12 995C Form – Fill Out and Use This PDF

INSTRUCTIONS FOR FLORIDA SUPREME COURT APPROVED FAMILY LAW

FORM 12.995(c)

RELOCATION/LONG DISTANCE PARENTING PLAN(11/15)

When should this form be used?

A Parenting Plan is required in all cases involving time-sharing with minor child(ren), even when time- sharing is not in dispute. The Parenting Plan must be developed and agreed to by the parents and every

other person entitled to access or time-sha i g		ith the hild e a d app o ed	the ou t. Other
Pe so	ea s a i di idual ho is ot the pa e	t, but with whom the child resides pursuant to court

order, or who has the right of access to, time-sharing with or visitation with the child(ren). If the parties cannot agree to a Parenting Plan or if the parents agreed to a Plan that is not approved by the court, a Parenting Plan will be established by the court with or without the use of Parenting Plan Recommendations.

This form or a similar form should be used in the development of a Parenting Plan when you are planning to relocate your or the child(re ’s p i ipal eside e o e tha 50 iles f o the p i ipal

place of residence:

∙at the time of the last order either establishing or modifying time-sharing, or

∙at the time of filing the pending action to either establish or modify time-sharing

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 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 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

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

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 Administration2.516.

Where can I look for more information?

Before proceedi g, you should read Ge eral I	for atio for “elf-Represe ted Litiga ts fou d 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...

At a minimum, the Relocation/Long Distance 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 that specifies the time that the minor child(ren) will spend with each parent and every other person entitled to access or time-sharing,

∙ 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,

∙The methods and technologies that the parties will use to communicate with the child(ren),and

∙Any transportation arrangements related to access or time-sharing.

The best interests of the child(ren) is the primary consideration in the Parenting Plan. In creating the Parenting Plan, all circu sta es et ee the pa ties, i ludi g the pa ties’ histo i elatio ship,

domestic violence, and other factors must be taken into consideration. Determination of the best interests of the 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 the family as listed in section 61.13(3), Florida Statutes, including, but not limited to:

∙The demonstrated capacity and disposition of each party 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 party to determine, consider, and act upon

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

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 party with a child(ren);

∙The moral fitness of the parties;

∙The mental and physical health of the parties;

∙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 party to be informed of the

i u sta es of the i o hild e , i ludi g, ut ot li ited to, the hild e ’s f ie ds,

teachers, medical care providers, daily activities, and favorite things;

∙The demonstrated capacity and disposition of each party 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 party to communicate with and keep the other part(y)ies

∙informed of issues and activities regarding the minor child(ren), and the willingness of each party to adopt a unified front on all major issues when dealing with thechild(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 best interests of the child(ren);

∙Evidence that any party 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 patty and the division of 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 party to participate and be involved in the

hild e ’s s hool a d e t a u i ula activities;

∙The demonstrated capacity and disposition of each party to maintain an environment for the child(ren) which is free from substance abuse;

∙The capacity and disposition of each party 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 any other party to the child)ren); and

∙The developmental stages and needs of the child(ren) and the demonstrated capacity and

dispositio of ea h pa t to eet the hild e ’s de elop e tal 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

Instructions for Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

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 Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

IN THE CIRCUIT COURT OF THE ____________________ JUDICIAL CIRCUIT

IN AND FOR ____________________ COUNTY, FLORIDA

Case No: ____________________

Division: ____________________

_____________________________________,

Petitioner,

and

_____________________________________,

Respondent.

RELOCATION/LONG-DISTANCE 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:

{Name of Parent or Other Person} _________________________________________________.

