Fill and Sign the Plaintiff Defendant Civil Action File Number Pursuant to Form

Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 1 IN THE SUPERIOR COURT OF __________________ COUNTY STATE OF GEORGIA FAMILY DIVISION , Petitioner, v. , Respondent. Civil Action Case Number ______________________ CONSENT PARENTING PLAN This is an agreement between _____________________________________ and ____________________________________, the parents of the minor child(ren) whose names and year(s) of birth are as follows: CHILD’S NAME YEAR OF BIRTH ______________________________________ ____________________ ______________________________________ ____________________ ______________________________________ ____________________ ______________________________________ ____________________ ______________________________________ ____________________ ______________________________________ _____ _______________ ______________________________________ ____________________ By signing below, the parties recognize that: A) a close and continuing parent- child relationship and continuity in the child(ren)’s life will be in the child(ren)’s best interest;B) the child(ren)’s needs will change and grow as the child matures; C) each parent shall make decisions regarding the day to day care of the child while that child is residing with that parent, including any emergency decisions Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 2 affecting the health or safety of a child; decisions that affect the other parent’s parenting time shall be communicated promptly; and D) both parents will have access to all of the child(ren)’s records and information, including but not limited to, education, health, extra-curricular activities and religious communications. SET FORTH BELOW IS THE AGREEMENT OF THE PARTIES ON EACH OF THE ISSUES LISTED. LEGAL CUSTODY (choose one): □ with the Petitioner □ with the Respondent □ joint custody PRIMARY PHYSICAL CUSTODY Name Year of Birth Petitioner Respondent Joint ____________________ ________________ □ □ □ ____________________ ________________ □ □ □ ____________________ ________________ □ □ □ ____________________ ________________ □ □ □ ____________________ ________________ □ □ □ MAJOR DECISIONS The parties will consult each other and attempt to arrive at consensus on major decisions. Should they be unable to reach consensus, final decisions will be made as follows. Education □Petitioner □Respondent □ Joint Non-emergency health care □Petitioner □Respondent □ Joint Religious upbringing □Petitioner □Respondent □ Joint Extracurricular activities □Petitioner □Respondent □ Joint ____________________ □Petitioner □Respondent □ Joint ____________________ □Petitioner □Respondent □ Joint ____________________ □Petitioner □Re spondent □ Joint DISAGREEMENTS Where parents have elected joint decision making in major decisions section above, please explain how any disagreements in decision making will be resolved. i.e. explain the process parents will use when a tie breaker is needed. Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 3 ________________________________________________________________________\ ________________________________________________________________________\ ________________________________________________________________________\ ________________________________________________________________________ ________________________________________________________________________\ ____________________________________________________________ PARENTING TIME If the parties cannot otherwise agree during the term of this parenting plan, the non- custodial parent, or in joint custodial arrangements, the □ Petitioner or □ Respondent shall have at a minimum the following parenting time: (choose one) □ first and third weekend of each month □ first, third, and fifth weekend of each month □ second and fourth weekend of each month. □ Every other weekend starting on __________________________________. □ Each _____ _____ _____ starting at _____am/pm and ending at ___ __ am/pm □ Other: ______________________________________________________________ __________________________________________________________________ _____________________________________________________________ □ w eekday time □n one □ every ______________ evening. □ every other ____________ evening during the week prior to a non- visitation weekend □ e very _________ ____ and ______ ______ evening. □ o ther: _________________________________________________________ ____ ____________________________________________________________ For purposes of this Parenting Plan, a weekend will start at _____am/pm on (circle one) Thursday/Friday/Saturday/Other: ____________ ____________ and end at ____am/pm on Sunday/Monday/Other (circle one):_________________________. Weekday visitation will begin at _____am/pm and will end at (circle one) 7:00/8:00pm/______pm/when the child(ren) return(s) to school or day care the next morning/Other:____ __ _____ __________________ _____________________________ ______________________________________________________________________. Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 4 This parenting schedule begins (check one) : □ _________________ ____ (date and time) OR □on the date of the C ourt’s Order. FALL VACATION The day to day schedule shall apply except as follows:__________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________beginning on _____________________ WINTER VACATION The (choose one) □ Petitioner □ Respondent shall have the child(ren) for the first period from the day and time school is dismissed until December _________ _at ______am/pm in (choose one ) □ odd numbered years □ even numbered years □ every year. The other parent will have the child(ren) for the second period from the day and time indicated above until _____________ at ____________am/pm. The parties shall alternate the first and seconds periods each year. Or the parties choose a different winter vacation plan as set out here: ________________________________________________________________________ ____________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________. SPRING VACATION: The day to day schedule shall apply except as follows: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ _________________________________beginning _____________________________ SUMMER VACATION: The day to day schedule shall apply except as follows: Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 5 ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ _________________________________beginning _____________________________ NOTICE: Parents will confer with each other by ____ ___________________( date) each year to confirm school breaks/vacations and by ______________________(date) to determine summer parenting schedule. SPECIAL DAYS AND HOLIDAYS: Indicate whether the child(ren) will be with the parent in ODD or EVEN numbered years or EVERY year: EXAMPLE: Petitioner Respondent Start/Stop Time Example Holiday ODD EVEN 9:00 AM – 6:00 PM Petitioner Respondent Start/Stop Time Martin Luther King Day President’s Day Petitioner ’s Day Memorial Day Respondent ’s Day July Fourth Labor Day Halloween Thanksgiving Day and Friday Child(ren)’s Birthday School Free Days Petitioner ’s Birthday Respondent ’s Birthday Religious Holiday Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 