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SUPERIOR COURT Unit AGREEMENT ON PARENTAL RIGHTS AND (Vermont Judiciary)

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400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 1 of 8
STATE OF VERMONT
FAMILY DIVISION
SUPERIOR COURT
Unit
Docket No.
Name
DOB
V.
Name
DOB
AGREEMENT ON PARENTAL RIGHTS AND RESPONSIBILITIES,
PARENT CHILD CONTACT and PROVISIONS RELATING TO CHILDREN
This Parenting Plan is: (Choose only one)
☐ Agreed upon by the parties.
☐ Proposed by: ________________________________.
(Name of Parent)
This Parenting Plan is:
(Choose only one)
☐
Temporary.
We request that the agreed upon provisions be made part of a temporary order and remain in
effect until a final order on parental rights and responsibilities and parent child contact is issued
by the Court.
☐
Final.
All completed paragraphs shall be incorporated into a final order.
☐
Modification.
A modification of a prior final order on parental rights and responsibilities and parent child
contact. The date of the prior order or plan is _______________.
This Parenting Plan is for the following children of the parties:
Name of Child Date of Birth Name of Child Date of Birth
___________________________ __________ _________________________ __________
___________________________ __________ _________________________ __________
___________________________ __________ _________________________ __________
A relief from abuse order involving the parties and/or these children:
☐ Is not in effect.
☐ Is in effect.
Starting date for the plan: ________________
400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 2 of 8
1. Legal Responsibility
a)
Major Decisions:
A parent with legal responsibility for a child has the responsibility to make decisions about
various
matters affecting a child's welfare including decisions about education, medical and dental care,
religion, and travel arrangements. Shared legal responsibility can only be
ordered by the court if both
parents agree.
Decision making for the children shall be: (Check only one box)
☐ 1. Shared.
Both parents share in the responsibility for making major decisions.
Unless emergency circumstances exist (see day to day decisions below), the parents
will
consult with each other and reach a decision that they both agree to before
taking action on
a major issue. (Note: If you decide to share decision making, you
must also agree to a
method for resolving disputes in paragraph 10.)
☐ 2. Primary.
____________________________ shall have primary legal responsibility and therefore the
right and responsibility to make major decision for the child(ren)
Optional provision for primary decision-making responsibility:
☐ The parent with primary legal responsibility shall consult with the other
parent before
making a major decision. He/she shall advise the other parent in advance of the decision and the
options he/she is considering. He/she shall give the other parent a meaningful opportunity to have
input regarding the
options prior to making a final decision.
☐ 3. Divided.
Decision making is divided between the parents.
___________________________ shall make decisions concerning:
_______________________________________________________________________
________________________________________________
shall make all other decisions.
b)
Day to Day Decisions:
☐ Each parent shall make day-to-day decisions for the child(ren) during the time he/she
is caring for the
child(ren). This includes any emergency decisions affecting the
health or safety of the child(ren). A
parent who makes an emergency decision shall
share the decision with the other parent as soon as
reasonably possible.
☐ Other: (explain)
______________________________________________________________________________
______________________________________________________________________________
2. Physical Responsibility
Physical Responsibility is the responsibility to provide the routine daily care of a child. Physical
responsibility can be held solely by one parent or may be shared by both parents. If physical
responsibility is held primarily by one parent, it is subject to the other parent's right to parent child
contact. Shared physical responsibility can only be ordered by the court if both parents agree.
Physical responsibility for the children who are subject to this order shall be: (Check only one box)
☐ Shared by both parents.
☐ Primary.
__________________________________ shall have primary physical responsibility for the child(ren).
400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 3 of 8
3.
Parenting Schedule (Parent Child Contact)
a) Routine Schedule:
☐ Describe the routine weekly schedule for the child by inserting the initials or name of the parent
with who the child(ren) will spend the night. For days on which there is a transition, indicate the
time of transition from one household to another.
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
1
2
☐ Schedule is based on a plan that is longer than two weeks. An appropriate calendar in similar
format is attached
☐ Other: (please describe)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
b) Holiday and Birthday Plan (Check appropriate box)
☐ No holiday/birthday schedule. Routine schedule applies regardless.
☐ Holiday and birthday parenting time shall be as parties agree.
☐ Holidays/birthdays that are checked below shall be shared. If a holiday/birthday is not
checked, the routine schedule shall apply. For each holiday/birthday, please describe the
arrangement and the start and end times (For example: Thanksgiving: Alternating
schedule: Mother even years; Father odd years; starting after school on Wednesday prior to
Thanksgiving and ending Friday after Thanksgiving at 6 p.m.).
