Form 12.995(A) - Florida Supreme Court Approved Family Law - Parenting Plan Page 6
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17_____ Address Confidential: {Please indicate here if father’s address and phone 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)
Name
Date 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.
Sections 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 all
other state and federal laws.
Other: ___________________________________________________________________________.
IV. PARENTAL RESPONSIBILITY AND DECISION MAKING
1. Parental Responsibility {Choose only one}
_____ Shared Parental Responsibility.
It is in the best interests of the child(ren) that the parents confer and jointly make all
major decisions affecting the welfare of the child(ren). Major decisions include, but are
not limited to, decisions about the child(ren)’s education, healthcare, and other
responsibilities unique to this family.
OR
_____ 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(a), Parenting Plan (11/15)
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