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FORM 12.995(b),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.995(b),
SUPERVISED/SAFETY-FOCUSED PARENTING PLAN
(02/18)
When should this form be used?
A Parenting Plan is required in all cases involving minor child(ren). This form or a similar form should be
used in cases when you feel your child(ren) cannot be safely alone with the other parent or if you
believe shared parental responsibility presents a detriment to the child(ren). In this case, a Parenting
Plan must be developed that allows time-sharing with any minor child(ren), while providing protection
for the child(ren). If safety or supervised time-sharing is not a concern, Parenting Plan, Florida Supreme
Court Approved Family Law Form 12.995(a) or a similar form should be used. If the case involves
relocation, pursuant to Section 61.13001, Florida Statutes, then Relocation/Long Distance Parenting
Plan, Florida Supreme Court Approved Family Law Form 12.995(c) or a similar form should be used.
The parents must identify a name or designation to be used throughout this Parenting Plan.
This form should be typed or printed in black ink. 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.
IMPORTANT INFORMATION REGARDING E-FILING
The Florida Rules of Judicial Administration now require that all petitions, pleadings, and documents be
filed electronically except in certain circumstances. Self-represented litigants may file petitions or other
pleadings or documents electronically; however, they are not required to do so. If you choose to file
your pleadings or other documents electronically, you must do so in accordance with Florida rule of
Judicial Administration 2.525, and you must follow the procedures of the judicial circuit in which you file.
The rules and procedures should be carefully read and followed.
IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION
After the initial service of process of the petition or supplemental petition by the Sheriff or certified
process server, the Florida Rules of Judicial Administration now require that all documents required or
permitted to be served on the other party must be served by electronic mail (e-mail) except in certain
circumstances. You must strictly comply with the format requirements set forth in the Rules of Judicial
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
Administration. If you elect to participate in electronic service, which means serving or receiving
pleadings by electronic mail (e-mail), or through the Florida Courts E-Filing Portal, you must review
Florida Rule of Judicial Administration 2.516. You may find this rule at www.flcourts.org through the link
to the Rules of Judicial Administration provided under either Family Law Forms: Getting Started, or Rules
of Court in the A-Z Topical Index.
SELF-REPRESENTED LITIGANTS MAY SERVE DOCUMENTS BY E-MAIL; HOWEVER, THEY ARE NOT
REQUIRED TO DO SO. If a self-represented litigant elects to serve and receive documents by e-mail, the
procedures must always be followed once the initial election is made.
To serve and receive documents by e-mail, you must designate your e-mail addresses by using the
Designation of Current Mailing and E-mail Address, Florida Supreme Court Approved Family Law Form
12.915, and you must provide your e-mail address on each form on which your signature appears.
Please CAREFULLY read the rules and instructions for: Certificate of Service (General), Florida Supreme
Court Approved Family Law Form 12.914; Designation of Current Mailing and E-mail Address, Florida
Supreme Court Approved Family Law Form 12.915; and Florida Rule of Judicial Administration 2.516.
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...
If you fear that disclosing your address would put you in danger, you should complete a Request for
Confidential Filing of Address, Florida Supreme Court Approved Form 12.980(h), file it with the clerk of
the circuit court and write confidential in the space provided in the Parenting Plan.
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).
