Worksheet For Individual Proposed Parenting Plan
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4IN THE FAMILY COURT OF
COUNTY, WEST VIRGINIA
IN RE:
Civil Action No.
The Marriage / Children Of:
,
and
.
Petitioner (First/Middle/Last)
Respondent (First/Middle/Last)
WORKSHEET FOR INDIVIDUAL PROPOSED PARENTING PLAN
Date:
/
/
This Worksheet completed by:
(Print your name.)
PARENTING RESPONSIBILITIES
Complete the following list which shows how you and the other parent have shared parenting
responsibilities in the last twenty-four months before your case was filed. Do not provide information for any
time after the filing of the case. For each responsibility, the blanks should always add up to 100 percent.
This list is for the children named:
.
(A)
Daily Physical Needs and Care
Examples: feeding, bedtime and wake-up routines; care when child is sick or hurt; bathing, grooming,
personal hygiene, and dressing; recreation and play; physical safety; transportation.
Petitioner
%
Respondent
%
(B)
Developmental Needs
Examples: learning to walk, talk and use eating utensils; toilet training; development of self-confidence
and maturity.
Petitioner
%
Respondent
%
(C)
Development of Proper Behavior
Examples: discipline, instruction in manners; assignment and supervision of chores.
Petitioner
%
Respondent
%
(D)
Educational Matters
Examples: making school arrangements; communicating with teachers and counselors; supervision of
homework; monitoring grades and discussing school related matters.
Petitioner
%
Respondent
%
(E)
Development of Social Skills
Examples: teaching the child how to develop proper personal relationships with friends, brothers and
sisters, and adults.
Petitioner
%
Respondent
%
SCA-FC-128: Worksheet for Individual Proposed Parenting Plan
Page 1 of 4
Review Date: 05/2014; Revision Date: 05/2014;
WVSCA Approved: 06/17/2014
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