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

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INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW
FORM 12.995(c)
RELOCATION/LONG DISTANCE PARENTING PLAN
(02/18)
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 every
other person entitled to access or time-sharing with the child(ren) and approved by the court. “Other
Person” means an individual who is not the parent, but with whom the child resides pursuant to court
order, or who has the right of access to, time-sharing with or visitation with the child(ren). 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. The parents or Other Person must identify a name or designation to be used
throughout this Parenting Plan.
This form or a similar form should be used in the development of a Parenting Plan when you are
planning to relocate your or the child(ren)’s principal residence more than 50 miles from the principal
place of residence:
at the time of the last order either establishing or modifying time-sharing, or
at the time of filing the pending action to either establish or modify time-sharing
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 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.
Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting
Plan (02/18)
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
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...
At a minimum, the Relocation/Long Distance 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 that specifies the time that the minor child(ren) will spend with each
parent and every other person entitled to access or time-sharing,
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,
Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting
Plan (02/18)
The methods and technologies that the parties will use to communicate with the child(ren), and
Any transportation arrangements related to access or time-sharing.
The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the
Parenting Plan, all circumstances between the parties, including the parties’ historic relationship,
domestic violence, and other factors must be taken into consideration. Determination of the best
interests of the 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 the family as listed in section 61.13(3), Florida
Statutes, including, but not limited to:
The demonstrated capacity and disposition of each party 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 party 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 party with a child(ren);
The moral fitness of the parties;
The mental and physical health of the parties;
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 party 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 party 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 party to communicate with and keep the other part(y)ies
informed of issues and activities regarding the minor child(ren), and the willingness of
each party 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 best interests of the child(ren);
Evidence that any party has knowingly provided false information to the court regarding any
prior or pending action regarding domestic violence, sexual violence, child abuse,
Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting
Plan (02/18)
child abandonment, or child neglect;
The particular parenting tasks customarily performed by each party and the division of
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 party to participate and be involved
in the child(ren)’s school and extracurricular activities;
The demonstrated capacity and disposition of each party to maintain an environment
for the child(ren) which is free from substance abuse;
The capacity and disposition of each party 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 any other party to the child)ren); and
The developmental stages and needs of the child(ren) and the demonstrated capacity
and disposition of each party 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 Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting
Plan (02/18)
IN THE CIRCUIT COURT OF THE ___________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: __________________
Division: __________________
_________________________________,
Petitioner,
And
_________________________________,
Respondent.
RELOCATION/LONG-DISTANCE 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:
{Name of Parent or Other Person}__________________________________.
_____ 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. PARTIES
Petitioner, hereinafter referred to as Parent
{name or designation} __________________________________________________
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ___________________ E-Mail: ____________________________
Respondent, hereinafter referred to as Parent
{name or designation} ___________________________________________________
Name:__________________________________________________________________
Address: ________________________________________________________________
Telephone Number: ___________________ E-Mail: ____________________________
Other Person {If Applicable}, hereinafter referred to as
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
II.
III.
IV.
{name or designation}___________________________________________________
Name:___________________________________________________________________
Address:_________________________________________________________________
Telephone Number___________________ E-mail:________________________________
CHILDREN: This parenting plan is for the following child(ren):
{Add additional lines as needed}
Name(s) Birth Date(s)
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: _____________________________________________________________________.
PARENTAL RESPONSIBILITY AND DECISION MAKING
{Insert the name or designation of the appropriate parent or other person in the space provided}
1. Parental Responsibility {Choose only one}
a. _____Shared Parental Responsibility.
It is in the best interests of the child(ren) that the parties 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. Either parent may consent to mental health
treatment for the child(ren).
OR
b. _____ Shared Parental Responsibility with Decision Making Authority
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
It is in the best interests of the child(ren) that the parties confer and attempt to agree on
the major decisions involving the child(ren). If the parties are unable to agree, the authority
for making major decisions regarding the child(ren) shall be as follows:
Education/
Academic
decisions
Parent_________
Parent_________
Other
Person
_______
Non-emergency
health care
Parent_________
Parent__________
Other
Person
_______
______________
Parent_________
Parent__________
Other
Person
_______
______________
Parent_________
Parent__________
Other
Person
_______
_____________
Parent_________
Parent__________
Other
Person
_______
OR
c. _____ Sole Parental Responsibility:
It is in the best interests of the child(ren) that_____ Parent_____________ or _______Other
person ________________shall have sole authority to make major decisions for the
child(ren). It is detrimental to the child(ren) for the parties to share decision-making.
