RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 1 of 16
Superior Court of Washington, County of
In re:Petitioner/s (person/s who started this case):And Respondent/s (other party/parties) :
No.
Parenting Plan (PPP / PPT / PP) Clerk’s action required: 1 .
Parenting Plan 1. This parenting plan is a (check one): Proposal (request) by a parent (name/s): .
It is not a signed court order. (PPP)
Court order signed by a judge or commissioner. This is a (check one):Temporary order. (PPT)Final order. (PP)This final parenting plan changes the last final parenting plan. 2. Children – This parenting plan is for the following children: Child’s name Age Child’s name Age 1. 4. 2. 5. 3. 6.3. Reasons for putting limitations on a parent (under RCW 26.09.191)a.Abandonment, neglect, child abuse, domestic violence, assault, or sex offense.
(If a parent has any of these problems, the court
must limit that parent’s contact with
the children, the right to make decisions for the children, and may not require dispute
resolution other than court.)
N eit h er p are nt h as a ny o f t h ese p ro ble m s. ( Skip to 3.b. )
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 2 of 16 A parent has one or more of these p ro ble m s a s f o llo w s ( c h eck a ll t h at a pply ): Abandonment – (Parent’s name): intentionally
abandoned a child listed in 2 for an extended time.
Neglect – (Parent’s name): substantially
refused to perform his/her parenting duties for a child listed in 2.
Child Abuse – (Parent’s name): (or someone
living in that parent’s home) abused or threatened to abuse a child. The abuse
was (check all that apply): physical sexual repeated emotional
abuse.
Domestic Violence – (Parent’s name): (or
someone living in that parent’s home) has a history of domestic violence as
defined in RCW 26.50.010(1).
Assault – (Parent’s name): (or someone
living in that parent’s home) has assaulted or sexually assaulted someone
causing grievous physical harm, causing fear of such harm or resulting in a
pregnancy.
Sex Offense – (Parent’s name): has been convicted
of a sex offense as an adult.
Someone living in (parent’s name): ’s home has
been convicted as an adult or adjudicated as a juvenile of a sex offense. b. Other problems that may harm the children’s best interests. (If a parent has any of
these problems, the court
may limit that parent’s contact with the children and right to
make decisions for the children.)
Neit h er p are nt h as a ny o f t h ese p ro ble m s. ( Skip to 4.) A parent has one or more of these p ro ble m s a s f o llo w s ( c h eck a ll t h at a pply ): Neglect – (Parent’s name): neglected
his/her parental duties towards a child listed in 2.
Emotional or physical problem – (Parent’s name):
has a long-term emotional or physical problem that gets in the way of his/her
ability to parent.
Substance Abuse – (Parent’s name): has a
long-term problem with drugs, alcohol, or other substances that gets in the way
of his/her ability to parent.
Lack of emotional ties – (Parent’s name):
has few or no emotional ties with a child listed in 2.
Abusive use of conflict – (Parent’s name):
uses conflict in a way that endangers or damages the psychological
development of a child listed in 2 .
Withholding the child – (Parent’s name):
has kept the other parent away from a child listed in 2 for a long time, without a
good reason.
Other (specify):
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 3 of 16 4. Limitations on a parent Does not apply. There are no reasons for limitations checked in 3.a. or 3.b. above.
(Skip to
5.)