6 Schedule Conflicts: When holiday parenting times conflict with extended/summer parenting time (choose one): □ holiday schedule will be observed □ extended visitation will be uninterrupted □ Other: ________________________________________________. If there is conflict between the regular schedule and the holiday schedule, the holiday schedule will prevail. For the purposes of this parenting plan, the holiday will start and end as follows: (choose one): □ Holidays that fall on Friday will include the following Saturday and Sunday. □ Holidays that fall on Monday will include the preceding Saturday and Sunday. □ Other: __________________________________________ ___________ _____________________________________________________________ _____________________________________________________________. TRANSPORTATION ARRANGEMENTS Exchanging the child(ren) between parents shall take place as follows: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Payment of long distance transportation costs, if applicable, will be paid by (choose one): □ Petitioner □Respondent □ both equallyLong distance for purposes of transportation is defined as: ______________________________________________________________________ ______________________________________________________________________ Other transportation arrangement: (Ex: disabled parent, parent without valid driver’s license, other approved transporters, etc.) ______________________________________________________________________ ______________________________________________________________________ Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 7 Should the parent picking up the child(ren) exceed a ________ minute grace period without prior notification or alerting the other parent by phone of an unavoidable breakdown or delay en route, the parenting time for that period if forfeited. Should either party repeatedly cause delay by not having the child(ren) prepared for exchange or being late for pick-up or return, a modification of parenting time may be sought. Repeatedly causing delay is defined as: ________________________________________________________________________\ ________________________________________________________________________\ __________________________________________________________________ RELOCATION If either parent decides to relocate more than ______ miles away for the other parent’s home, the moving parent will give the other parent written notice of the intent to relocate no less that (c hoose one): □ 30 days □ 60 days □ 90 days □ 180 days prior to the date of moving. COMMUNICATION ACCESS The parents agree that when the child(ren) reside with one parent, the other parent will have the right to unimpeded telephone conversations with the child(ren) as follows: (check all that apply): □ Unrestricted telephone access during reasonable hours and of reasonable duration. □ _______ telephone calls to the child(ren) per day/week with the duration of each call not to exceed _____ minutes with the following time consideration: ______________________________________________________________________ □ The child(ren) are allowed to call either parent at any time. □ Other agreed provisions for telephone/email access: ______________________ __________________________________________________________________ OTHER PARENTING TIME PROVISIONS/AGREEMENTS □ Each parent shall promptly notify the other parent of a change of address, phone number or cell phone number so that the other parent may exercise their parenting time, notify the other parent as needed, and reach the child(ren) while they are in the other parent’s household. □ When making childcare arrangements while the child is with them, parents agree to the following (ex: age before child(ren) will be left alone, appropriate caregivers, right of first refusal to provide care, etc.): ______________________________________________________________________ Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 8 ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ □ Excluding any agreed limitations on access rights below, both parents will have access to child ’s(ren’s ) records and information, including but not limited to, education, health, extracurricular activities and religious communications. Agreed limitations: ________________________________________________________________________\ ________________________________________________________________________ ________________________________________________________________________\ ________________________________________________________________________\ ________________________________________________________________________ □ Petitioner □ Respondent will notify school authorities where child(ren) are enrolled each year to list both parents to receive all notifications, reports. □ Each parent shall promptly notify the other parent of any information received thr ough the child(ren) concerning parent meetings, reports or school activities in which the child(ren) may be engaged or interested. □ Parents will consult with each other prior to scheduling any activity that will impact time the other parent spends with the child(ren). Additional agreements: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ SUPERVISED PARENTING TIME □ Supervised parenting time shall apply during the day- to-day schedule as follows: Place:_________________________________________________________________ Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 9 ______________________________________________________________________ ______________________________________________________________________ Person/Organization supervising: ___________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Responsibility for cost: □ Petitioner □ Respondent □ both equally Any transition to alter supervised parenting would require_________________________ ______________________________________________________________________ ______________________________________________________________________ MODIFICATION OF PLAN Over time, as the child(ren) and families circumstances/change, parties may, by mutual agreement, vary the parenting schedule. Such altered agreement shall not be a binding Court Order and custody shall only be modified by Court Order. □ Prior to involving the Court in resolving disagreements, parties will attempt further mediation, consultation with a child specialist/family counselor or _________________ _____________________________________________________________________ Petitioner’s Initials ______ Respondent’s Initials______ Rev. 9/2015 Page 10 I have read, understand and agree to each of the provision of this Parenting Plan Agreement, this ________ day of ______________________, 20______________. _____________________________ PETITIONER Sworn and subscribed before me this _______ day of __________________, 20__________. ______________________________ NOTARY PUBLIC My commission expires: I have read, understand and agree to each of the provision of this Parenting Plan Agreement, this ________ day of ______________________, 20______________. _____________________________ RESPONDENT Sworn and subscribed before me this _______ day of __________________, 20__________. ______________________________ NOTARY PUBLIC My commission expires: ______________________________