PARENTING PLAN

Step 1: Caption

-Check the ❑ district court box

-Write Larimer (for County)

-Check whichever box applies to you

❑ The marriage of:

or

❑ Parental responsibilities concerning:

-Write down Petitioners name

-Write down Co-Petitioner or Respondent’s

name

-Write down your case number

-Write down your name and address (party

without attorney)

Step 2:

-Check appropriate box:

❑ Full joint parenting plan (both fully agree

and will sign the form)

❑ Partial joint parenting plan (agree to some

and both will sign the form)

❑ Parenting plan prepared by one party (no

agreement and only one party will sign the

form)

-Check appropriate box:

-The petitioner is the child(ren)’s

❑ father ❑mother ❑ other party

-The co-petitioner/respondent is the

child(ren)’s ❑ father ❑mother ❑ other party

If you are the other party, state your

relationship to the child

STEP 3: CHILDREN’S INFORMATION

-Write down the child(ren)’s information

-Full name of child(ren)

-The child(ren)’s present address

-Sex of child(ren)

-Date of birth of child(ren)

Section a: decision making

-Read through each section

-On number 5, check the appropriate box:

for the purposes of school attendance

only the child(ren) will reside with the:

❑mother

❑ father

❑ other party

Check the appropriate boxes

-Types of Major Decision Making

-Check appropriate box for each issue

(who will have decision making for

each specific issue?)

❑ Joint

❑ Mother

❑ Father

❑ Other party

Section b: parenting time

-Read the section in the box

1. Write down the weekday AND weekend

schedule for the school year only

o Mother: list days of the week and

times

o Father: list days of the week and

times-

IF THE CHILD(REN) WILL BE IN THE CARE OF ANOTHER PARTY (INTERVENOR), FILL IN THIS SECTION AND BE SPECIFIC ABOUT THE PARENTING TIME (DAYS OF

THE WEEK AND TIMES)

TRANSPORTATION ARRANGEMENT

Transportation:

o Be specific about how transportation (pick

ups and drops off) will be handled

Section b: summer schedule

o Check the appropriate box:

❑ If the parenting time schedule

will be the same throughout the

year, check the first box

*In the next sections, check the boxes

and write down the weekday and

weekend schedule during the

summer months only

❑ Mother: list days of the week

and times the children will be with

mother.

❑ Father: list days of the week and times the children will be with father.

Section b: #3: holidays & special occassions

Check the appropriate box on each event

❑Mother will have child(ren):

(write “mother” in the odd, even or all

years box)

❑ Father will have child(ren):

(write in “father” in the odd, even or all

years box)

❑ List the time and place of the

exchange for each event

❑ If there are other parenting time

arrangements, check the box and be

specific about what they are

Number of overnights, telephone access & travel/vacation plans

4. Number of overnights, telephone access &

travel/vacation plans

-Figure out and write down the number of

overnights each parent will have with the child(ren)

*the numbers must equal 365

5. Check the appropriate box regarding telephone

access

-If you check the “other” box be specific about

what the telephone access will be

6. Check the appropriate box regarding travel and

vacation plans

o If you check the “other” box be specific

about what the travel/vacation plans will

be

SECTION C: RELOCATION

-Check the appropriate box(es) regarding

relocation of the child(ren)

❑ Neither the mother or father have

current plans to relocate with the

child(ren).

The ❑Mother ❑ Father ❑ Other

party is planning to relocate with

the child(ren) to ___ (city) ___

(state) ___ (date) and we have

agreed to the following terms:

(be specific about your plans)

Section d: financial obligations for the benefit of the child(ren)

1. Child Support (Read this section)

a. Child Support Calculation

• Check the appropriate box regarding child support (check

only one)

❑ Previously Issued child support order(fill in the

information about the order) OR

❑ Amount to be paid based on the child support

worksheet (write in the calculated amount from the child

support worksheet) OR

❑ Amount agreed upon, NOT based on the child support

worksheet (enter the worksheet amount in the first

highlighted area and enter the agreed to amount in the

second area; where the 3 blank lines are)

b. Child support agreement• Check the appropriate boxes

The ❑Mother ❑ Father shall pay support to ❑ Mother ❑ Father ❑ Other Party• Write in the amount of support to be paid• Write in the date the support payments will begin

HOW WILL THE CHILD SUPPORT PAYMENTS BE PAID/RECEIVED?