No l im it a tio ns d esp it e r e aso ns ( e xp la in w hy t h ere a re n o lim it a tio ns o n a p are nt e ve n
th o ugh t h ere a re r e aso ns f o r lim it a tio ns c h ecke d in
3a. or 3. b. above ):
The following limits or conditions apply to (parent’s name):
(check all that apply):
No contact with the children. Limited contact as sh ow n in the Parenting Time Schedule (sections 8 – 11) belo w .Limited contact as f o llo w s ( s p ecif y s ch edule , lis t all contact here instead of in a
Parenting Time Schedule, skip sections
8 – 11 ):
S up erv is e d c o nta ct. A ll p are ntin g t im e s h all b e s u perv is e d. A ny c o sts o f
su p erv is io n m ust b e p aid b y ( n am e): T he s u perv is o r s h all b e: a pro fe ssio nal s u perv is o r ( n am e): a non-professional supervisor (nam e): T he d a te s a nd t im es o f s u pe rv is e d c o nta ct w ill b e: a s s h ow n in the Parenting Time Schedule (sections 8 – 11 ) belo w .as f o llo w s ( s p ecif y ): ( S pecif ic r u le s f o r s u perv is io n, if a ny): O th er lim it a tio ns o r c o nd it io ns d urin g p are ntin g t im e ( s p ecif y ): Evaluation or treatment required. (Name): must: be evaluated for: .start (or continue) and comply with treatment:as recommended by the evaluation.as follows (specify kind of treatment and any other details): provide a copy of the evaluation and compliance reports (specify details):
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 4 of 16 If this parent does not follow the evaluation or treatment requirements above, then
(what happens):
5. Decision-making When the children are with you, you are responsible for them. You can make day-to-day
decisions for the children when they are with you, including decisions about safety and
emergency health care. Major decisions must be made as follows. a. Who can make major decisions about the children? Type of Major Decision Joint
(parents make
these decisions
together) Limited
(only the parent named below has
authority to make these decisions) School / Educational (Name): Health care (not
emergency) (Name): Other: (Name): Other: (Name): Other: (Name): b. Reasons for limits on major decision-making, if any: There are no reasons to limit major decision-making. Major decision-making must be limited because one of the parents has problems
as described in 3.a. above. Major decision-making should be limited because (check all that apply): Both parents are against shared decision-making. One of the parents does not want to share decision-making and this is
reasonable because of:problems as described in 3.b. above.the history of each parent’s participation in decision-making.the parents’ ability and desire to cooperate with each other in decision-
making. the distance between the parents’ homes makes it hard to make timely
decisions together. 6. Dispute Resolution – If you and the other parent disagree:From time to time, the parents may have disagreements about shared decisions or about
what parts of this parenting plan mean. To solve disagreements about this parenting plan,
the parents will go to a dispute resolution provider or court. The court may only require a
dispute resolution provider if there are no limitations in 3a. a. The parents will go to (check one): The dispute resolution provider below (before they may go to court):
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 5 of 16 Mediation (mediator or agency name): If t h ere a re d o m estic v io le nce is su es, y o u m ay o nly u se m edia tio n if t h e v ic tim
ask s f o r m edia tio n, m edia tio n is a g ood f it f o r t h e s it u atio n, a nd t h e v ic tim c a n
brin g a s u pport p ers o n t o m edia tio n. Arbitration (arbitrator or agency name): Counseling (counselor or agency name): If a dispute resolution provider is not named above, or if the named provider is no
longer available, the parents may agree on a provider or ask the court to name
one. Im porta n t! U nle ss t h ere is a n e m erg ency, t h e p are nts m ust p artic ip ate in t h e
dis p ute r e so lu tio n p ro ce ss lis te d a bove in g ood f a it h , b efo re g oin g t o c o urt. T his
se ctio n d oes n ot a pply t o d is a gre em ents a bout m oney o r s u pport. Court (without having to go to mediation, arbitration, or counseling).
(If you check this box, skip to section
7 below, do not fill out 6, b.)
b. If mediation, arbitration, or counseling is required, one parent must notify the other
parent by (check one): certified mail other (specify):
The parents will pay for the mediation, arbitration, or counseling services as follows
(check one): (Name): will pay %, (Name): will pay %. base d o n e ach p are nts ’ P ro portio nal S hare o f I n co m e ( p erc e nta ge) f r o m lin e 6 o f t h e
Child S upp ort W ork sh eet. as decided through the dispute resolution process. What to expect in the dispute resolution process:Pre fe re nce s h all b e g iv e n t o c a rry in g o ut t h e p are ntin g p la n. If y o u r e ach a n a gre em ent, it m ust b e p ut in to w rit in g, s ig ned, a nd b oth p are nts m ust
ge t a c o py. If t h e c o urt f in ds t h at y o u h ave u se d o r f r u str a te d t h e d is p ute r e so lu tio n p ro ce ss
wit h out a g ood r e aso n, t h e c o urt c a n o rd er y o u t o p a y f in ancia l s a nctio ns ( p enalt ie s)
in clu din g t h e o th er p are nt’s le gal f e es. You m ay g o b ack t o c o urt if the dispute resolution pro ce ss d oesn ’t s o lv e t h e
dis a gre em ent o r if y o u d is a gre e w it h t h e a rb it r a to r’s d ecis io n. 7. CustodianThe custodian is (name): solely for
the purpose of all state and federal statutes which require a designation or determination
of custody. Even though one parent is called the custodian, this does not change the
parenting rights and responsibilities described in this plan.