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
☐ Child(ren)'s birthdays: _______________________________________________________
☐ Thanksgiving:
☐ Christmas Eve:
☐
Christmas Day:
☐ Mother's Day:
☐ Father’s Day:
☐ Plaintiff s birthday: _______________________________________________________
☐ Defendant's birthday: _______________________________________________________
400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 4 of 8
☐ July 4th Holiday: _______________________________________________________
☐ Other religious, civil and family celebrated special occasions:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
c) Three Day Weekends
☐ No three-day weekend schedule. Routine schedule or vacation schedule (for summer holidays)
applies.
☐ The parent exercising parenting time on the weekend before a Monday holiday shall have
parenting time on that Monday holiday.
☐ Three-day weekends checked below shall be shared or alternated as described. If a three-day
weekend is not checked the routine schedule applies.
☐ M. L. King Day
________________________________________________________________________________________________________________________________________________
☐ Presidents' Day ___________________________________________________________
☐ Memorial Day ___________________________________________________________
☐ Labor Day ___________________________________________________________
☐ Other ___________________________________________________________
d) School Vacation Schedule
i) December or Christmas Vacation
☐ No December vacation schedule. Routine schedule and/or Christmas holiday schedule applies.
☐ Beginning in the year 20_____
, the December vacation shall be divided between the
parents as
follows:
The parent who has the child(ren) on Christmas Eve (as indicated in the Holiday schedule
above) shall have the following additional parenting time:
_________________________________________________________________________
The parent who has the child(ren) on Christmas Day (as indicated in the Holiday schedule
above) shall have the following additional parenting time
:
______________________________________________________________________________
☐ Beginning in the year
20_____
, the December vacation shall be alternated as follows:
Even numbered years with _____________________________________________________
Odd numbered years with ______________________________________________________
☐ The choices above do not fit this parenting situation. Instead, the schedule for the child(ren)'s
December vacation shall be
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
ii) February and April School Vacations
☐ No special schedule for mid-year school vacations. Routine schedule applies.
☐ Beginning in the year
20_____
, the parents shall divide the vacations. The children shall be with:
_________________________________ for the February vacation.
_________________________________ for the April vacation.
400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 5 of 8
☐ Beginning in the year
20_____
, the parents shall alternate the vacations:
February vacation: Even numbered years with __________________________________
Odd numbered years with __________________________________
April vacation: Even numbered years with __________________________________
Odd numbered years with __________________________________
☐ The choices above do not fit this parenting situation. Instead, the schedule for the child(ren)
during any midyear school vacations other than Christmas shall be:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
e) Summer Vacation
☐ No special schedule for summer vacations. Routine schedule applies.
☐ Beginning 20_____
, the child(ren) shall be with each parent for
_____
weeks of
uninterrupted
vacation time as follows:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
☐ Beginning 20_____
, the child(ren)'s schedule during the summer shall be as follows:
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
4) Transportation and Exchange of Child(ren):
(Check all that apply)
☐ Transportation arrangements person responsible for transporting the child(ren) shall be as follows:
___________________________________________________________________________
___________________________________________________________________________
☐ Unless both parents agree upon a different meeting place, the exchange of the child(ren) shall be at:
___________________________________________________________________________
___________________________________________________________________________
☐ Transportation costs shall be shared as follows:
___________________________________________________________________________
___________________________________________________________________________
☐ Other:
___________________________________________________________________________
___________________________________________________________________________
5)
Parent Child Telephone Contact:
The child(ren) shall be given privacy during their conversations with either parent. While the
child(ren) are with one parent, the other parent shall be permitted to speak by telephone with the
child(ren):
☐
At reasonable times.
☐ At the following times only: __________________________________________________________
☐ Other: ___________________________________________________________________________
400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 6 of 8
6)
Parent Child Written Communication:
☐ Both parents and child(ren) shall have the right to communicate in writing, including by
e-mail or phone
texting, during reasonable hours without interference or monitoring by the other parent.
☐ Written communications are subject to the following restrictions/conditions:
________________________________________________________________________________
________________________________________________________________________________
7)
Information Sharing and Access
Unless there is a Court order stating otherwise:
a) Both parents shall have equal rights to inspect and receive the child(ren)'s school records.
Both parents may consult with school staff concerning the child(ren)'s welfare and
education.
