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MARYLAND PARENTING PLAN TOOL Use this form to (Maryland Judiciary)

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MARYLAND PARENTING PLAN TOOL
☐ Par
enting plan of ,
.
☐ Joint parenting plan of:
Name Relationship to Child(ren)
Ty
pe of filing:
☐ Initial pleading
☐ Modification
☐ Relocation
Special circumstances: (choose all that apply)
☐ Allegation of domestic abuse (under Family Law Art., § 4-501)
☐ Supervised parenting time requested (abuse of a parent, child, or drug/alcohol addiction)
☐ Other: (describe)
BIOGRAPHICAL INFORMATION
Party 1
Name:
Address: ☐ Address unknown
☐ Address confidential due to:
☐ protective order that expires
☐ other court order: , entered
Street Address:
City, State, Zip:
Phone: E-mail:
CC-DR-109 (Rev. 11/2020) Page 1 of 9 MAPPT
Relationship to child(ren)
NOTES:
• Use this form to create a parenting plan for your child(ren). A parenting plan is a guide for
how parties will make decisions about the child(ren) and handle conflicts. Complete this form
separately, together, or with a mediator. Attach additional sheets if needed.
• If you and the other party/parties cannot ag
ree on a comprehensive parenting plan, complete a
Joint Statement of the Parties Concerning D
ecision-Making Authority and Parenting Time
(form CC-DR-110).
• “Party”: A person seeking to establish or m
aintain a parent-child relationship with the
child(ren).
• MDEC counties only: You must file a Notice Regarding Restricted Information
Pursuant to Rule 20-201.1 (form MDJ-008) with this submission.
Name of party
Date
Date
This form contains Restricted Information.
Party 2
Name:
Address: ☐ Address unknown
☐ Address confidential due to:
☐ protective order that expires
☐ other court order: , entered
Street Address:
City, State, Zip:
Phone: E-mail:
Party 3
Name:
Address: ☐ Address unknown
☐ Address confidential due to:
☐ protective order that expires
☐ other court order: , entered
Street Address:
City, State, Zip:
Phone: E-mail:
Child(ren)
This parenting plan is for the following minor child(ren) (add lines or attach additional sheets if needed):
Name Date of Birth
PARENTAL RESPONSIBILITES
Choose from the general options below or make choices based on what is important to your family.
1. DECISION-MAKING AUTHORITY
Parental responsibility – Day-to-day decisions are the responsibility of the party/parties the child(ren)
are with at the time, such as how the child(ren) dress(es), or their home routine. How will major
decisions such as medical and mental health care, education, religious training, extracurricular
CC-DR-109 (Rev. 11/2020) Page 2 of 9 MAPPT
Date
Date
Date
Date
activities, communication among the parties, and information sharing be made?
(choose one)
☐ Shared parental responsibility
We will jointly make major decisions about the child(ren).
☐ Sole parenting responsibility
will make major decisions for the child(ren).
☐ Shared parental responsibility with decision-making authority
We will try to reach an agreement on issues. If we cannot agree, tie-breaking authority goes
to the following party:
Tie-breaking authority
Medical care ☐ No tie-breaking authority
Mental health ☐ No tie-breaking authority
Education ☐ No tie-breaking authority
Religious training ☐ No tie-breaking authority
Extracurricular activities ☐ No tie-breaking authority
Other: ☐ No tie-breaking authority
Communication between the parties – How will you communicate with each other about the child(ren)?
Do not use the child(ren) as messengers to convey information, ask questions, or set up schedule changes.
We will communicate with each other: (choose all that apply)
☐ In person
☐ By telephone
☐ By text or similar method
☐ By e-mail
☐ Other:
Information sharing – How will you share and access information about the child(ren)’s health, mental
health, education, and welfare? Be listed as emergency contacts? Notify each other about changes to your
address or contact information?
(choose all that apply)
☐ Each of us will have access to medical and school records and information about the child(ren) and
may consult with professionals.
☐ Each of us will share information about the health, mental health, education, and welfare of the
child(ren) and sign documentation ensuring that we each have access to records.
☐ We will give each other advance notice of medical appointments and appointments with the
child(ren)’s school.