(Washington law generally refers to parenting time and decision-making, rather than
custody. However, some state and federal laws require that one person be named the
custodian. The custodian is the person with whom the children are scheduled to reside a
majority of their time.)
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 6 of 16 Parenting Time Schedule (Residential Provisions)Check one: Skip the parenting time schedule in sections 8 - 11 if one parent has no contact with the
children other than what is described in section 4 – Limitations.
The children live with (name): except as described in section 4. Complete the parenting time schedule in sections 8 - 11 . 8. School Schedulea.Children under School-Age Does not apply. All children are school-age. The schedule for children under school-age is the same as for school-age children.Children under school-age are scheduled to live with (name): ,
except when they are scheduled to live with (name): on
(check all that apply):
WEEKENDS: every week every other week other (specify): from (day) at : .m. to (day) at : .m.from (day) at : .m. to (day) at : .m. WEEKDAYS: every week every other week other (specify): from (day) at : .m. to (day) at : .m.from (day) at : .m. to (day) at : .m. OTHER (specify): Other (specify) : b.School-Age ChildrenThis schedule will apply when (check one): the youngest child the oldest child
each child begins:
(check one): Kindergarten 1st grade Other: The children are scheduled to live with (name): ,
except when they are scheduled to live with (name): on
(check all that apply):
WEEKENDS: every week every other week other (specify): from (day) at : .m. to (day) at : .m.from (day) at : .m. to (day) at : .m. WEEKDAYS: every week every other week other (specify): from (day) at : .m. to (day) at : .m.
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 7 of 16 from (day) at : .m. to (day) at : .m. OTHER (specify): Other (specify) : 9. Summer ScheduleSummer begins and ends according to the school calendar. as follows: . The Summer Schedule is the same as the School Schedule. (Skip to 10 .) The Summer Schedule is the same as the School Schedule except that each parent
shall spend weeks of uninterrupted vacation time with the children each
summer. The parents shall confirm their vacation schedules in writing by the end of
(date) each year. (Skip to
10 .)
The Summer Schedule is different than the School Schedule. The Summer Schedule
will begin the summer before:
(check one): the youngest child the oldest child each child
begins (check one): Kindergarten 1st grade Other:
During the summer the children are scheduled to live with (name): ,
except when they are scheduled to live with (name): on
(check all that apply):
WEEKENDS: every week every other week other (specify): from (day) at : .m. to (day) at : .m.from (day) at : .m. to (day) at : .m. WEEKDAYS: every week every other week other (specify): from (day) at : .m. to (day) at : .m.from (day) at : .m. to (day) at : .m. OTHER (specify): 10. Holiday Schedule (includes school breaks) The Holiday Schedule is the same as the School and Summer Schedules above for all
holidays and school breaks. (Skip to
11 .)
This is the Holiday Schedule for all children school-age children only:
(Put one parent’s name in each column and fill out when the children will be with that
parent for holidays and school breaks.)
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 8 of 16 Holiday Children with (name) : Children with (name): Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Martin Luther
King Jr. Day
With the parent who has the children for the attached weekend Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Presidents’ Day
With the parent who has the children for the attached weekend Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Mid-winter Break
Each parent has the children for the half of break attached to his/her
weekend. The children must be exchanged on Wednesday at (time): . Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Spring Break
Each parent has the children for the half of break attached to his/her
weekend. The children must be exchanged on Wednesday at (time): . Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr.