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the
Parenting Plan, all circumstances between the parents, including their historic relationship, domestic
violence, and other factors must be taken into consideration. Determination of the best interests of the
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
child(ren) shall be made by evaluating all of the factors affecting the welfare and interest of the
particular minor child(ren) and the circumstances of that family, as listed in section 61.13(3), Florida
Statutes, including, but not limited to:
The demonstrated capacity and disposition of each parent to facilitate and encourage a close
and continuing parent-child relationship, to honor the time-sharing schedule, and to be
reasonable when changes are required;
The anticipated division of parental responsibilities after the litigation, including the extent to
which parental responsibilities will be delegated to third parties;
The demonstrated capacity and disposition of each parent to determine, consider, and act upon
the needs of the child(ren) as opposed to the needs or desires of the parent;
The length of time the child(ren) has lived in a stable, satisfactory environment and the
desirability of maintaining continuity;
The geographic viability of the parenting plan, with special attention paid to the needs of school-
age children and the amount of time to be spent traveling to effectuate the parenting plan. This
factor does not create a presumption for or against relocation of either parent with a child(ren);
The moral fitness of the parents;
The mental and physical health of the parents;
The home, school, and community record of the child(ren);
The reasonable preference of the child(ren), if the court deems the child(ren) to be of sufficient
intelligence, understanding, and experience to express a preference;
The demonstrated knowledge, capacity, and disposition of each parent to be informed of the
circumstances of the minor child(ren), including, but not limited to, the child(ren)’s friends,
teachers, medical care providers, daily activities, and favorite things;
The demonstrated capacity and disposition of each parent to provide a consistent routine for
the child(ren), such as discipline, and daily schedules for homework, meals, and bedtime;
The demonstrated capacity of each parent to communicate with and keep the other parent
informed of issues and activities regarding the minor child(ren), and the willingness of each
parent to adopt a unified front on all major issues when dealing with the child(ren);
Evidence of domestic violence, sexual violence, child abuse, child abandonment, or child
neglect, regardless of whether a prior or pending action relating to those issues has been
brought. If the court accepts evidence of prior or pending actions regarding domestic violence,
sexual violence, child abuse, child abandonment, or child neglect, the court must specifically
acknowledge, in writing that such evidence was considered when evaluating the bests interests
of the child(ren);
Evidence that either parent has knowingly provided false information to the court regarding any
prior or pending action regarding domestic violence, sexual violence, child abuse, child
abandonment, or child neglect;
The particular parenting tasks customarily performed by each parent and the division or
parental responsibilities before the institution of litigation and during the pending litigation,
including the extent to which parenting responsibilities were undertaken by third parties;
The demonstrated capacity and disposition of each parent to participate and be involved in the
child(ren)’s school and extracurricular activities;
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
The demonstrated capacity and disposition of each parent to maintain an environment for the
child(ren) which is free from substance abuse;
The capacity and disposition of each parent to protect the child(ren) from the ongoing litigation
as demonstrated by not discussing the litigation with the child(ren), not sharing documents or
electronic media related to the litigation with the child(ren), and refraining from disparaging
comments about the other parent to the child)ren); and
The developmental stages and needs of the child(ren) and the demonstrated capacity and
disposition of each parent to meet the child(ren)’s developmental needs.
This standard form does not include every possible issue that may be relevant to the facts of your case.
The Parenting Plan should be as detailed as possible to address the time-sharing schedule. Additional
provisions should be added to address all of the relevant factors. The parties should give special
consideration to the age and needs of each child.
In developing the Parenting Plan, you may wish to consult or review other materials which are available
at your local library, law library or through national and state family organizations.
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 a 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.
Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
_______________________________
_______________________________
IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT
IN AND FOR ________________________ COUNTY, FLORIDA
Case No: _____________________
Division: _____________________
Petitioner,
and
Respondent.
SUPERVISED/SAFETY-FOCUSED 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
Petitioner, hereafter referred to in this Parenting Plan as Parent
{name or designation} __________________________________________________
Name:__________________________________________________________________
Address:________________________________________________________________
Telephone Number:___________________E-Mail:_________________________________
_____ Address Unknown: {Please indicate if Petitioner’s address is unknown}
_____ Address Confidential: {Please indicate if Petitioner’s address and phone numbers are
confidential pursuant to either a _____ Final Judgment for Protection Against Domestic Violence
or _____ other court order _____________________________________________.}
Respondent, hereafter referred to in this Parenting Plan as Parent
{name or designation} ___________________________________________________
Name:__________________________________________________________________
Address:________________________________________________________________
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Telephone Number: _________________ E-Mail: _____________________________________
_____ Address Unknown: (Please indicate if Respondent’s address is unknown}
_____ Address Confidential: (Please indicate if Respondent’s address and telephone
numbers are confidential pursuant to either a _____ Final Judgment for Protection Against
Domestic Violence or _____other court order _________________________________________.)
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. Section 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
other state and federal laws.
Other: _________________________________________________________________.
