12 995 B Form – Fill Out and Use This PDF

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.995(b),

SUPERVISED/SAFETY-FOCUSED PARENTING PLAN

(02/18)

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.

The parents must identify a name or designation to be used throughout this Parenting Plan.

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 filed 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 filed by either parent at the time of or any time prior to the final hearing. If an agreed Parenting Plan is not filed 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 filed 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 file 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 file.

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 Sheriff or certified 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

Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

Administration. If you elect to participate in electronic service, which 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 find 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 defined there. For further information, see chapter 61, Florida Statutes, and the instructions for the petition and/or answer that were filed in this case.

Special notes...

If you fear that disclosing your address would put you in danger, you should complete a Request for Confidential Filing of Address, Florida Supreme Court Approved Form 12.980(h), file it with the clerk of the circuit court and write confidential 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

Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

child(ren) shall be made by evaluating all of the factors affecting 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 effectuate the parenting plan. This factor does not create a presumption for or against relocation of either parent with a child(ren);

The moral fitness 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 sufficient 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 unified 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 specifically 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;

The demonstrated capacity and disposition of each parent to participate and be involved in the child(ren)’s school and extracurricular activities;

Instructions for Florida Supreme Court Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

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 fill 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 fill 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 (02/18)

IN THE CIRCUIT COURT OF THE ______ JUDICIAL CIRCUIT

IN AND FOR ________________________ COUNTY, FLORIDA

Case No: _____________________

Division: _____________________

_______________________________

Petitioner,

and

_______________________________

Respondent.

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 final Parenting Plan established by the court.

_____ A temporary Parenting Plan established by the court.

_____ A modification of a prior final Parenting Plan or prior final order.

I.PARENTS

Petitioner, hereafter referred to in this Parenting Plan as Parent

{name or designation} __________________________________________________

Name:__________________________________________________________________

Address:________________________________________________________________

Telephone Number:___________________E-Mail:_________________________________

_____ Address Unknown: {Please indicate if Petitioner’s address is unknown}

_____ Address Confidential: {Please indicate if Petitioner’s address and phone numbers are confidential pursuant to either a _____ Final Judgment for Protection Against Domestic Violence

or _____ other court order _____________________________________________.}

Respondent, hereafter referred to in this Parenting Plan as Parent

{name or designation} ___________________________________________________

Name:__________________________________________________________________

Address:________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

Telephone Number: _________________ E-Mail: _____________________________________

_____ Address Unknown: (Please indicate if Respondent’s address is unknown}

_____ Address Confidential: (Please indicate if Respondent’s address and telephone

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)

NameDate 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}

{Insert the name or designation of the appropriate parent in the space provided.}

1. _____ Sole Parental Responsibility

It is in the best interests of the child(ren) that Parent

{name or designation} _____________________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.

OR

2. _____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:

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

Education/Academic decisions	Parent ______________
Non-emergency health care	Parent ______________
________________________	Parent ______________ ______
________________________	Parent _____________ ______
_________________________	Parent ______________

_____Other: {Specify}___________________________________________.

V. TIME-SHARING SCHEDULE {Choose only one}

{Insert the name or designation of the appropriate parent in the space provided}

1.______No Time-Sharing: Parent ______________________ 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 ________Parent

___________________, the supervisor shall be present .______Parent ____________

has the right to spend time with the child(ren) even though the other parent will be making most, if not all, of the parenting 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 Parent

____________.

b._____ From ___ m. to ____m. on the following day(s) ______________________

_____________________________________________________________________.

3._____ Restricted Time-Sharing: _____Parent __________________ 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:_______________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________.

a._______ hours per week. The place(s), and time(s) shall be set by Parent

__________

b. ______Other: _______________________________________________________.

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

VI. SUPERVISOR AND SUPERVISION {Choose only one}

{Insert the name or designation of the appropriate parent in the space provided.}

1. Supervisor. The person supervising the time-sharing shall be selected by: {Choose only one}

_____ both parents .

_____ Parent {name or designation} ____________________, 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 Parent

{name or designation} __________________________________.

