Free Parenting Plan - Hawaii

STATE OF HAWAI`I FAMILY COURT OF THE FIFTH CIRCUIT

PROPOSED PARENTING PLAN


CASE NUMBER FCNO.



CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI`I, and

This document is prepared by: Plaintiff/Petitioner Caretaker/Other* Defendant/Respondent Attorney for Petitioner/Plaintiff

(Name: First, Middle, Last) vs.



MOTHER



FATHER

PLAINTIFF(S)/PETITIONER(S),



Defendant/Respondent

(Name: First, Middle, Last) MOTHER FATHER CARETAKER

__________________________________________________ Name __________________________________________________ __________________________________________________ Address __________________________________________________ City, State, Zip Code __________________________________________________ Telephone Number *Relationship of Caretaker/Other to the child(ren): __________________________________________________

(Name: First, Middle, Last) MOTHER FATHER CARETAKER



and CHILD SUPPORT ENFORCEMENT AGENCY, STATE OF HAWAI`I DEFENDANT(S)/RESPONDENT(S).

I will be relocating to __________________________________ on or about __________________. (If you are relocating, file one plan for before relocation and another plan for after relocation.) This is the plan for before relocation. This is the plan for after relocation. 1. Child(ren): See attached sheet for additional children. Full Name Birth Date Gender
Child 1 _______________________________ Child 2 _______________________________ Child 3 _______________________________ Child 4 _______________________________ Child 5 _______________________________ Child 6 _______________________________ *CSP stands for Child Protective Services

School/Grade
____________________ ____________________ ____________________ ____________________ ____________________ ____________________

________ ________ ________ ________ ________ ________

MF MF MF MF MF MF

Is CPS* Involved? Yes No Yes No Yes No Yes No Yes No Yes No

2. Legal Custody should be awarded to (person(s) making the major decisions, such as, school enrollment, medical, driver's license): Mother Father Jointly to both Mother and Father Caretaker 3. Physical Custody should be awarded to (the child(ren) will primarily live with this person): Mother Father Jointly to both Mother and Father Caretaker
(State Pending Time Below*)

* __________ Joint custody with the child(ren) will be shared between Mother and Father as follows (even if your are suggesting joint custody, you can also use the checklist in Section 5 and 6.): ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ __________________________________________________________ .
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FOR COURT USE ONLY
PROPOSED PARENTING PLAN 5F-E-160

4. Special Concerns: (i.e. breast-feeding infant, special needs of child(ren) or disability of either parent): _______________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ . 5. Visitation Schedule: Father Mother (check one) shall have visitation, which shall commence on (fill in date), as follows: Reasonable visitation as agreed to by the parties. Every other weekend Every weekend from _______________________________ (day of the week) at ________ A.M. P.M. to (day of the week) __________________________________at _________ A.M. P.M. Midweek dinner visits on _______________ (days of the week) from ____P.M. to _____P.M. (Note: For Friday and Monday holidays, the child(ren) will stay with the parent who has the child(ren) for that weekend.) Summer Vacation: Should be split as agreed to by Father and Mother Father and Mother shall each have one-half of the summer vacation with alternate weekends to the other parent. The child(ren) should be returned to the custodial parent at lease one (1) week prior to the start of school. Other: ____________________________________________________________________. Christmas and New Year's Vacation: Should be split as agreed to by Father and Mother Father and Mother shall each have one-half of the Christmas/New Year's vacation. Other: ____________________________________________________________________. Intersession Vacation: (Spring Break and Fall Break): Each intersession break should be split as agreed to by Father and Mother Each intersession break should be alternated yearly between Father and Mother. Father and Mother shall each have one-half each intersession break. Other: ____________________________________________________________________. Child(ren)'s Birthday(s): The child(ren)'s birthday(s) should be celebrated as agreed to by Father and Mother A child's birthday will be spent with the parent who has the child on that day. [ ] Father [ ] Mother should have the child(ren) on the child(ren)'s birthday on even-numbered years. The other parent should have the child(ren) on the child(ren)'s birthday on odd-numbered years. Father and Mother will share the child(ren) for at least half the day on the child(ren)'s birthday. Other: ____________________________________________________________________. Extensive Visitation (if applicable) should be as follows: ______________________________ ____________________________________________________________________________ ____________________________________________________________________________. Out-of-State Visitation (if applicable) should be as follows: ____________________________ ____________________________________________________________________________ ____________________________________________________________________________.
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6. Detailed Holiday Schedule: Some cases work better if more details are listed. Use this as a checklist. You do not have to fill in everything. Anything that is left blank means that the child will spend the day with the parent who has the child on that day. (Note: For Friday and Monday holidays, the child(ren) will stay with the parent who has the child(ren) for that weekend.) Check "M" for Mother and "F" for Father. An example is shaded in gray. Holiday Example Holiday New Year's Eve New Year's Day Martin Luther King, Jr. Day President's Day Prince Kuhio Day (March 26th) Good Friday Memorial Day King Kamehameha Day (June 11th) Independence Day (July 4th) Statehood Day (Admissions) Labor Day Veterans' Day (Nov. 11th) Thanksgiving Day Christmas Eve Christmas Day Mother's Day Father's Day Mother's Birthday Father's Birthday Halloween (Oct. 31st) Other: Time (put a.m. or p.m.) 9 a.m. to 7 p.m. Every Year Even Years Odd Years X MF MF MF X MF MF MF