IV. PARENTAL RESPONSIBILITY {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}
1. _____ Sole Parental Responsibility
It is in the best interests of the child(ren) that Parent
{name or designation} _____________________shall have sole authority to make major
decisions for the child(ren.) It is detrimental to the child(ren) for the parents to have
shared parental responsibility.
OR
2. _____Shared Parental Responsibility with Decision Making Authority
It is in the best interests of the child(ren) that the parents confer and attempt to agree
on the major decisions involving the child(ren). If the parents are unable to agree, the
authority for making major decisions regarding the child(ren) shall be as follows:
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
__________
Education/Academic decisions Parent ______________
Non-emergency health care Parent ______________
________________________ Parent ______________ ______
________________________
Parent _____________ ______
_________________________
P
arent ______________
_____Other: {Specify}___________________________________________.
V. TIME-SHARING SCHEDULE {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided}
1.______No Time-Sharing: Parent ______________________ shall have no contact with
the child(ren) until further order of the court. All parenting decisions shall be made by
the other parent.
2._____Supervised Time-Sharing: Whenever the child(ren) are with ________Parent
___________________, the supervisor shall be present .______Parent ____________
has the right to spend time with the child(ren) even though the other parent will be
making most, if not all, of the parenting decisions which are made on the child(ren)’s
behalf. The time-sharing schedule shall be mutually agreed to between the parents,
but not less than the schedule set forth below: {Choose only one}
a. _____hours per week. The place(s), and time(s) shall be set by Parent
____________.
b. _____ From ___ m. to ____m. on the following day(s) ______________________
_____________________________________________________________________.
3. _____ Restricted Time-Sharing: _____Parent __________________ shall have
time-sharing with the following restrictions. {The restrictions should be described in
detail such as time-sharing only in public places, no overnight visits, etc.} The time-
sharing schedule shall be mutually agreed upon between the parents, but not less
than the schedule set forth below:_______________________________________
____________________________________________________________________.
a._______ hours per week. The place(s), and time(s) shall be set by Parent
b. ______Other: _______________________________________________________.
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
___________________________________________________________________________
VI. SUPERVISOR AND SUPERVISION {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}
1. Supervisor. The person supervising the time-sharing shall be selected by: {Choose only one}
_____ both parents .
_____ Parent {name or designation} ____________________, subject to the other parent’s
approval.
_____ Other: ______________________________________________________________.
2. Restrictions or Level of Supervision: _________________________________________
__________________________________________________________________________ .
3. Costs of Supervision
_____The costs of the supervision shall be paid by Parent
{name or designation} __________________________________.
_____Other: ______________________________________________________.
VII. LOCATION: {Choose only one}
{Insert the name or designation of the appropriate parent in the space provided.}
_____Parent_________________________ _____ Parent ______________________shall
spend his/her time-sharing with the child(ren) at the following location(s):
1. _____Supervised visitation center (name and address of facility) ________________________
_______________________________________________________________________.
2._____ _______________________________________ {location} or other location designated
by Parent ______________
3._____Any location designated by Parent ____________________ with the approval of the
supervisor.
4._____Other: _____________________________________________________ .
VIII. DESIGNATION FOR OTHER LEGAL PURPOSES
{Insert the name or designation of the appropriate parent in the space provided.}
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
1. The child(ren) named in this Safety-Focused Parenting Plan are scheduled to reside the
majority of the time with Parent {name or designation} ______________________________.
This majority designation is SOLELY for purposes of all other state and federal statutes which
require such a designation. This designation does not affect either parent’s rights and
responsibilities under this parenting plan.
2. For purposes of school boundary determination and registration, the address of Parent {name
or designation} ____________________shall be used.
IX. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
{Insert the name or designation of the appropriate parent in the space provided.}
1. Transportation
The child(ren) shall not be driven in a car unless the driver has a valid driver’s license,
automobile insurance, seat belts, and child safety seats as required by Florida law.
P
arent
____________
Parent _ _ or mutually agreed upon person shall be ____________
respo
nsible for transporting the child(ren) to the exchange point. The child(ren) shall be
picked up and/or returned to the exchange point by {Choose only one}
a. _____ Parent _ with the supervisor present. _______________
b. _____ The supervisor alone.
c. ____ Other: _______________________________________________.
