Fill and Sign the Supervisedsafety Focused Parenting Plan and Instructions Florida Form

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW FORM 12.995(b), SUPERVISED/SAFETY-FOCUSED PARENTING PLAN (11/15) When should this form be used? A Parenting Plan is required in all cases involving minor child(ren). This form or a similar form should be used in cases when you feel your child(ren) cannot be safely alone with the other parent or if you believe shared parental responsibility presents a detriment to the child(ren). In this case, a Parenting Plan must be developed that allows time-sharing with any minor child(ren), while providing protection for the child(ren). If safety or supervised time-sharing is not a concern, Parenting Plan , Florida Supreme Court Approved Family Law Form 12.995(a) or a similar form should be used. If the case involves relocation, pursuant to Section 61.13001, Florida Statutes, then Relocation/Long Distance Parenting Plan, Florida Supreme Court Approved Family Law Form 12.995(c) or a similar form should be used. 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 fled 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 the parents have not reached an agreement, a proposed Parenting Plan may be fled by either parent at the time of or any time prior to the fnal hearing. If an agreed Parenting Plan is not fled 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 fled 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 fle 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 fle. The rules and procedures should be carefully read and followed. IMPORTANT INFORMATION REGARDING E-SERVICE ELECTION After the initial service of process of the petition or supplemental petition by the Sherif or certifed 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 Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety- Focused Parenting Plan (11/15) 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 fnd 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 defned there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or answer that were fled in this case. Special notes... If you fear that disclosing your address would put you in danger, you should complete a Request for Confdential Filing of Address, Florida Supreme Court Approved Form 12.980(h), fle it with the clerk of the circuit court and write confdential in the space provided in the Parenting Plan. At a minimum, the 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 arrangements that specify the time that the minor child(ren) will spend with each parent,  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, and  The methods and technologies that the parents will use to communicate with the child(ren). The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the Parenting Plan, all circumstances between the parents, including their historic relationship, domestic violence, and other factors must be taken into consideration. Determination of the best interests of the child(ren) shall Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety- Focused Parenting Plan (11/15) be made by evaluating all of the factors afecting the welfare and interest of the particular minor child(ren) and the circumstances of that family, as listed in section 61.13(3), Florida Statutes, including, but not limited to:  The demonstrated capacity and disposition of each parent 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 parent 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 efectuate the parenting plan. This factor does not create a presumption for or against relocation of either parent with a child(ren);  The moral ftness of the parents;  The mental and physical health of the parents;  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 sufcient intelligence, understanding, and experience to express a preference;  The demonstrated knowledge, capacity, and disposition of each parent 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 parent 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 parent to communicate with and keep the other parent informed of issues and activities regarding the minor child(ren), and the willingness of each parent to adopt a unifed 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 specifcally acknowledge, in writing that such evidence was considered when evaluating the bests interests of the child(ren);  Evidence that either parent has knowingly provided false information to the court regarding any prior or pending action regarding domestic violence, sexual violence, child abuse, child abandonment, or child neglect;  The particular parenting tasks customarily performed by each parent and the division or parental responsibilities before the institution of litigation and during the pending litigation, including the extent to which parenting responsibilities were undertaken by third parties; Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety- Focused Parenting Plan (11/15)  The demonstrated capacity and disposition of each parent to participate and be involved in the child(ren)’s school and extracurricular activities;  The demonstrated capacity and disposition of each parent to maintain an environment for the child(ren) which is free from substance abuse;  The capacity and disposition of each parent 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 the other parent to the child)ren); and  The developmental stages and needs of the child(ren) and the demonstrated capacity and disposition of each parent 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 fll 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 fll 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 Family Law Form 12.995(b), Supervised/Safety- Focused Parenting Plan (11/15) IN THE CIRCUIT COURT OF THE ____________________ JUDICIAL CIRCUIT IN AND FOR ____________________ COUNTY, FLORIDA Case No: ____________________ Division: ____________________ _________________________________ Mother, and _________________________________ Father. SUPERVISED/SAFETY-FOCUSED 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: {Parent’s Name} . A Parenting Plan established by the court. This parenting plan is: {Choose only one} A fnal Parenting Plan established by the court. A temporary Parenting Plan established by the court. A modifcation of a prior fnal Parenting Plan or prior fnal order. I. PARENTS Mother Name: _________________________________________________________________________ Address: _______________________________________________________________________ Telephone Number: ______________________________________________________________ E-Mail: ________________________________________________________________________ _____ Address Unknown: {Please indicate here if mother’s address is unknown} _____ Address Confdential: {Please indicate here if mother’s address and phone numbers are confidential pursuant to either a _____ Final Judgment for Protection Against Domestic Violence, or _____ other court order _______________________________________________________ }. Father Name: _________________________________________________________________________ Address: _______________________________________________________________________ Telephone Number: ______________________________________________________________ E-Mail: Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) ________________________________________________________________________ _____ Address Unknown: {Please indicate here if mother’s address is unknown} _____ Address Confdential: {Please indicate here if mother’s address and phone numbers are confidential pursuant to either a _____ Final Judgment for Protection Against Domestic Violence, or _____ other court order _______________________________________________________ }. II. CHILDREN : This parenting plan is for the following child(ren) born to, or adopted by the parties: (add additional lines as needed) Name Date of Birth III. 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. Section 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 other state and federal laws. Other: . IV. PARENTAL RESPONSIBILITY {Choose only one } Sole Parental Responsibility It is in the best interests of the child(ren) that the Mother Father shall have sole authority to make major decisions for the child(ren.) It is detrimental to the child(ren) for the parents to have shared parental responsibility. Shared Parental Responsibility with Decision Making Authority It is in the best interests of the child(ren) that the parents confer and attempt to agree on the major decisions involving the child(ren). If the parents are unable to agree, the authority for making major decisions regarding the child(ren) shall be as follows: Education/Academic decisions _____ Mother _____ Father Non-emergency health care _____ Mother _____ Father Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) ______________________________ _____ Mother _____ Father ______________________________ _____ Mother _____ Father ______________________________ _____ Mother _____ Father Other : (Explain) . V. TIME SHARING SCHEDULE {Choose only one} 1. _____ No Time-Sharing: The _____ Mother _____ Father shall have no contact with the child(ren) until further order of the court. All parenting decisions shall be made by the other parent. 2. _____ Supervised Time-Sharing: Whenever the child(ren) are with the _____ Mother _____ Father, the supervisor shall be present. The Mother Father has the right to spend time with the child(ren) even though the other parent will be making most, if not all, of the parenti ng decisions which are made on the child(ren)’s behalf. The time - sharing schedule shall be mutually agreed to between the parents, but not less than the schedule set forth below: {Choose only one} a. _____ hours per week. The place(s), and time(s) shall be set by the _____ Mother _____ Father. b. _____ From _____ m. to _____ m, on the following day(s) ____________________ ______________________________________________________________________ 3. Restricted Time-Sharing: The _____ Mother _____ Father shall have time-sharing with the following restrictions. {The restrictions should be described in detail such as time-sharing only in public places, no overnight visits, etc.} The time-sharing schedule shall be mutually agreed upon between the parents, but not less than the schedule set forth below: __________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ 4. _____ hours per week. The place(s), and time(s) shall be set by the _____ Mother _____ Father. 5. _____ Other: _____ __________________________________________________ _____ . VI. SUPERVISOR AND SUPERVISION {Choose only one} 1. Supervisor. The person supervising the time-sharing shall: {Choose only one} _____ Be selected by the _____ Mother _____ Father. Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) _____ Be selected by the _____ Mother _____ Father, subject to the other parent’s approval. _____ Other: _____ __________________________________________________ _____ . 2. Restrictions or Level of Supervision : _________________________________________ _______________________________________________________________________ _______________________________________________________________________ 3. Costs of Supervision _____ The costs of the supervision shall be paid by the _____ Mother _____ Father _____ Other: _____ __________________________________________________ _____ . VII. LOCATION: {Choose only one} The _____ Mother _____ Father shall spend his/her time-sharing with the c hild(ren) at the following location(s): 1. _____ Supervised visitation center (name and address of facility, ___________________ ___________________________________________________________________________ 2. __________________________________ ( location ) or other location designated by the _____ Mother _____ Father 3. _____ Any location designated by the _____ Mother _____ Father with the approval of the supervisor. 4. _____ Other: _____ __________________________________________________ _____ . VIII. DESIGNATION FOR OTHER LEGAL PURPOSES 1. The child(ren) named in this Safety-Focused Parenting Plan are scheduled to reside the majority of the time with the _____ Mother _____ Father . This majority designation is SOLELY for purposes of all other state and federal statutes which require such a designation. This designation does not affect either parent’s rights and responsibilities under this parenting plan. 2. For purposes of school boundary determination and registration, the _____ Mother’s _____ Father ’s address shall be designated. IX. TRANSPORTATION AND EXCHANGE OF CHILD(REN, 1. Transportation The child(ren) shall not be driven in a car unless the driver has a valid Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) driver’s license, automobile insurance, seat belts, and child safety seats as required by Florida law. The _____ Mother _____ Father or mutually agreed upon person shall be responsible for transporting the child(ren) to the exchange point. The child(ren) shall be picked up and/or returned to the exchange point by {Choose only one} a. _____ The _____ Mother _____ Father with the supervisor present. b. _____ The supervisor alone. c. _____ Other: _____ __________________________________________________ _____ . 