Worksheet For Individual Proposed Parenting Plan Page 4
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4CHILD CARE
Explain the arrangements for chid care currently provided to your children by persons other than the
parents. Explain who provides child care, and explain the child care schedule. (If you have filed an Affidavit
To Withhold Identifying Information, then you do not have to provide the name of the childcare provider.)
None of our children receive child care from any person other than the parents.
This list is for the children named:
.
OTHER INFORMATION
Provide any other information you think the court should know concerning how you and the other parent
take care of the children.
VERIFICATION
I, _________________________________________, after making an oath or affirmation to tell the truth,
say that the facts I have stated in this Proposed Parenting Plan Worksheet are true to the best of my personal
knowledge and belief; and if I have provided information given to me by others, I believe that information to
be true.
_________________________________________
___________________________________
Signature
Date
This Verification was sworn to or affirmed before me on the ________ day of ___________________ 20____.
_________________________________________
Notary Public / Other Official
My commission expires: __________________________________________.
SCA-FC-128: Worksheet for Individual Proposed Parenting Plan
Page 4 of 4
Review Date: 05/2014; Revision Date: 05/2014;
WVSCA Approved: 06/17/2014
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