MF MF MF

MONDAY HOLIDAY (see above note) MONDAY HOLIDAY (see above note)

MF
FRIDAY HOLIDAY (see above note) MONDAY HOLIDAY (see above note)

MF

MF

MF MF
FRIDAY HOLIDAY (see above note) MONDAY HOLIDAY (see above note)

MF MF

MF MF

Other: 7. Childcare: These are the arrangements for childcare when I am at work (if you have agreed to joint custody, also state the arrangements of the other parent): ____________________________ 8. Parents covering each other: If we cannot care for the child(ren) during a time assigned to us, we will ask the other parent to take care of the child(ren) before we ask anybody else. It will be up to each parent who they ask for help during their assigned times.
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MF MF MF MF MF MF MF MF MF MF MF

MF MF MF MF MF MF MF MF MF MF MF

MF MF MF MF MF MF MF MF MF MF MF

9. Transportation: The parent will agree to who can transport the child(ren). Only the following people can help the parents with transportation: 10. Communication and Information Sharing: The parent without the child(ren) can call the child(ren) (check only one) At reasonable hours _____________________________________ OR Everyday from ______________ a.m./p.m. to ____________ a.m./p.m. E-Mail at this address: ________________________ Other: ______________________ Parents will share information with each other Parent must get information from the source (e.g., Doctor, school) 11. Supervised Visitation/No visitation: Father Mother Will have supervised visitation with the child(ren): at PACT Visitation Center Under the supervision of: _________________________ Will have no visitation. (State the reason why supervised or suspended visitation is necessary) ___________________ ____________________________________________________________________________ 12.Modificationstothevisitationschedule: Any additional visitation or changes to the visitation schedule can be agreed upon by the parents/caretaker with at least 24-hour notice. If the non-custodial parent fails to arrive at the appointment time, then the custodial parent/ caretaker will wait for ____________minutes before considering the visitation cancelled. Other: ____________________________________________________________________ No modifications allowed except by a court order. 13.MediationandSolvingDisagreements: The parties should mediate any unresolved issues or future disagreements at: The Mediation Center of the Pacific: Other: ______________________ Mediation is inappropriate because: Domestic Violence/TRO Other: ______________ Before going to court, the parents will ask the following person to help them solve disagreements: _____________________________________________________________ ____________________________________________________________________________ (list name, relationship, address, phone number) 14.Counseling: List present counselors for: Mother: ______________________Father: __________________Child(ren): _______________ Under penalty of perjury, I/we declare that this plan is proposed in good faith and is in the best interest of the child(ren) listed in Section 1. ____________________________________ Print Attorney's Name Date ____________________________________ Attorney's Signature Date
Effective 12/19/05 Reprographics (09/08)

______________________________________ Party's Name Date ______________________________________ Party's Signature Date
PROPOSED PARENTING PLAN 5F-E-160

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CLEAR FORM