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Instructions for Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.995(a), PARENTING PLAN (12/10)

When should this form be used?

A Parenting Plan is required in all cases involving time-sharing with minor child(ren), even when time-

sharing is not in dispute. The Parenting Plan must be developed and agreed to by the parents and

approved by the court. If the parties cannot agree to a Parenting Plan or if the parents agreed to a plan

that is not approved by the court, a Parenting Plan will be established by the court with or without the

use of parenting plan recommendations. This form or a similar form should be used in the development

of a Parenting Plan. If the case involves supervised time-sharing, the Safety Focused Parenting Plan,

Florida Supreme Court Approved Family Law Form 12.995 (b) or a similar form should be used.

This form should be typed or printed in black ink. Please either delete or strike-through terms or

paragraphs that are inappropriate or inapplicable to your agreement. If an agreement has been

reached, both parties must sign the Parenting Plan and have their signatures witnessed by a notary

public or deputy clerk. After completing this form, you should file the original with the clerk of the

circuit court in the county where the petition was filed and keep a copy for your records. You should

then refer to the instructions for your petition, answer, or answer and counterpetition concerning the

procedures for setting a hearing or trial (final hearing). If the parents have not reached an agreement, a

proposed Parenting Plan may be filed by either parent at the time of or any time prior to the final

hearing. If an agreed Parenting Plan is not filed by the parties, the court shall establish a Plan.

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. The words that are in “bold underline” in these instructions are defined

there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition

and/or answer that were filed in this case.

Special notes...

At a minimum, the Parenting Plan must describe in adequate detail:

 How the parties will share and be responsible for the daily tasks associated with the upbringing of

the child(ren),

 The time-sharing schedule arrangements that specify the time that the minor child(ren) will spend

with each parent,

 A designation of who will be responsible for any and all forms of health care, school-related matters,

including the address to be used for school-boundary determination and registration, other

activities, and

 The methods and technologies that the parents will use to communicate with the child(ren).

Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

PARENTING PLAN

This Parenting Plan is: (Choose only one)

[ ] A Parenting Plan submitted to the court with the agreement of the parties.

[ ] A proposed Parenting Plan submitted by or on behalf of:

{Parent’s Name}

[ ] A Parenting Plan established by the court.

This Parenting Plan is: (Choose only one)

[ ] A final Parenting Plan established by the court.

[ ] A temporary Parenting Plan established by the court.

[ ] A modification of a prior final Parenting Plan or prior final order.

I. PARENTS

Mother

Name:

Address:

Telephone Number:

E-Mail:

( ) Address Unknown: (Please indicate here if mother’s address is unknown)

( ) Address Confidential: (Please indicate here if mother’s

address and phone numbers are

confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence, or

( ) Other court order:

Father

Name:

Address:

Telephone Number:

E-Mail:

( ) Address Unknown: (Please indicate here if father’s address is unknown)

IN THE CIRCUIT COURT OF THE JUDICIAL CIRCUIT,

IN AND FOR COUNTY, FLORIDA

Case No.:

Division:

Petitioner,

and

Respondent.

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Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

II. CHILDREN: This Parenting Plan is for the following child(ren) born to, or adopted by the parties: (add

additional lines as needed)

Name

Date of Birth

III.

JURISDICTION

The United States is the

country of habitual residence of the child(ren).

The State of Florida is the child(ren)’s home state for the purposes of the Uniform Child Custody

Jurisdiction and Enforcement Act.

This Parenting Plan is a child custody determination for the purposes of the Uniform Child Custody

Jurisdiction and Enforcement Act, the International Child Abduction Remedies Act, 42 U.S.C.

Sections 11601 et seq., the Parental Kidnapping Prevention Act, and the Convention on the Civil

Aspects of International Child Abduction enacted at the Hague on October 25, 1980, and for all

other state and federal laws.

Other:

IV. PARENTAL RESPONSIBILITY AND DECISION MAKING

1. Parental Responsibility (Choose only one)

[ ] Shared Parental Responsibility.

It is in the best interests of the child(ren) that the parents confer and jointly make all major

decisions affecting the welfare of the child(ren). Major decisions include, but are not

limited to, decisions about the child(ren)’s education, healthcare, and other responsibilities

unique to this family.

[ ] Shared Parental Responsibility with Decision Making Authority

( ) Address Confidential: (Please indicate here if father’s

address and phone numbers are

confidential pursuant to either a ( ) Final Judgment for Protection Against Domestic Violence, or

( ) Other court order:

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Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

2. Academic Break Definition

When defining academic break periods, the period shall begin at the end of the last scheduled

day of classes before the holiday or break and shall end on the first day of regularly scheduled

classes after the holiday or break.

3. Schedule Changes (Choose all that apply)

[ ] A parent making a request for a schedule change will make the request as soon as possible,

but in any event, except in cases of emergency, no less than before the

change is to occur.

[ ] A parent requesting a change of schedule shall be responsible for any additional child care,

or transportation costs caused by the change.

