Response By Parenting Coordinator - 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.
RESPONSE BY PARENTING COORDINATOR
I, {name}_________________________________________notify the Court and affirm the
following:
1. Acceptance.
[Choose only one]
a. ____ I accept the appointment as parenting coordinator.
b. ____ I decline the appointment as parenting coordinator.
2. Qualifications.
[Choose only one]
a. ____ I meet the qualifications in section 61.125(4), Florida Statutes.
b. ____ I do not meet the qualifications in section 61.125(4), Florida Statutes. However, the parties
have chosen me by mutual consent and I believe I can perform the services of a parenting
coordinator because: ____________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
3. I am not aware of any conflict, circumstance, or reason that renders me unable to serve as the
parenting coordinator in this matter and I will immediately inform the court and the parties if such
arises.
4. I understand my role, responsibility, and authority under the Order of Referral to Parenting
Coordinator, Florida Family Law Rules of Procedure Form 12.984(a); section 61.125, Florida Statutes;
Florida Family Law Rule of Procedure 12.742; and Rules for Qualified and Court Appointed Parenting
Coordinators.
Florida Family Law Rules of Procedure Form 12.984(b), Response by Parenting Coordinator (07/14)
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