Worksheet For Individual Proposed Parenting Plan Page 2
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4(F)
Health Care
Examples: making arrangements and appointments for health care; accompanying child to doctor's and
dentist's appointments; discussing child's health care needs with doctors, dentists, and other health care
providers; providing care in the home when child is ill.
Petitioner
%
Respondent
%
(G)
Moral and Religious Matters
Examples: discussing moral and religious matters with the child; providing moral and religious
guidance; accompanying the child to church.
Petitioner
%
Respondent
%
(H)
Child Care Matters
Examples: making arrangements for child care by family members, baby-sitters, or child care facilities;
supervising and communicating with these child care providers.
Petitioner
%
Respondent
%
MAKING MAJOR DECISIONS FOR THE CHILDREN
MAKING MAJOR DECISIONS FOR THE CHILDREN
Explain how you and the other parent have shared the responsibilities for making major decisions for the
Explain how you and the other parent have shared the responsibilities for making major decisions for the
children. This information is for only the last twenty-four months before your case was filed. Do not provide
children. This information is for only the last twenty-four months before your case was filed. Do not provide
information for any time after the filing of the case.
information for any time after the filing of the case.
1.
First, review the types of decisions in the list on the next page, then answer the following question.
Did you and the other parent always make the types of major decisions on the list by talking the
decision over, and coming to an agreement on what the decision should be?
YES
NO
If you answered "Yes," you don't need to complete the list; you're finished with this section. If you
answered "No," read item 2.
2.
Complete the list on the next page by indicating the percentage of time each type of decision was
shared, which means you and the other parent talked the decision over and came to an agreement on the
decision; or the percentage of time each type of decision was made by you or the other parent, alone,
without talking it over. For each type of decision, the numbers in all of the blanks should always add up
to 100 percent. In items (F) and (G), you may write in other types of major decisions, and complete
those items just as you completed the first part of the list.
SCA-FC-128: Worksheet for Individual Proposed Parenting Plan
Page 2 of 4
Review Date: 05/2014; Revision Date: 05/2014;
WVSCA Approved: 06/17/2014
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