Fill and Sign the We Request that the Agreed Upon Provisions Be Made Part of a Temporary Order and Remain in Form

400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (03/2018) Page 1 o f 8 STATE OF VERMONT SUPERIOR COURT FAMILY DIVISION 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 responsibiliti es 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 respo nsibilities 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 childre n: ☐Is not i n e f f e c t . ☐ Is in effect. Starting date for the plan: ________________ 400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (03/2018) 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 matte rs affectin g a child' s welfare includin g decision s ab out education, medic al 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 sha re 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 dail y 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 chi ld(ren). 400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (03/2018) Page 3 of 8 3. Parenting Schedule (Parent Child Contact) a) Routine Schedule: ☐ Describe the routine weekly schedule for the child by inserting th e 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 Week 1 Week 2 ☐ Schedule is based on a plan that is longer than two weeks. An appropriat e 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/birth day is not checked, the routine schedule shall apply. For each holiday/birthday, pl ease 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 pri or to Thanksgiving and ending Friday after Thanksgiving at 6 p.m.). ☐ Thanksgiving: ________________________________ ______________________ _ _____________________________ __________________________ ☐ Christmas Eve: _______________________________________________________ ☐ Christmas Day: _______________________________________________________ ☐ Mother's Day: _______________________________________________________ ☐ Father’s Day : _______________________________________________________ ☐ Child(ren)'s birthdays: _______________________________________________________ ☐ Plaintiff s birthday: _______________________________________________________ ☐ Defendant's birthday: _______________________________________________________ ☐ July 4th Holiday: _______________________________________________________ ☐ Other religious, civil and family celebrated special occasions: ___________________________________________________________________________ 400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (03/2018) Page 4 of 8 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 sched ule 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 sc hedule 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 appl ies. ☐ Beginning in the year 20_____ , the parents shall divide the vacations. The children shall be with : _________________________________ for the February vacation. _________________________________ for the April vacation. ☐ 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 __________________________________ 400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (03/2018) Page 5 of 8 ☐ The choices above do not fit this parenting situation. Instead, the sc hedule 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 chil d(ren) shall be as follows: ___________________________________________________________________________ ___________________________________________________________________________ ☐ Unless both parents agree upon a different meeting place, the exchange of th e 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 (03/2018) 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 t he 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 notic e. In addition, the following provisions shall apply: ___________________________________________________________________________ ___________________________________________________________________________ 9) Procedure for Review and Adjustment of Parenting Plan: (Choose only o ne) ☐ The parents shall meet to review the parenting plan and make any changes th at 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 t he benefit of the child(ren). ☐ Other: ____________________________________________ _____________________ 400-00825 – Agreement on PR&R/Parent Child Contact & Provision Relating to Child (03/2018) 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 th e child(ren) and the other parent and shall not speak negatively about the other parent in any ma nner 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 a ct in good faith and ask the other parent about such change as soon as possible. The parents are expect ed 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 (03/2018) 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 PA RENT CHILD CONTACT MAY BE SUBJECT TO CONTEMPT OF COURT CHARGES. THE COURT MAY IMPOSE ADDITIONAL REM EDIES INCLUDING A MODIFICATION OF THE CURRENT PARENT CHILD CONTACT ORDER IF FOUND TO BE IN THE BEST INTERESTS OF THE CHILD.