2. Day-to-Day Decisions
Unless otherwise specified in this plan, each party shall make decisions regarding day-to-day
care and control of each child, including the performance of daily tasks, while the child is with
that party. Regardless of the allocation of decision making in the Parenting Plan, any party
may make emergency decisions affecting the health or safety of the child(ren) when the child
is residing with that party. A party who makes an emergency decision shall share the decision
with the other party as soon as reasonably possible.
3. Extracurricular Activities (Indicate all that apply)
{Insert the name or designation of parent or other person in the space provided.}
a. _____ Any party may register the child(ren) and allow them to participate in the activity of
the child(ren)’s choice.
b. _____ The parties must mutually agree to all extracurricular activities.
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
c. _____ The party with the minor child(ren) shall transport the minor child(ren) to and/or
from all mutually agreed upon extra-curricular activities, providing all necessary uniforms and
equipment within the party’s possession.
d. _____The costs of the extracurricular activities shall be paid by:
Parent ____________ _______%
Parent _____________ ________ %
Other Person _______________ ____%
e. _____ The uniforms and equipment required for the extracurricular activities shall be paid
by:
Parent ______________ ______ %
Parent _______________ _______%
Other Person _____________ _____%
f. _____ Other: _____________________________________________________ .
V. INFORMATION SHARING. Unless Otherwise Indicated or Ordered by the Court:
1. Unless otherwise prohibited by law, the parties shall have access to medical and school records,
and information pertaining to the child(ren), and shall be permitted to independently consult
with any and all professionals involved with the child(ren). The parties shall cooperate with each
other in sharing information related to the health, education, and welfare of the child(ren) and
they shall sign any necessary documentation ensuring that all parties have access to said
records.
2. Each party shall be responsible for obtaining records and reports directly from the school and
health care providers.
3. The parties have equal rights to inspect and receive governmental agency and law enforcement
records concerning the child(ren).
4. The parties shall have equal and independent authority to confer with the child(ren)’s school, day
care, health care providers, and other programs with regard to the child(ren)’s educational,
emotional, and social progress.
5. The parties shall be listed as “emergency contacts” for the child(ren).
6. Each party has a continuing responsibility to provide a residential and mailing address, and contact
telephone number (s) to the other parties. Each party shall notify the other parties in writing
within 24 hours of any changes. Each party shall notify the court in writing within seven (7) days
of any changes.
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
__________________________________________________________________
7. Other: _________________________________________________________________
__________________________________________________________________.
VI. SCHEDULING
1. School Calendar
a. _____ If necessary, on or before ______________ of each year, the parties should obtain
a copy of the school calendar for the next school year. The parties shall discuss the calendars
and the time-sharing schedule so that any differences or questions can be resolved.
b. _____The parties shall follow the school calendar of: {Indicate all that apply}
_____ the oldest child
_____ the youngest child
_____ ______________ County
_____ _________________ School
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 {Indicate all that apply}
a. _____ A party 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.
b. _____ A party requesting a change of schedule shall be responsible for any additional child
care, or transportation costs caused by the change.
c. _____ Other ______________________________________________________.
VII. TIME-SHARING SCHEDULE
{Insert the name or designation of the appropriate parent in the space provided. A time-sharing
scheduled must be indicated for both parents, and/or the Other Person}
1. Weekday and Weekend Schedule
The following schedule shall apply beginning on ________________________ with
Parent ____________________, or, _____ {If Applicable} Other Person
_____________________ and continue as follows:
The child(ren) shall spend time with Parent ____________ on the following dates and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}: _______________________
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
______________________________________________________________
______________________________________________________________
______________________________________________________________
_______________________________________________________________
_______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
From ___________________________ to ___________________________
WEEKDAYS: {Specify days} _______________________________________
From _____________________________ to _________________________
OTHER: {Specify} _______________________________________________
The child(ren) shall spend time with Parent ______________ on the following dates and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}:
From____________________________ to ___________________________
WEEKDAYS: {Specify days} ________________________________________
From _____________________________ to __________________________
OTHER: {Specify} _________________________________________________
{If Applicable} The child(ren) shall spend time with the Other Person ___________________
on the following dates and times:
WEEKENDS: _____ Every _____ Every Other _____ Other {Specify} :
From _____________________________to __________________________
WEEKDAYS: {Specify Days}________________________________________
From _____________________________to __________________________
OTHER: {Specify} ________________________________________________
Please indicate if there is a different time sharing schedule for any child. Complete a separate
Attachment for each child for whom there is a different time sharing schedule.