2. Exchange
{Insert the name or designation of the appropriate parent in the space provided.}
The exchange of the child(ren) shall occur at: {Indicate all that apply}
a._____ The site of the supervised visit.
b._____ A monitored exchange location {specify name and address of facility}________
_______________________________________________________________________.
c._____ Other: ____________________________________________________________.
d. Parent ___________________ is prohibited from coming to the exchange point.
X. COMMUNICATION
1. Between Parents
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
All communications regarding the child(ren) shall be between the parents. The
parents shall not use the child(ren) as messengers to convey information, ask questions, or
set up schedule changes.
_____The parents shall communicate with each other: {Indicate all that apply}
_____in person
_____by telephone
_____by letter
_____by e-mail
_____Other: {Specify] ___________________________________________.
_____ No Communication. Unless otherwise prohibited by court order, all information
and communication regarding the child(ren) shall be exchanged via or through
______________________________________________________________________.
2. Between Parent and Child(ren)
{Insert the name or designation of the appropriate parent in the space provided.}
Parent {name or designation} __________________ {Indicate all that apply}
a. ______Shall not telephone, write, or e-mail the child(ren) unless the contact is agreed
to in advance by the other parent.
b. ______May write or e-mail the child(ren) at any time. Each parent shall provide a
contact address (and e-mail address if appropriate) to the other parent, unless other
prohibited by court order.
c. ______May call the child(ren) on the telephone _____ times per week. The call shall
last no more than _____ minutes and shall take place between _____ __m. and _____
__ m. Each parent shall provide a telephone number to the other parent, unless
otherwise prohibited by court order or law.
d._____ Long distance telephone calls made by the child(ren) to a parent shall be paid
by ______________________. Each parent shall provide a telephone number to the
other parent, unless otherwise prohibited by court order or law.
e. _____Other: ___________________________________________________________.
3. Costs of Electronic Communication
“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.
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
_____________________________________________________________________
_____________________________________________________________________
The costs of electronic communication shall be addressed as follows:
_____________________________________________________________________.
XI. ACCESS TO ACTIVITIES AND EVENTS
{Insert the name or designation of the appropriate parent in the space provided.}
______Parent ______________________ {Choose only one}
1._____Shall not attend the child(ren)’s activities and events, including but not limited
to, school, athletic, and extra-curricular activities and events.
2._____May attend the child(ren)’s school, athletic, and extra-curricular activities and
ev
ents.
3._____ Must stay
______ feet from the other parent and ______ feet from the child.
4
._____ Other _______________________________________________.
XII. CHILD(REN)’S SAFETY
{Insert the name or designation of the appropriate parent in the space provided.}
______Parent {name or designation} ______________________ shall follow the safety rules
checked below. (Indicate all that apply)
1._____There shall be no firearms in the home, car, or in the child(ren)’s presence
during time-sharing.
2. _____No alcoholic beverages shall be consumed from twenty-four (24) hours before
the child(ren) arrive until they are returned to the other parent.
3._____The child(ren) shall not be disciplined by corporal punishment.
4._____The following person(s) present a danger to the child(ren) and shall not be
present during time-sharing: ________________________________________________
_______________________________________________________________________.
5._____Other: __________________________________________________________
XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN
All changes to the Safety-Focused Parenting Plan must be pursuant to a court order.
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
XIV. OTHER PROVISIONS
________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
SIGNATURES 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 Petitioner/Parent ____________________
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):___________________
__________________________________________
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 _________________________________
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
_____________________________________________
__________________________________________
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: ________________________
STATE OF FLORIDA
Signature of Respondent/Parent ___________________
Printed Name:
Address:
City, State, Zip:
Telephone Number:
Fax Number:
Designated E-mail Address(es):___________________
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] This form was prepared for the: {choose only one} _____ Petitioner
_____ Respondent.
This form was completed with the assistance of:
{name of individual} __________________________________________________________________,
{name of business} ____________________________________________________________________,
{address} ____________________________________________________________________________,
{city} ___ ,{state} , {zip code}____________,{telephone number} .
Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan
(02/18)
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FORM 12.995(b),: INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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Completed 28 March 2021

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