☐ Each of us will get records and reports from the school and health care providers. Each of us have
equal rights to inspect and receive governmental agency and law enforcement records concerning
the child(ren).
CC-DR-109 (Rev. 11/2020) Page 3 of 9 MAPPT
Name
Name
Name
Name
Name
Name
Name
☐ Each o
f us may consult with the child(ren)’s school, day care, health care providers, and other
programs about the child(ren)’s health, mental health, educational, emotional, and social progress.
☐ Each of us will be listed as “emergency contacts” for the child(ren) on all matters.
☐ Each of us will give a residential, mailing, and contact address and telephone number to the other
party/parties and notify each other in writing (may be by text or email) within 24 hours of
changes.
☐ Other:
Schooling – What type of schooling will the child(ren) have (for example, will the child(ren) attend
public or private schools or be homeschooled)? Which party’s address will be used to determine the
child(ren)’s school district?
We agree that the child(ren) will:
☐ Attend public school. address will be designated for
school registration.
☐ Attend private school.
☐ Be homeschooled.
☐ Other:
Extracurricular activities – How will you manage activity calendars for practices, rehearsals, games
recitals, etc.? How will you handle conflicts with parenting time and exchange of activity calendars?
(choose all that apply)
☐ Each of us will agree to extracurricular activities that may occur during each party’s scheduled
parenting time.
☐ Each of us will transport the child(ren) to and from all extracurricular activities during each
party’s scheduled parenting time.
☐ Each of us may register the child(ren) for an activity of the child(ren)’s choice, so long as it does
not interfere with the other party’s/parties’ parenting time.
☐ Each of us agrees as to the following extracurricular activities:
2. PARENT
ING TIME
What parenting time schedule will work best for your family?
Special considerations: (choose all that apply)
☐ We will not use drugs during our time with the child(ren).
☐ We will not drink alcohol during our time with the child(ren).
CC-DR-109 (Rev. 11/2020) Page 4 of 9 MAPPT
☐ We und
erstand emergencies happen. We will accommodate reasonable changes that are timely
requested.
☐ Other:
Regular weekday and weekend schedule-
☐ The following schedule begins on with
and continues as follows:
The child(ren) will be with :
☐ Weeken
ds: ☐ every ☐ every other ☐ other: (specify) from
to .
☐ Weekdays: (specify days) from
to .
☐ Other: (describe)
The
child(ren) will be with :
☐ Weeken
ds: ☐ every ☐ every other ☐ other: (specify) from
to .
☐ Weekdays: (specify days) from
to .
☐ Other: (describe)
The
child(ren) will be with :
☐ Weekends: ☐ every ☐ every other ☐ other: (specify) from
to .
☐ Weekdays: (specify days) from
to .
☐ Other: (describe)
☐ See a
ttached calendar for regular schedule.
☐ There is a different parenting time schedule for the following child(ren):
CC-DR-109 (Rev. 11/2020) Page 5 of 9 MAPPT
Date
Name
Name
Name
Holiday schedule- How will holidays be defined? Add special events or occasions important to your
family.
(choose one)
☐ No holiday parenting time will apply. The regular weekday and weekend schedule above will
apply.
☐ Holiday parenting time will be as we agree.
☐ Holiday parenting time will follow the schedule below. It will take priority over the regular
weekday, weekend, and summer schedules.
Fill in the blanks with your names 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 be with the party according to the regular schedule.
The following is not a complete list of holidays. Add holidays that apply to your family (other school
holidays, religious observances, Halloween, New Year’s Eve/day, etc.)
Holidays Even years Odd years Every year Begin/end time
Mother’s Day
Father’s Day
Martin Luther King Day
President’s Day
Memorial Day
Fourth of July
Labor Day
Columbus Day
Thanksgiving
Veteran’s Day
Child(ren)’s Birthdays
Religious holidays (list):
Other (list):
Win
ter, spring, and summer breaks are times when the child(ren) are out of school and you can
determine how those out-of-school times, including weekends, will be shared between you.
Winter break-
(choose one)
☐ We will follow the regular weekday and weekend schedule.
☐ We will alternate winter breaks. The child(ren) will stay with
CC-DR-109 (Rev. 11/2020) Page 6 of 9 MAPPT
Name
in ☐ odd-numbered years ☐ even-numbered years, and with
in ☐ odd-numbered years ☐ even-numbered years.