Check the appropriate box(es)

• How will the payments be made?

❑ Through the Family Support Registry OR

Directly to the ❑mother, ❑ father or ❑

other party

• When will the child support payments be

made?

❑Weekly

❑ Bi-weekly (every other week)

❑ Twice a month

❑ Monthly

❑ Other (be specific on the date)

And will be paid on the ______ day of the ❑

week ❑month

Medical, dental, vision, mental health insurance & extraordinary/out of pocket medical expenses:

2. Who will provide insurance?

Check the appropriate box(es):❑Mother shall provide ❑medical, ❑ dental, ❑

mental health, ❑ vision insurance?

AND/OR

❑ Father shall provide ❑medical, ❑ dental, ❑

mental health, ❑ vision insurance?

AND/OR

❑ ______ (name of party) shall provide ❑

medical, ❑ dental, ❑mental health, ❑ vision

insurance?

-How will the extraordinary medical expenses be

divided or will one person be responsible?

Write in the percentage of what the party will be

paying.

-If you check the “other” box be specific about

which party will cover which expense

EXTRAORDINARY EXPENSES(PRIVATE SCHOOLS, SCHOOL/SPORT/EXTRACURRICULAR ACTIVITIES, ETC.)

3. Who will cover extraordinary

expenses?

• Private school

• Sports

• Extracurricular activities

• Other

-If you have an agreement,

check the box

❑ The parties agree to the

following: and be specific

about what the agreement

is.

OPTIONAL- POST SECONDARY EXPENSES (COLLEGE, TRADE SCHOOL, ETC.)

Check appropriate box(es)

4. How will ❑ Post-Secondary

education expenses be divided or

will one person pay? Write in the

percentage of what each party will

pay.

The expenses include:

❑ Tuition (indicate any

restrictions or maximum monetary

amounts) _______

❑ Room and Board

❑ Books

❑ Fees

❑ Travel

❑ Other (be specific) ______

SECTION E: CHILD TAX EXEMPTION

o Only 1 person can claim a deduction on

his/her income tax return

-Write in the child(ren)’s information

Check appropriate box(es) for each

section

-Who will claim the child?*❑(M) Mother ❑(F) Father ❑(O) Other party

❑ Every year

❑ Odd years

❑ Even years

-If you check the “other” box, be

specific about what the arrangements

are

SECTION F: OTHER TERMS

❑ If the parties cannot reach an agreement in the

future on any issues involving the children, they

agree to enter into:

*You may check more than 1 box

❑Mediation

❑ Arbitration

❑ Parenting coordinator

❑ Decision-maker

Check the appropriate box(es) if applicable

❑ The parties will exchange financial

information on an annual basis

❑ Identify any other issues or agreements not

already identified in this agreement (be specific)

o Check appropriate box

❑ I am acknowledging I am filling in the blanks and not changing anything

else on the form

❑ I am acknowledging that I have made a change to the original content

of this form (You would be changing the form if you changed any of the

printed content on the court form)

VERIFICATION/Signature page:

• Petitioner

o Print name

o Sign name

o Enter date signing document

o Write in full address and phone number

• Co-Petitioner/Respondent

o Print name

o Sign name

o Enter date signing document

o Write in full address and phone number

CERTIFICATE OF SERVICE* If both parties sign the separation agreement you

may skip this step

-If only one party signs the separation agreement:

-Write in the date you provided a copy to the other

party(s) and check the appropriate box as to how you

have provided it

❑ Fax

❑ US mail

❑ Hand delivery

❑ E-filed

❑ Email

- In the To: section: List the name

of the party if hand-delivered; list the

name and address of the party if

mailed; list the name and email address

(or fax number) if emailed (or faxed)

- Sign the certificate of service