_____Other: ______________________________________________________.

VII. LOCATION: {Choose only one}

{Insert the name or designation of the appropriate parent in the space provided.}

_____	Parent_________________________	_____	Parent ______________________shall

spend his/her time-sharing with the child(ren) at the following location(s):

1._____Supervised visitation center (name and address of facility) ________________________

_______________________________________________________________________.

2._____ _______________________________________ {location} or other location designated

by Parent ______________

3._____Any location designated by Parent ____________________ with the approval of the

supervisor.

4._____Other: _____________________________________________________ .

VIII. DESIGNATION FOR OTHER LEGAL PURPOSES

{Insert the name or designation of the appropriate parent in the space provided.}

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

1.The child(ren) named in this Safety-Focused Parenting Plan are scheduled to reside the majority of the time with Parent {name or designation} ______________________________.

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 address of Parent {name or designation} ____________________shall be used.

IX. TRANSPORTATION AND EXCHANGE OF CHILD(REN)

{Insert the name or designation of the appropriate parent in the space provided.}

1.Transportation

The child(ren) shall not be driven in a car unless the driver has a valid driver’s license, automobile insurance, seat belts, and child safety seats as required by Florida law.

Parent ____________ Parent ______________ 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._____ Parent ________________ with the supervisor present.

b._____ The supervisor alone.

c.____ Other: _______________________________________________.

2.Exchange

{Insert the name or designation of the appropriate parent in the space provided.}

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._____ Other: ____________________________________________________________.

d. Parent ___________________ is prohibited from coming to the exchange point.

X.COMMUNICATION

1.Between Parents

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

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)

{Insert the name or designation of the appropriate parent in the space provided.}

Parent {name or designation} __________________ {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.

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

The costs of electronic communication shall be addressed as follows:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________.

XI. ACCESS TO ACTIVITIES AND EVENTS

{Insert the name or designation of the appropriate parent in the space provided.}

______Parent ______________________ {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._____ Must stay ______ feet from the other parent and ______ feet from the child.

4._____ Other _______________________________________________.

XII. CHILD(REN)’S SAFETY

{Insert the name or designation of the appropriate parent in the space provided.}

______Parent {name or designation} ______________________ shall follow the safety rules

checked below. (Indicate all that apply)

1._____There shall be no firearms 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.

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

XIV. OTHER PROVISIONS

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________.

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

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 Petitioner/Parent ____________________
		Printed Name:
		Address:
		City, State, Zip:
		Telephone Number:
		Fax Number:
		Designated E-mail Address(es):___________________
	__________________________________________

STATE OF FLORIDA

COUNTY OF ___________________________

Sworn to or affirmed and signed before me on

by

.

		NOTARY PUBLIC or DEPUTY CLERK
		{Print, type, or stamp commissioned name of notary or
		clerk}
__	Personally known
__	Produced identification
	Type of identification produced _________________________________

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)

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 Respondent/Parent ___________________
	Printed Name:
	Address:
	City, State, Zip:
	Telephone Number:
	Fax Number:
	Designated E-mail Address(es):___________________
	__________________________________________

STATE OF FLORIDA

COUNTY OF ________________________

Sworn to or affirmed and signed before me on

by

.

NOTARY PUBLIC or DEPUTY CLERK

{Print, type, or stamp commissioned name of notary or clerk.}

__ Personally known

__ Produced identification

Type of identification produced __________________________

IF A NONLAWYER HELPED YOU FILL OUT THIS FORM, HE/SHE MUST FILL IN THE BLANKS BELOW:

[fill in all blanks] This form was prepared for the: {choose only one} _____ Petitioner

_____ Respondent.

This form was completed with the assistance of:

{name of individual} __________________________________________________________________,

{name of business} ____________________________________________________________________,

{address} ____________________________________________________________________________,

{city} ___		,{state}		, {zip code}____________,{telephone number}	.

Florida Supreme Court Approved Family Law Form 12.995(b), Supervised/Safety-Focused Parenting Plan (02/18)