[ ] Other

VII. TIME-SHARING SCHEDULE

1. Weekday and Weekend Schedule

The following schedule shall apply beginning on with the

[

] Mother [

] Father and continue as follows:

A. The child(ren) shall spend time with the Mother on the following dates and times:

WEEKENDS: [ ] Every [ ] Every Other [ ] Other (specify)

From to

WEEKDAYS: Specify days

From to

OTHER: (Specify)

B. The child(ren) shall spend time with the Father on the following dates and times:

WEEKENDS: [ ] Every [ ] Every Other [ ] Other (specify)

____________

From to

WEEKDAYS: Specify days _______________________________________________________

From

OTHER: (Specify)

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Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

1. Transportation (Choose only one)

[ ] The [ ] Mother [ ] Father shall provide all transportation.

[ ] The parent beginning their time-sharing shall provide transportation for the child(ren).

[ ] The parent ending their time-sharing shall provide transportation for the child(ren).

[ ] Other:

2. Exchange

Both parents shall have the child(ren) ready on time with sufficient clothing packed and ready at

the agreed upon time of exchange. If a parent is more than minutes late without

contacting the other parent to make other arrangements, the parent with the child(ren) may

proceed with other plans and activities. (Choose only one):

[ ] Exchanges shall be at Mother’s and Father’s homes unless both parents agree to a

different meeting place.

[ ] Exchanges shall occur at

unless both parties agree in advance to a different meeting place.

[ ] Other:

3. Transportation Costs (Choose only one)

[ ] Transportation costs are included in the Child Support Worksheets and/or the Order for

Child Support and should not be included here.

[ ] The Mother shall pay % and the Father shall pay % of the transportation

costs.

[ ] Other:

4. Foreign and Out-Of-State Travel (Choose all that apply)

[ ] Either parent may travel within the United States with the child(ren) during his/her

time-sharing. The parent traveling with the child(ren) shall give the other parent at least

____ days written notice before traveling out of state unless there is an emergency, and

shall provide the other parent with a detailed itinerary, including locations and

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Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

The parents shall communicate with each other: (Choose all that apply)

[ ] in person

[ ] by telephone

[ ] by letter

[ ] by e-mail

[ ] Other:

2. Between Parent and Child(ren)

Both parents shall keep contact information current. Telephone or other electronic

communication between the child(ren) and the other parent shall not be monitored by or

interrupted by the other parent. “Electronic communication” includes telephones, electronic

mail or e-mail, webcams, video-conferencing equipment and software or other wired or wireless

technologies or other means of communication to supplement face to face contact.

The child(ren) may have [ ] telephone [ ] e-

mail [

] other electronic communication in the

form of with the other parent: (Choose only one)

[ ] Anytime

[ ] Every day during the hours of to

[ ] On the following days

during the hours of to

[ ] Other:

3. Costs of Electronic Communication shall be addressed as follows:

XII. CHILD CARE (Choose only one)

[ ] Each parent may select appropriate child care providers

[ ] All child care providers must be agreed upon by both parents.

[ ] Each parent must offer the other parent the opportunity to care for the child(ren) before

using a child care provider for any period exceeding hours.

[ ] Other

XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN

Temporary changes to this Parenting Plan may be made informally without a written document;

however, if the parties dispute the change, the Parenting Plan shall remain in effect until further

order of the court.

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Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

Any substantial changes to the Parenting Plan must be sought through the filing of a supplemental

petition for modification.

XIV. RELOCATION

Any relocation of the child(ren) is subject to and must be sought in compliance with section

61.13001, Florida Statutes.

XV. DISPUTES OR CONFLICT RESOLUTION

Parents shall attempt to cooperatively resolve any disputes which may arise over the terms of the

Parenting Plan. The parents may wish to use mediation or other dispute resolution methods and

assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court action.

XVI. OTHER PROVISIONS

SIGNATURE OF PARENTS

I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this

Plan and intend to be bound by it.

Dated: _____________________________________________

Signature of Mother

Printed Name:

Address:

City:

State, Zip:

Telephone Number:

Fax Number:

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Florida Supreme Court Approved Family Law Form 12.995(a), Parenting Plan (12/10)

I certify that I have been open and honest in entering into this Parenting Plan. I am satisfied with this

Plan and intend to be bound by it.

Dated: _____________________________________________

Signature of Father

Printed Name:

Address:

City:

State, Zip:

Telephone Number:

Fax Number:

STATE OF FLORIDA

COUNTY OF _________________________

Sworn to or affirmed and signed before me on__________________ by __________________________.

NOTARY PUBLIC or DEPUTY CLERK

[Print, type, or stamp commissioned name of

notary or clerk.]

Personally known

Produced identification

Type of identification produced ____________________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks]

I, {full legal name and trade name of nonlawyer}

a nonlawyer, whose address is: {street}

{city}

{state}

, {phone}

, helped

{ name}

who is the [Choose one

only]

petitioner or

fill out this form.

respondent,

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