_____There is a different time-sharing schedule for the following child(ren) in Attachment_____.
______________________________, and _________________________.
{Name of Child} {Name of Child}
2. Holiday Schedule {Choose only one}
{Insert the name or designation of the appropriate parent or Other Person in the space provided.}
a. _____No holiday time sharing shall apply. The regular time-sharing schedule set forth above
shall apply.
b. _____Holiday time-sharing shall be as the parties agree.
c. _____Holiday time-sharing shall be in accordance with the following schedule. The Holiday
schedule will take priority over the regular weekday, weekend, and summer schedules. Fill in the
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
blanks with the name of either the appropriate parent or {If Applicable} Other Person to indicate
where the child(ren) will be for the holidays. Provide the beginning and ending times. If a holiday
is not specified as even, odd, or every year with one party, then the child(ren) will remain with
the other party in accordance with the regular schedule
Holidays
Odd Years
{name}
Every Year
{name}
Begin/End
Time
New Year’s Day
Martin Luther King
Wknd
President’s Day Wknd
Easter
Passover
Mother’s Day
Memorial Day Wknd
Father’s Day
4th of July
Labor Day Weekend
Rosh Hashanah
Yom Kippur
Columbus Day Wknd
Veteran’s Day
Thanksgiving
Hanukkah
Christmas
Other_______________
Children’s Birthday’s
This holiday schedule may affect the regular time-sharing schedule. Parties may wish to specify
one or more of the following options:
d. _____ When the parties are using an alternating weekend plan and the holiday schedule
would result in one party having the child(ren) for three weekends in a row, the parties will
exchange the following weekend, so that each has two weekends in a row before the regular
alternating weekend pattern resumes.
e. _____ If a party has the child(ren) on a weekend immediately before or after an unspecified
holiday or non-school day, they shall have the child(ren) for the holiday or non-school day.
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
______________________________________________________________
______________________________________________________________
________________________________________________________________________
________________________________________________________________________
3.
4.
5.
6.
Winter Break {choose only one}
a. _____ Parent _______________ or _____{If Applicable} Other Person {name or designation}
_______________________shall have the child(ren) from the day and time school is dismissed
until December ____ at ____ a.m./p. m in _____odd-numbered years _____ even-numbered
years _____ every year. The other party will have the child(ren) for the second portion of the
Winter Break. The parties shall alternate the arrangement each year.
b. _____ Parent _________________ or _____ {If Applicable} Other Person {name or
designation} _____________________shall have the child(ren) for the entire Winter Break
during _____ odd-numbered years _____ even-numbered years _____ every year
c. _____ Other:_________________________________________________________
Specific Winter Holidays
If not addressed above, the specific Winter Holidays such as Christmas, New Year’s Eve,
Hanukkah, Kwanzaa, etc. shall be shared as follows: _____________________________
________________________________________________________________________.
Spring Break {Choose only one}
a. _____The parties shall follow the regular schedule.
b. _____ The parties shall alternate the entire Spring Break with Parent __________________,
or ___________ {If Applicable} Other Person {name or designation} _________________
having the child(ren) during the _____ odd-numbered _____ even-numbered years
c. _____ Parent __________________, or _____ {If Applicable} Other Person {name or
designation} _______________________shall have the child(ren) for the entire Spring Break
every year.
d. _____ The Spring Break will be evenly divided. The first half of the Spring Break will go to the
party whose regularly scheduled weekend falls on the first half and the second half going to
the party whose weekend falls during the second half.
e. _____ Other: __________________________________________________________.
Summer Break {Choose only one}
a. _____ The parents shall follow the regular schedule through the summer.
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
b. _____ Parent _______________________, or _____ {If Applicable} Other Person {name or
designation} ______________________shall have the entire Summer Break from
_____________________________after school is out until ____________________ before
school starts.
c. _____The parties shall equally divide the Summer Break as follows:
_________________________________________________________________.
d. _____ Other: ________________________________________________________
_________________________________________________________________.
7. Number of Overnights:
Based upon the time-sharing schedule, Parent {name or designation}____________________
has a total of _____ overnights per year, _____Parent {name or designation} _______________
has a total of _____ overnights per year and ______{If Applicable} the Other Person {name or
designation} _________________________ has a total of ______ overnights per year.