_____ 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.PARTIES Mother

Name: _________________________________________________________________________

Address: _______________________________________________________________________

Telephone Number: ______________________________________________________________

E-Mail: ________________________________________________________________________

Father

Name: _________________________________________________________________________

Address: _______________________________________________________________________

Telephone Number: ______________________________________________________________

E-Mail: ________________________________________________________________________

Other Person {If Applicable}

Name: _________________________________________________________________________

Address: _______________________________________________________________________

Telephone Number: ______________________________________________________________

E-Mail: ________________________________________________________________________

II.CHILDREN: This parenting plan is for the following child(ren):

{Add additional lines as needed}
Name(s)	Birth Date(s)

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

that party. Regardless of the allocation of decision making in the Parenting Plan, any party may make emergency decisions affecting the health or safety of the child(ren) when the child is residing with that party. A party who makes an emergency decision shall share the decision with the other party as soon as reasonably possible.

3.Extracurricular Activities (Indicate all that apply)

a._____ Any party may register the child(ren) and allow them to participate in the activity of the hild e ’s hoi e.

b._____ The parties must mutually agree to all extracurricular activities.

c._____ The party with the minor child(ren) shall transport the minor child(ren) to and/or from all mutually agreed upon extra-curricular activities, providing all necessary uniforms

	a d e uip e t ithi the pa t ’s possession.
d.	_____ The costs of the extracurricular activities shall be paid by:
	Mother _____% Father _____%
e.	_____ The uniforms and equipment required for the extracurricular activities shall
	be paid by: Mother _____%	Father _____%

f._____ Other: ______________________________________________________________

V. INFORMATION SHARING. Unless Otherwise Indicated or Ordered by the Court:

1.Unless otherwise prohibited by law, the parties shall have access to medical and school records, and information pertaining to the child(ren), and shall be permitted to independently consult with any and all professionals involved with the child(ren). The parties shall cooperate with each other in sharing information related to the health, education, and welfare of the child(ren) and they shall sign any necessary documentation ensuring that all parties have access to said records.

2.Each party shall be responsible for obtaining records and reports directly from the school and health care providers.

3.The parties have equal rights to inspect and receive governmental agency and law enforcement records concerning the child(ren).

4.	The pa ties shall ha e e ual a	d i depe	de	t autho it to o	fe ith the	hild e ’s s hool,
day care, health care providers, and other programs with regard to the child						e ’s edu atio al,
emotional, and social progress.
5.	The pa ties shall e listed as e	e ge	o	ta ts fo the hild	e .

6.Each party has a continuing responsibility to provide a residential and mailing address, and contact telephone number (s) to the other parties. Each party shall notify the other parties in writing within 24 hours of any changes. Each party shall notify the court in writing within seven (7) days of any changes.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

7.Other: _________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

VI. SCHEDULING

1.School Calendar

a._____ If necessary, on or before _______________ of each year, the parties should obtain a copy of the school calendar for the next school year. The parties shall discuss the calendars and the time-sharing schedule so that any differences or questions can be resolved.

b._____ The parties shall follow the school calendar of: {Indicate all that apply}

_____ the oldest child

_____ the youngest child

_____ _______________ County

_____ _______________ School

2.Academic Break Definition

When defining academic break periods, the period shall begin at the end of the last scheduled day of classes before the holiday or break and shall end on the first day of regularly scheduled classes after the holiday or break.

3.Schedule Changes {Indicate all that apply}

a._____ A party making a request for a schedule change will make the request as soon as possible, but in any event, except in cases of emergency, no less than

______________________________________________ before the change is to occur.

b._____ A party requesting a change of schedule shall be responsible for any additional child care, or transportation costs caused by the change.

c._____ Other: ______________________________________________________________.

VII. TIME-SHARING SCHEDULE

1.Weekday and Weekend Schedule

The following schedule shall apply beginning on ______________________________________ with

the _____ Mother _____ Father _____ {If Applicable} Other Person and continue as follows:

The child(ren) shall spend time with the Mother on the following dates and times: WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}:

_____________________________________________________________________

From _______________________________ to _______________________________

WEEKDAYS: {Specify days} _______________________________________________

From _______________________________ to _______________________________

OTHER: {Specify} _______________________________________________________

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

The child(ren) shall spend time with the Father on the following dates andtimes: WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}:

_____________________________________________________________________

From _______________________________ to _______________________________

WEEKDAYS: {Specify days} _______________________________________________

From _______________________________ to _______________________________

OTHER: {Specify} _______________________________________________________

The child(ren) shall spend time with the Other Person {If Applicable} on the following dates and times:

WEEKENDS: _____ Every _____ Every Other _____ Other {Specify}:

_____________________________________________________________________

From _______________________________ to _______________________________

WEEKDAYS: {Specify days} _______________________________________________

From _______________________________ to _______________________________

OTHER: {Specify} _______________________________________________________

Please indicate if there is a different time sharing schedule for any child. Complete a separate Attachment for each child for whom there is a different time sharing schedule.

_____ There is a different time-sharing schedule for the following child(ren) in Attachment _____.

______________________________________, and _____________________________________.

{Name of Child}

{Name of Child}

2.Holiday Schedule {Choose only one}

a._____ No holiday time sharing shall apply. The regular time-sharing schedule setforth above shall apply.

b._____ Holiday time-sharing shall be as the parties agree.

c._____ Holiday time-sharing shall be in accordance with the following schedule. The Holiday schedule will take priority over the regular weekday, weekend, and summer schedules. Fill in the blanks with Mother, Father, or {If Applicable} Other Person to indicate where the child(ren) will be for the holidays. Provide the beginning and ending times. If a holiday is not specified as even, odd, or every year with one party, then the child(ren) will remain with the other party in accordance with the regular schedule.

Holidays	Even Years	Odd Years	Every Year	Begin/End Time
Mothe ’s Da	___________	_______________	_______________	______________
Fathe ’s Da	___________	_______________	_______________	______________
P eside t’s Da	___________	_______________	_______________	______________
M. L. King Day	___________	_______________	_______________	______________
Easter	___________	_______________	_______________	______________
Passover	___________	_______________	_______________	______________
Memorial Day Wkd	___________	_______________	_______________	______________
4th of July	___________	_______________	_______________	______________
Labor Day Wkd	___________	_______________	_______________	______________

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

Columbus Day Wkd		___________	_______________	_______________	______________
Halloween		___________	_______________	_______________	______________
Thanksgiving		___________	_______________	_______________	______________
Vete a	’s Da	___________	_______________	_______________	______________
Hanukkah		___________	_______________	_______________	______________
Yom Kippur		___________	_______________	_______________	______________
Rosh Hashanah		___________	_______________	_______________	______________
Child e	’s Bi thda s:	___________	_______________	_______________	______________
___________________		___________	_______________	_______________	______________
___________________		___________	_______________	_______________	______________

This holiday schedule may affect the regular time-sharing schedule. Parties may wish to specify one or more of the following options:

d._____ When the parties are using an alternating weekend plan and the holiday schedule would result in one party having the child(ren) for three weekends in a row, the parties will exchange the following weekend, so that each has two weekends in a row before the regular alternating weekend pattern resumes.

e._____ If a party has the child(ren) on a weekend immediately before or after an unspecified holiday or non-school day, they shall have the child(ren) for the holiday or non-school day.

3.Winter Break {choose only one}

a._____The _____ Mother _____ Father _____ {If Applicable} Other Person shall have the child(ren) from the day and time school is dismissed until December at _____ a.m./p.m. in

_____ odd-numbered years _____ even-numbered years _____ every year. The other party will have the child(ren) for the second portion of the Winter Break. The parties shall alternate the arrangement each year.

b._____The _____ Mother _____ Father _____ {If Applicable} Other Person shall have the child(ren) for the entire Winter Break during _____ odd-numbered years _____ even- numbered years _____ every year.

c._____ Other: ______________________________________________________________.