Both parents may participate in and attend the child(ren)'s school events.
☐ The parents agree that they will sign any releases required by a school to allow the
other parent
to review records and consult with school staff.
b) Both parents have equal rights to inspect and receive governmental agency and law
enforcement records concerning the children.
c) Both parents have equal rights to consult with any person who may provide medical, dental or
psychological care or treatment for the child(ren)'s, subject to HIPPA and other statutory
regulations.
☐ The parents agree that they will sign any releases required by a medical provider for the
child(ren) to allow the other parent to review records and consult with the
provider.
d) Each parent shall notify the other parent of any change in residential or mailing address and
any
change in his/her telephone number.
e) Each parent has a continuing responsibility to notify the other parent of any emergency
circumstances or substantial changes or decisions affecting the child(ren), including the
child(ren)'s medical needs, as close in time to the emergency circumstances as possible.
8)
Plans to Relocate a Parent's Residence:
☐ If either parent plans to relocate to a residence that will impact the child(ren)'s school
enrollment or
increase the distance between the parents' homes by more than __________ miles,
the parent who
relocates shall provide the other parent with reasonable advance notice.
In addition, the following provisions shall apply:
_________________________________________________________________________________
_________________________________________________________________________________
9)
Procedure for Review and Adjustment of Parenting Plan: (Choose only one)
☐ The parents shall meet to review the parenting plan and make any changes that are appropriate as
follows (fill in appropriate month):
☐ Twice a year in _______________and _______________
☐ Once a year in _______________
☐ Every two years in _______________
☐ Meetings shall not be on a set schedule, but shall be as often as necessary for the benefit of the
child(ren).
☐
Other: _________________________________________________________________
400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 7 of 8
10) Procedure for Resolving Disputes
☐ In the future, if the parents have a disagreement about parenting issues, the parents shall
try to
work out their disagreement in the best interests of the child(ren). If the parents
are unable to work
out their disagreement on their own, they will attempt to resolve the
dispute through mediation
before coming back to C ourt.
☐ The parties agree to use the following procedure to resolve disputes instead of mediation:
______________________________________________________________________________
______________________________________________________________________________
11) Other Parental Responsibilities
a) Each parent shall promote a healthy beneficial relationship between the child(ren) and the other
parent and shall not speak negatively about the other parent in any manner that would damage
the relationship between the other parent and the child or permit anyone-
else to do so in the
presence of the child(ren).
b) Neither parent will abuse alcohol or drugs when the child(ren) are with them or permit anyone
else to do so.
c) The parents also agree to the following: (Check all that apply)
☐ A parent requesting a temporary change to the parenting schedule shall act in good faith and
ask the other parent about such change as soon as possible. The parents are expected to fairly
adjust parenting schedules when family situations, illnesses, or other commitments make
modification reasonable.
☐ Each parent shall supply the appropriate child(ren)'s clothing for their scheduled
time with the
other parent. These clothes shall be considered the child(ren)'s clothes
and shall be returned
with the child(ren).
☐ Each parent shall be responsible for ensuring that the child(ren) attend regularly
scheduled
activities, including but not limited to extra-curricular activities, while the
child(ren) are with that
parent.
☐
Other:
___________________________________________________________________________
___________________________________________________________________________
12) Other Parenting Agreements
Other agreements related to the children are described below or are set forth in the attached
pages
number _______________ through _______________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
______ _________________________________________________________________________
_______________________________________________________________________________
400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (10/2018) Page 8 of 8
We, the undersigned, agree that the provisions set forth above may be incorporated into a parental rights
and responsibilities order of this Court.
Approved as to Form
Plaintiff’s Attorney
Plaintiff
Date
Defendant’s Attorney
Defendant
Date
GAL
Date
A PERSON WHO FAILS TO COMPLY WITH ALL TERMS OF THE CURRENT ORDER GOVERNING PARENT CHILD CONTACT
MAY BE SUBJECT TO CONTEMPT OF COURT CHARGES. THE COURT MAY IMPOSE ADDITIONAL REMEDIES INCLUDING A
MODIFICATION OF THE CURRENT PARENT CHILD CONTACT ORDER IF FOUND TO BE IN THE BEST INTERESTS OF THE
CHILD.
Dated
_____________________________ ________________________________
Superior Court Judge
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SUPERIOR COURT Unit AGREEMENT ON PARENTAL RIGHTS AND (Vermont Judiciary)

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Completed 30 July 2020

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