Note: The total of these numbers must equal 365.
8. Attached Time-Sharing Schedule:
_____If not set forth above, the parties shall have time-sharing in accordance with the
schedule which is attached as Attachment ______and incorporated herein.
VIII. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
{Insert the name or designation of the appropriate parent or Other Person in the space provided.}
1. The parties shall have the child(ren) ready on time with sufficient clothing packed and ready at
the agreed upon time of exchange. All necessary information and medicines will accompany the
child(ren).
2. The parties shall exchange travel information and finalize travel plans at least ______days in
advance of the date of travel. Except in cases of emergency, any party requesting a change of
travel plans after the date of finalization shall be solely responsible for any additional costs.
3. Automobile Transportation and Exchange {Choose only one}
If a party is more than _____minutes late without contacting the other party to make other
arrangements, the party with the child(ren) may proceed with other plans and activities.
a. _____ Parent {name or designation} __________________, or_____ {If Applicable} Other
Person {name or designation} ______________________shall provide all transportation.
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
b. _____ Parent {name or designation} _____________, or _____ {If Applicable} Other Person
{name or designation} _______________________shall pick up the child(ren) at the
beginning of the visit and the other party shall pick up the child(ren) at the end of the
visit. The exchange shall take place:
_____At the parties’ homes unless otherwise agreed;
_____At the following location unless the parties agree in advance to a different
location: {specify}_______________________________________;
_____ At the following central location: {specify}__________________;
c. _____Other:___________________________________________________________.
4. Airplane and Other Public Transportation and Exchange
Airline regulations govern the age at which a child may fly unescorted. An older child or
children may fly under such regulations as each airline may establish.
a. _____ Until a child reaches the age of ______, the parties agree that the child(ren) shall
take a direct flight and/or fly accompanied by: _____________________.
b. _____ Once a child reaches the age of _____, the child shall be permitted to fly
accompanied by an airline employee.
c. _____ Once a child reaches the age of _____, the child shall be permitted to fly unescorted.
d. _____ Other: _______________________________________________________.
Airline reservations should be made well in advance and preferably, non-stop or direct.
All flight information shall be sent to the other party(ies) at least _____days in advance of the
flight by the party purchasing the tickets.
If the child(ren) are flying accompanied by a party, the party picking up the child(ren) shall
exchange the child(ren) with the other party at__________________ and the party returning
the child(ren) shall exchange the children at _________________________.
If the exchange is to be made at the airport, the party flying in to pick up or drop off the
child(ren) from/to the airport must notify the other party of any flight delays.
Unless otherwise agreed in advance, the party taking the child(ren) to the airport must call
the other party(ies) immediately upon departure to notify the other party(ies) that the
child(ren) is/are arriving, and the party who meets the child(ren) must immediately notify the
other party(ies) upon the child(ren)’s arrival.
5. Costs of Airline and Other Public Transportation {Indicate all that apply}
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
{Insert the name or designation of the appropriate parent in the space provided.}
a. _____ Ticket Purchase {If Applicable}:
The parties shall work together to purchase the most convenient and least expensive
tickets.
After consultation among the parties, it shall be the responsibility of ___________________
to purchase the tickets by {date} _______________.
All parties entitled to access to, or time-sharing with the child(ren) shall be notified of the
purchase by {date}_____________________.
Proof of the purchase and a copy of the itinerary (choose only one) _____ shall be provided
to all parties by ____________________ {date}______shall not be provided.
Unless otherwise agreed or in the case of an unavoidable emergency, any costs incurred by
a missed travel connection shall be the sole responsibility of the party who failed to timely
deliver the child(ren) to the missed connection.
b. _____ Transportation costs are included in the Child Support Worksheets and/or the Order
for Child Support and should not be included here.
c. _____ Parent _______________ shall pay _____%
Parent ________________ shall pay _____% of the transportation costs.
d. _____ Parent _____________ shall pay _____%
Parent ___________ shall pay _____% of the transportation costs for an adult to
accompany the child(ren) during travel.
e. _____ If the parties are sharing travel costs, the non-purchasing party shall reimburse the
other party within ______days of receipt of documentation establishing the travel costs.
f. _____ Other:____________________________________________________.
