {name}_________________________________________notify the Court and affirm the
following:
1. Acceptance.
[Choose only one]
a. ____ I accept the appointment as parenting coordinator.
b. ____ I decline the appointment as parenting coordinator.
2. Qualifications.
[Choose only one]
a. ____ I meet the qualifications in section 61.125(4), Florida Statutes.
b. ____ I do not meet the qualifications in section 61.125(4), Florida Statutes. However, the parties
have chosen me by mutual consent and I believe I can perform the services of a parenting
coordinator because: ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. I am not aware of any conflict, circumstance, or reason that renders me unable to serve as the
parenting coordinator in this matter and I will immediately inform the court and the parties if such
arises.
4. I understand my role, responsibility, and authority under the Order of Referral to Parenting
Coordinator, Florida Family Law Rules of Procedure Form 12.984(a); section 61.125, Florida Statutes;
Florida Family Law Rule of Procedure 12.742; and Rules for Qualified and Court Appointed Parenting
Coordinators.
Florida Family Law Rules of Procedure Form 12.984(b), Response by Parenting Coordinator (07/14)
I hereby affirm the truth of the statements in this acceptance and understand that if I make any false
representations in this acceptance, I am subject to sanctions by the Court.
_____________________ _____________________________________________
Date Signature of Parenting Coordinator
Printed Name:_________________________________
Address: _____________________________________
City, State, Zip: ________________________________
Telephone Number: ____________________________
E-mail: _______________________________________
Professional License # (if applicable) _______________
Professional Certification # (if applicable) ____________
Copies to:
_____Petitioner
_____Attorney for Petitioner
_____Respondent
_____Attorney for Respondent
_____Other: _______________________________
IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:
[fill in all blanks] This form was completed with the assistance of:
{name of individual} ___________________________________________________________________,
{name of business}_____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ______________________,{state} __________,{telephone number} ________________________.
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FORM 12.984(b): INSTRUCTIONS FOR FLORIDA FAMILY LAW RULES (Florida)

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Completed 10 January 2021

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