If a holiday designated above doesn’t fall within a party’s winter break time, the holiday schedule
will take precedent.
☐ We will divide winter break as follows:
Spring break-
(choose one)
☐ We will follow the regular weekday and weekend schedule.
☐ We will alternate spring breaks. The child(ren) will stay with
in ☐ odd-numbered years ☐ even-numbered years, and with
in ☐ odd-numbered years ☐ even-numbered years.
If a holiday designated above doesn’t fall within a party’s spring break time, the holiday schedule
will take precedent.
☐ We will divide spring break as follows:
Summer break-
(choose one)
☐ We will follow the regular weekday and weekend schedule.
☐ Each of us will have weeks with the child(ren) during the summer. These weeks may
be ☐ consecutive ☐ non-consectutive and start and end on . We will
request the week(s) by of each year. If there is a conflict,
will get first pick of the date in odd-numbered years and
will get first pick of the date in even-numbered years.
☐ We will divide summer break as follows:
Out-of-state travel-
(choose all that apply)
☐ Each of us may travel within the United States with the child(ren) during our parenting
time/vacation. The party traveling with the child(ren) will give the other party/parties at least
days written notice before traveling out-of-state unless there is an emergency, and
will include an itinerary, with locations and telephone numbers where the child(ren) and that
party can be reached.
CC-DR-109 (Rev. 11/2020) Page 7 of 9 MAPPT
Name
Name
Name
Name
Day of week
Date
Name
☐ Each of us may travel out of the country with the child(ren) during our parenting time/vacation.
The party traveling with the child(ren) will give the other party/parties at least days
written notice before traveling out of the country and will include an itinerary, with locations
and telephone numbers where the child(ren) and that party can be reached. We agree to provide
documentation necessary for the other party/parties to take the child(ren) out of the country.
☐ Other:
3. TRANSPORTATION AND EXCHANGE OF CHILD(REN)
Transportation-
(choose one)
☐ The party beginning their parenting time will provide transportation for the child(ren).
☐ The party ending their parenting time will provide transportation for the child(ren).
☐ will provide all transportation.
☐ Other:
Exchanges of the child(ren)-
Each of us will have the child(ren) ready and on time with proper clothing, medications, homework,
extracurricular activity uniforms or equipment, etc., at the time of exchange. The receiving party will
be notified if the child(ren) took any medications within 24 hours of the transition.
(choose one)
☐ Exchanges will be at each party’s home.
☐ Exchanges will occur at unless we agree
in advance to a different meeting place.
☐ Other:
4. COMMUNICATION BETWEEN PARENTS AND CHILD(REN)
Each of us will keep contact information current.
The child(ren) may have ☐ telephone ☐ e-mail ☐ other electronic communication in the form of
with the other party/parties: (choose one)
☐ Anytime
☐ Every day during the hours of to
☐ On the following days: during the hours of
to
☐ Other:
CC-DR-109 (Rev. 11/2020) Page 8 of 9 MAPPT
Name
5. CHILD CARE
(choose all that apply)
☐ Each of us may select child care providers.
☐ We must agree on child care providers.
☐ Each of us must offer the other party/parties the opportunity to care for the child(ren) before
using a child care provider for any period exceeding hours.
☐ Other:
6. DISPUTES
How will you resolve disputes relating to the parenting plan?
(select one)
☐ We agree to attend at least mediation session(s) before asking the court to intervene.
☐ Other: (describe)
7. OTHER ISSUES
For example, the child(ren)’s name(s), names used to refer to step-parents or other adults,
circumstances requiring parental consent (driving, marriage, military service, employment, etc.),
restrictions on what the child(ren) are exposed to (entertainment, firearms, all-terrain vehicles, etc.),
and discipline.
NOTE:
You have the right to consult with a lawyer to review this document before you sign it.
I/We enter this parenting plan voluntarily. I/We believe this plan is in the best interest of the
child(ren) at this time. I am/We are satisfied with this plan and intend to be bound by it.
CC-DR-109 (
Rev. 11/2020) Page 9 of 9
MAPPT
Date
Printed Name
Date
Signature
Printed Name
Signature
Date
Printed Name
Signature
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Completed 22 March 2022

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