2. Exchange The exchange of the child(ren) shall occur at: {Indicate all that apply} a. _____ The site of the supervised visit. b. _____ A monitored exchange location {specify name and address of facility} _________ c. _______________________________________________________________________. d. _____ Other: ____________________________________________________________. e. _____ The _____ Mother _____ Father is prohibited from coming to the exchange point. X. COMMUNICATION 1. Between Parents All communications regarding the child(ren) shall be between the parents. The parents shall not use the child(ren) as messengers to convey information, ask questions, or set up schedule changes. _____ The parents shall communicate with each other: {Indicate all that apply} _____ in person _____ by telephone _____ by letter _____ by e-mail _____ Other: {Specify} ___________________________________________________. _____ No Communication . Unless otherwise prohibited by court order, all information and communication regarding the child(ren) shall be exchanged via or through _____________________ _________________________________________________________________________________ _ 2. Between Parent and Child(ren, Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) The _____ Mother _____ Father {Indicate all that apply} a. _____ Shall not telephone, write, or e-mail the child(ren) unless the contact is agreed to in advance by the other parent. b. _____ May write or e-mail the child(ren) at any time. Each parent shall provide a contact address (and e-mail address if appropriate) to the other parent, unless other prohibited by court order. c. _____ May call the child(ren) on the telephone _____ times per week. The call shall last no more than _____ minutes and shall take place between _____ m. and _____ m. Each parent shall provide a telephone number to the other parent, unless otherwise prohibited by court order or law. d. _____ Long distance telephone calls made by the child(ren) to a parent shall be paid by __________________ . Each parent shall provide a telephone number to the other parent, unless otherwise prohibited by court order or law. e. _____ Other: ____________________________________________________________. 3. Costs of Electronic Communication “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 costs of electronic communication shall be addressed as follows: _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ XI. ACCESS TO ACTIVITIES AND EVENTS The _____ Mother _____ Father {Choose only one} 1. _____ Shall not attend the child(ren)’s activities and events, including but not limited to, school, athletic, and extra-curricular activities and events. 2. _____ May attend the child(ren)’s school, athletic, and extra-curricular activities and events. 3. _____ The _____ Mother _____ Father must stay _____ feet from the other parent and _____ feet from the child. 4. _____ Other: ____________________________________________________________. XII. CHILD(REN,’S SAFETY Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) The _____ Mother _____ Father shall follow the safety rules checked below. (Indicate all that apply ) 1. _____ There shall be no frearms in the home, car, or in the child(ren)’s presence during time-sharing. 2. _____ No alcoholic beverages shall be consumed from twenty-four (24) hours before the child(ren) arrive until they are returned to the other parent. 3. _____ The child(ren) shall not be disciplined by corporal punishment. 4. _____ The following person(s) present a danger to the child(ren) and shall not be present during time-sharing: _______________________________________________________________________ __________________________________________________________________________________ 5. _____ Other: ____________________________________________________________. XIII. CHANGES OR MODIFICATIONS OF THE PARENTING PLAN All changes to the Safety-Focused Parenting Plan must be pursuant to a court order. XIV. OTHER PROVISIONS ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) SIGNATURES OF PARENTS 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: ______________________ _______________________________________ Signature of Mother Printed Name: _____________________________ Address: __________________________________ City, State, Zip: _____________________________ Telephone Number: _________________________ Fax Number: ______________________________ Designated E-mail Address(es): ________________ _________________________________________ STATE OF FLORIDA COUNTY OF _________________________ Sworn to or afrmed and signed before me on _____ by _______________________________________ . _______________________________________ NOTARY PUBLIC or DEPUTY CLERK _______________________________________ {Print, type, or stamp commissioned name of notary or clerk.} _____ Personally known _____ Produced identifcation Type of identifcation produced _______________________ Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15) 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: ______________________ _______________________________________ Signature of Father Printed Name: _____________________________ Address: __________________________________ City, State, Zip: _____________________________ Telephone Number: _________________________ Fax Number: ______________________________ Designated E-mail Address(es): ________________ _________________________________________ STATE OF FLORIDA COUNTY OF _________________________ Sworn to or afrmed and signed before me on _____ by _______________________________________ . _______________________________________ NOTARY PUBLIC or DEPUTY CLERK _______________________________________ {Print, type, or stamp commissioned name of notary or clerk.} _____ Personally known _____ Produced identifcation Type of identifcation produced _______________________ IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW: [fll in all blanks] This form was prepared for the: {choose only one } ( ) Mother ( ) Father This form was completed with the assistance of: {name of individual} ____________________________________________________________________, {name of business} ____________________________________________________________________, {address} ____________________________________________________________________________, {city} __________________ , {state} _____, {zip code} __________ , {telephone number} ______________, Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (11/15)