Mother’s Day
Begin Begin
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Plan p. 9 of 16 Holiday Children with (name): Children with (name):day/time: day/time:End day/time: End day/time: Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Memorial Day
With the parent who has the children for the attached weekend Other plan: Holiday Children with (name) : Children with (name): Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Father’s Day
Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Fourth of
July
Follow the Summer Schedule in section 9. Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:
Labor Day
End End
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Planp. 10 of 16 Holiday Children with (name): Children with (name):day/time: day/time: With the parent who has the children for the attached weekend Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Thanksgiving Day / Break
Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Winter Break
Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Christmas Eve
Follow the Winter Break schedule above. Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:
Christmas Day
End day/time: End day/time:
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Planp. 11 of 16 Holiday Children with (name): Children with (name): Follow the Winter Break schedule above. Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
New Year’s
Eve / New
Year’s Day(odd/even is
based on
New Year’s
Day)
Follow the Winter Break schedule above. Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Children’s Birthdays
Other plan:
All three-day
weekends not listed
elsewhere(Federal holidays, school in-service days, etc.) The children shall spend any unspecified holiday or non-school day with
the parent who has them for the attached weekend. Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:End day/time: End day/time:
Other occasion important to
the family:_________
Other plan: Odd Years Even Years
Every Yr. Odd Years Even Years
Every Yr. Begin day/time: Begin day/time:Other occasion important to
the family:_________End End
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Planp. 12 of 16 Holiday Children with (name): Children with (name):day/time: day/time: Other plan:
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Planp. 13 of 16
11. Conflicts in SchedulingThe Holiday Schedule must be observed over all other schedules. If there are conflicts
within the Holiday Schedule (check all that apply): Named holidays shall be followed before school breaks. Children’s birthdays shall be followed before named holidays and school breaks. Other (specify): 12. Transportation Arrangements The children will be exchanged for parenting time (picked up and dropped off) at: each parent’s homeschool or day care when in sessionother location (specify): Who is responsible for arranging transportation? The picking up parent – The parent who is about to start parenting time with the
children must arrange to have the children picked up. The dropping off parent – The parent whose parenting time is ending must
arrange to have the children dropped off. Other details (if any): 13. Moving with the Children (Relocation)If the person with whom the children are scheduled to reside a majority of their time plans
to move (relocating person), s/he must notify every person who has court-ordered time
with the children.
Move to a different school districtIf the move is to a different school district, the relocating person must complete the form
Notice of Intent to Move with Children (FL Relocate 701) and deliver it at least 60 days
before the intended move. Exceptions:If the relocating person could not reasonably have known enough information to
complete the form in time to give 60 days’ notice, s/he must give notice within 5
days after learning the information. If the relocating person is relocating to a domestic violence shelter or moving to
avoid a clear, immediate and unreasonable risk to health or safety, notice may be
delayed 21 days .If information is protected under a court order or the address confidentiality program,
it may be withheld from the notice.A relocating person who believes that giving notice would put her/himself or a child
at unreasonable risk of harm, may ask the court for permission to leave things out of
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Planp. 14 of 16 the notice or to be allowed to move without giving notice. Use form Motion to Limit
Notice of Intent to Move with Children (Ex Parte) (FL Relocate 702).The Notice of Intent to Move with Children can be delivered by having someone personally
serve the other party or by any form of mail that requires a return receipt. If the relocating person wants to change the Parenting Plan because of the move, s/he
must deliver a proposed Parenting Plan together with the Notice . Move within the same school districtIf the move is within the same school district, the relocating person still has to let the other
parent know. However, the notice does not have to be served personally or by mail with a
return receipt. Notice to the other party can be made in any reasonable way. No specific
form is required.Warning! If you do not notify…A relocating person who does not give the required notice may be found in contempt of
court. If that happens the court can impose sanctions. Sanctions can include requiring
the relocating person to bring the children back if the move has already happened, and
ordering the relocating person to pay the other side’s costs and lawyer’s fees. Right to objectA person who has court-ordered time with the children can object to a move to a different
school district and/or to the relocating person’s proposed Parenting Plan . If the move is
within the same school district, the other party doesn’t have the right to object to the move,
but s/he may ask to change the Parenting Plan if there are adequate reasons under the
modification law (RCW 26.09.260).An objection is made by filing the Objection about Moving with Children and Petition about
Changing a Parenting/Custody Order (Relocation) (form FL Relocate 721). File your
Objection with the court and serve a copy on the relocating person and anyone else who
has court-ordered time with the children. Service of the Objection must be by personal
service or by mailing a copy to each person by any form of mail that requires a return
receipt. The Objection must be filed and served no later than 30 days after the Notice of
Intent to Move with Children was received. Right to moveDuring the 30 days after the Notice was served, the relocating person may not move to a
different school district with the children unless s/he has a court order allowing the move.After the 30 days, if no Objection is filed, the relocating person may move with the children
without getting a court order allowing the move. After the 30 days, if an Objection has been filed, the relocating person may move with the
children pending the final hearing on the Objection unless: The other party gets a court order saying the children cannot move, or The other party has scheduled a hearing to take place no more than 15 days after
the date the Objection was served on the relocating person. (However, the
relocating person may ask the court for an order allowing the move even though a
hearing is pending if the relocating person believes that s/he or a child is at
unreasonable risk of harm.)T he c o urt m ay m ake a d if fe re nt d ecis io n a bout t h e m ove a t a f in al h earin g o n t h e O bje ctio n .