6. Foreign and Out-Of-State Travel {Indicate all that apply}
a. _____ The parties may travel within the United States with the child(ren) during his/her time-
sharing. The party traveling with the child(ren) shall give the other party(ies) at least ____
days written notice before traveling out of state unless there is an emergency, and shall
provide the other party(ies) with a detailed itinerary, including locations and telephone
numbers where the child(ren) and party can be reached at least ____ days in advance of the
date of travel.
b. _____ A party may travel out of the country with the child(ren) during his/her time-sharing.
At least ____ days in advance of the date of travel, the party shall provide a detailed
itinerary, including locations, and telephone numbers where the child(ren) and party may be
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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reached during the trip. Each party agrees to provide whatever documentation is necessary
for the other party(ies) to take the child(ren) out of the country.
c. _____ If a party wishes to travel out of the country with the child(ren), he/she shall provide
the following security for the return of the child _________________________________
_____________________________________________________________________.
d. _____ Other_______________________________________________________________.
7. Other Travel and Exchange Arrangements: ___________________________________
IX. EDUCATION
1. School designation. For purposes of school boundary determination and registration, the address
of Parent {name or designation}_______________________ or _____ {If Applicable} Other
Person’s {name or designation} __________________________ address shall be used .
2. {If Applicable} The following provisions are made regarding private or home schooling:
_______________________________________________________________________.
3. Other. ________________________________________________________________
______________________________________________________________________.
X. DESIGNATION FOR OTHER LEGAL PURPOSES
The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time with the
Parent {name or designation} ______________________or _____ {If Applicable} Other Person
{name or designation}_____________________________. This majority designation is SOLELY for
purposes of all other state and federal laws which require such a designation. This designation does
not affect the rights or responsibilities of any party under this Parenting Plan.
XI. COMMUNICATION
1. Between Parties
All communications regarding the child(ren) shall be between the parties. The parties shall not
use the child(ren) as messengers to convey information, ask questions, or set up schedule
changes.
The parties shall communicate with each other by: {Indicate all that apply}
_____ in person
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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_____ by telephone
_____ by letter
_____ by e-mail
_____ Other:___________________________________________________.
2. Between Parties and Child(ren)
The parties shall keep contact information current. Telephone or other electronic
communication between the child(ren) and another party shall not be monitored by or
interrupted by the other party. “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 party:
{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}
1. _____ Each party may select appropriate child care providers
2. _____ All child care providers must be agreed upon by the parties.
3. _____ Each party must offer the other party the opportunity to care for the child(ren)
before using a child care provider for any period exceeding _______ hours.
4. _____ Other ________________________________________________________.
XIII. CHANGES TO OR MODIFICATIONS OF THE PARENTING PLAN
Temporary changes may be made informally without a written document. When the parties do not
agree, this Parenting Plan remains in effect until further order of the court.
Any substantial changes to the Parenting Plan must be sought through the filing of a supplemental
petition for modification.
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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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
The parties shall attempt to cooperatively resolve any disputes which may arise over the terms of
the Parenting Plan. The parties 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
___________________________________________________________________________.
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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SIGNATURES OF PARTIES
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
COUNTY OF ____________________
Signature of Petitioner/ Parent _____________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ___________________________
Designated E-mail Address(es):______________
Sworn to or affirmed and signed before me on __________ by ___________________________.
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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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
COUNTY OF ____________________
Signature of Respondent/Parent ____________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ___________________________
Designated E-mail Address(es):______________
Sworn to or affirmed and signed before me on __________ by ___________________________.
NOTARY PUBLIC or DEPUTY CLERK
[Print, type, or stamp commissioned name of notary or
deputy clerk.]
____ Personally known
____ Produced identification
____ Type of identification produced ________________________________
Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (02/18)
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________________________________________
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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
COUNTY OF ____________________
Signature of Other Person __________________
Printed Name: ___________________________
Address: _______________________________
City, State, Zip: __________________________
Telephone Number: ______________________
Fax Number: ___________________________
Designated E-mail Address(es):______________
Sworn to or affirmed and signed before me on __________ by ___________________________.
NOTARY PUBLIC or DEPUTY CLERK
_______________________________________
[Print, type, or stamp commissioned name of notary or
deputy 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
_____ Other Person.
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(c), Relocation/Long Distance Parenting Plan (02/18)
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FORM 12.995(c): INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED (Florida)

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Completed 4 February 2021

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