Parenting Coordinator Report Of An Emergency - Florida Circuit Court Page 3
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4IN THE CIRCUIT COURT OF THE _____________________ JUDICIAL CIRCUIT,
IN AND FOR ______________________________ COUNTY, FLORIDA
Case No: ________________________
Division: ________________________
_________________________________,
Petitioner,
and
_________________________________,
Respondent.
PARENTING COORDINATOR REPORT OF AN EMERGENCY
The undersigned parenting coordinator reports an emergency to the court:
1. _____ With notice to the parties. A party has obtained a final order or injunction of protection
against domestic violence or has been arrested for an act of domestic violence as provided
under chapter 741, F.S.
2. _____ Without notice to the parties pursuant to section 61.125 (8)(a), Florida Statutes, because:
(choose all that apply)
a. _____ There is a reasonable cause to suspect that a child will suffer or is suffering abuse,
neglect, or abandonment as provided under chapter 39, Florida Statutes.
b. _____ There is a reasonable cause to suspect a vulnerable adult has or is being abused,
neglected, or exploited as provided under chapter 415, Florida Statutes.
c. _____ A party, or someone acting on a party’s behalf, is expected to wrongfully remove or is
wrongfully removing the child from the jurisdiction of the court without prior approval
or compliance with the requirements of section 61.13001, Florida Statutes.
3. Describe the emergency: ____________________________________________________________
_________________________________________________________________________________
____________________________________________________________________________.
VERIFICATION BY PARENTING COORDINATOR
I, _______________________________________________ (name of parenting coordinator) do hereby
swear or affirm that the facts contained in this Parenting Coordinator Report of an Emergency are true
and correct to the best of my knowledge and belief.
Florida Family Law Rules of Procedure Form 12.984(c), Parenting Coordinator Report of an Emergency (07/14)
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