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Planp. 15 of 16 Parenting Plan after moveIf the relocating person served a proposed Parenting Plan with the Notice, and if no
Objection is filed within 30 days after the Notice was served (or if the parties agree):Both parties may follow that proposed plan without being held in contempt of the
Parenting Plan that was in place before the move. However, the proposed plan
cannot be enforced by contempt unless it has been approved by a court. Either party may ask the court to approve the proposed plan. Use form Ex Parte
Motion for Final Order Changing Parenting Plan – No Objection to Moving with
Children (FL Relocate 706). FormsYou can find forms about moving with children at:The Washington State Courts’ website: www.courts.wa.gov/forms,The Administrative Office of the Courts – call: (360) 705-5328,Washington LawHelp: www.washingtonlawhelp.org, orThe Superior Court Clerk’s office or county law library (for a fee). (This is a summary of the law. The complete law is in RCW 26.09.430 through 26.09.480.)14. Other 15. Proposal Does not apply. This is a court order. This is a proposed (requested) parenting plan. (The parent/s requesting this plan
must read and sign below.) I declare under penalty of perjury under the laws of the state of Washington that this
plan was proposed in good faith and that the information in section 3 above is true. Parent requesting plan signs here Signed at (city and state)Other parent requesting plan (if agreed) signs here Signed at (city and state)
16. Court Order Does not apply. This is a proposal. This is a court order (if signed by a judge or commissioner below). Findings of Fact – Based on the pleadings and any other evidence considered:The Court adopts the statements in section 3 (Reasons for putting limitations on a
parent) as its findings. The Court makes additional findings which are:contained in an order or findings of fact entered at the same time as this
Parenting Plan .
RCW 26.09.016, .181, .187, .194Mandatory Form (07/2017)FL All Family 140 Parenting Planp. 16 of 16 attached as Exhibit A as part of this Parenting Plan.other: Conclusions of Law – This Parenting Plan is in the best interest of the children. Other: Order – The parties must follow this Parenting Plan. Date Judge or Commissioner signs hereWarning! If you don’t follow this Parenting Plan, the court may find you in contempt
(RCW 26.09.160). You still have to follow this Parenting Plan even if the other
parent doesn’t. Violation of residential provisions of this order with actual knowledge of its terms is
punishable by contempt of court and may be a criminal offense under RCW
9A.40.060(2) or 9A.40.070(2). Violation of this order may subject a violator to arrest.
If this is a court order, the parties and/or their lawyers (and any GAL) sign below.
This order (check any that apply): This order (check any that apply): is an agreement of the parties. is an agreement of the parties. is presented by me. is presented by me. may be signed by the court without notice to me. may be signed by the court without notice to me. Petitioner signs here or lawyer signs here + WSBA # Respondent signs here or lawyer signs here + WSBA #Print Name DatePrint Name DateThis order (check any that apply): This order (check any that apply): is an agreement of the parties. is an agreement of the parties. is presented by me. is presented by me. may be signed by the court without notice to me. may be signed by the court without notice to me. Other party signs here or lawyer signs here + WSBA # Other party or Guardian ad Litem signs here Print Name DatePrint Name Date