________________________________________________________________

________________________________________________________________

4.Specific Winter Holidays

If not addressed above, the spe ifi Wi te Holida s su h as Ch ist as, Ne Yea ’s E e, Hanukkah, Kwanzaa, etc. shall be shared as follows:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

5.Spring Break {Choose only one}

a. _____The parties shall follow the regular schedule.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

2.The parties shall exchange travel information and finalize travel plans at least _____ days in advance of the date of travel. Except in cases of emergency, any party requesting a change of travel plans after the date of finalization shall be solely responsible for any additional costs.

3.Automobile Transportation and Exchange {Choose only one}

If a party is more than _____ minutes late without contacting the other party to make other

arrangements, the party with the child(ren) may proceed with other plans and activities.

a. _____ The _____ Mother _____ Father _____ {If Applicable} Other Person shall provide all

transportation.

b._____ The _____ Mother _____ Father _____ {If Applicable} Other Person shall pick up the

child(ren) at the beginning of the visit and the other party shall pick up the child(ren) at the end of the visit. The exchange shall take place:

_____ At the pa ties’ ho es u less othe ise agreed

_____ At the following location unless the parties agree in advance to a different location: {specify}

_______________________________________________________________________________.

_____ The parties shall meet at the following central location: {specify} ______________________

________________________________________________________________________________

________________________________________________________________________________

c. _____ Other: ________________________________________________________________.

4.Airplane and Other Public Transportation and Exchange

Airline regulations govern the age at which a child may fly unescorted. An older child or children may fly under such regulations as each airline may establish.

a._____ Until a child reaches the age of _____, the parties agree that the child(ren) shall take a direct flight and/or fly accompanied by: ______________________________.

b._____ Once a child reaches the age of_____, the child shall be permitted to fly accompanied by an airline employee.

c._____ Once a child reaches the age of_____, the child shall be permitted to fly unescorted.

d._____ Other: ___________________________________________________________________.

Airline reservations should be made well in advance and preferably, non-stop or direct.

All flight information shall be sent to the other party(ies) at least _____ days in advance of the flight by

the party purchasing the tickets.

If the child(ren) are flying accompanied by a party, the party picking up the child(ren) shall exchange the child(ren) with the other party at _______________________ and the party returning the child(ren) shall

exchange the children at _______________________.

If the exchange is to be made at the airport, the party flying in to pick up or drop off the child(ren) from/to the airport must notify the other party of any flight delays.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

Unless otherwise agreed in advance, the party taking the child(ren) to the airport must call the other party(ies) immediately upon departure to notify the other party(ies) that the child(ren) is/are arriving,

and the party who meets the child(ren) must immediately notify the other party(ies) upon the hild e ’s arrival.

5.Costs of Airline and Other Public Transportation {Indicate all that apply}

a._____ Ticket Purchase {If Applicable}:

The parties shall work together to purchase the most convenient and least expensive tickets. After consultation among the parties, it shall be the responsibility of ______ to purchase the tickets by {date} ________________. All parties entitled to access to, or time-sharing with the child(ren) shall be notified of the purchase by {date} ________________.

Proof of the purchase and a copy of the itinerary (choose only one) ______ shall be provided to all parties by ________________ {date} ______ shall not be provided.

Unless otherwise agreed or in the case of an unavoidable emergency, any costs incurred by a missed travel connection shall be the sole responsibility of the party who failed to timely deliver the child(ren) to the missed connection.

b.______ Transportation costs are included in the Child Support Worksheets and/or the Order for Child Support and should not be included here.

c.______ Mother shall pay ______ % Father shall pay ______ % of the transportation costs.

d.______ Mother shall pay ______ % Father shall pay ______ % of the transportation costs for an adult to accompany the child(ren) during travel.

e.______ If the parties are sharing travel costs, the non-purchasing party shall reimburse the other party within ______ days of receipt of documentation establishing the travel costs.

f.______ Other: ___________________________________________________________________.

6.Foreign and Out-Of-State Travel {Indicate all that apply}

a.______ The parties may travel within the United States with the child(ren) during his/her time- sharing. The party traveling with the child(ren) shall give the other party(ies) at least ______

days written notice before traveling out of state unless there is an emergency, and shall provide the other party(ies) with a detailed itinerary, including locations and telephone numbers where the child(ren) and party can be reached at least ______ days in advance of the date of travel.

b.______ A party may travel out of the country with the child(ren) during his/her time-sharing. At least ______ days in advance of the date of travel, the party shall provide a detailed itinerary, including locations, and telephone numbers where the child(ren) and party may be reached during the trip. Each party agrees to provide whatever documentation is necessary for the other party(ies) to take the child(ren) out of the country.

c.______ If a party wishes to travel out of the country with the child(ren), he/she shall provide the

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

following security for the return of the child ______________________________

__________________________________________________________________.

d.______ Other ______________________________________________________.

7.Other Travel and Exchange Arrangements: ______________________________________

__________________________________________________________________________

__________________________________________________________________________

IX. EDUCATION

1.School designation. For purposes of school boundary determination and registration, the

______ Mothe ’s______ Fathe ’s______ {If Appli a le} Othe Pe so ’s add ess shall e desig ated.

2.{If Applicable} The following provisions are made regarding private or homeschooling:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

3.Other _____________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

X.DESIGNATION FOR OTHER LEGAL PURPOSES

The child(ren) named in this Parenting Plan are scheduled to reside the majority of the time with the

______ Mothe ’s______ Fathe ’s______ {If Applicable} Other Person. This majority designation is

SOLELY for purposes of all other state and federal laws which require such a designation. This designation does not affect the rights or responsibilities of any party under this Parenting Plan.

XI. COMMUNICATION

1.Between Parties All communications regarding the child(ren) shall be between the parties. The parties shall not use the child(ren) as messengers to convey information, ask questions, or set up schedule changes.

The parties shall communicate with each other by: {Indicate all that apply}

______ in person

______ by telephone

______ by letter

______ by e-mail

______ Other: _________________________________________________________________________.

2.Between Parties and Child(ren)

The parties shall keep contact information current. Telephone or other electronic communication between the child(ren) and another party shall not be monitored by or interrupted by the other party.

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

Ele t o i o u i atio i ludes telepho es, 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 child(ren) may have ______ telephone ______ e-mail ______ other electronic communication in the

form of ______________________________________________ with the other party: {Choose only one}

______ Anytime

______ Every day during the hours of _____________________ to __________________________

______ On the following days ________________________________________________________

during the hours of _____________________ to __________________________

______ Other: _______________________________________________________________________

3.Costs of Electronic Communication shall be addressed as follows:

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

XII. CHILD CARE {Choose only one}

1._____ Each party may select appropriate child care providers.

2._____ All child care providers must be agreed upon by the parties.

3._____ Each party must offer the other party the opportunity to care for the child(ren) before using a child care provider for any period exceeding _____ hours.

4._____ Other ________________________________________________________________.

XIII. CHANGES TO OR MODIFICATIONS OF THE PARENTING PLAN

Temporary changes may be made informally without a written document. When the parties do not agree, this Parenting Plan remains in effect until further order of the court.

Any substantial changes to the Parenting Plan must be sought through the filing of a supplemental petition for modification.

XIV. RELOCATION

Any relocation of the child(ren) is subject to and must be sought in compliance with Section 61.13001, Florida Statutes.

XV.	DISPUTES OR CONFLICT RESOLUTION

The parties shall attempt to cooperatively resolve any disputes which may arise over the terms of the Parenting Plan. The parties may wish to use mediation or other dispute resolution methods and assistance, such as Parenting Coordinators and Parenting Counselors, before filing a court action.

XVI. OTHER PROVISIONS

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Florida Supreme Court Approved Family Law Form 12.995(c), Relocation/Long Distance Parenting Plan (11/15)

SIGNATURES OF PARTIES

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 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(c), Relocation/Long Distance 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 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(c), Relocation/Long Distance 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 Other Person
	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} ( ) Mother ( ) Father ( ) Other Person. 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(c), Relocation/Long Distance Parenting Plan (11/15)