Child Custody Form

Documents the custody agreement between both parents, including pickup schedules, holidays, and signatures from both parties.

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Court Name

Case Number

Plaintiff's Name

First Name

Last Name

Defendant's Name

First Name

Last Name

Has physical custody been decided?

Yes No

First Name

Any change in the time we pick up or drop off our child(ren) will require at least 48 hours' notice from both of us. We pledge to get in touch with the other parent right away in the event of an emergency or other circumstance beyond the parent's control.

Agree Disagree

We commit to communicate openly with one another about any scheduling changes for our child(ren). We won't ask our child(ren) to relay these messages to one another.

Agree Disagree

We agreethat our child(ren) will be prepared for pickup and drop-off at the scheduled times. We will allow a grace period of fifteen minutes before and after these hours in order to pick up and deliver our child(ren) to the other parent on time. If we anticipate being early or late, we will phone in advance.

Agree Disagree

Both of us will respect the time spent with our child(ren) by the other parent. We resolve to do our best efforts to avoid scheduling events or appointments for our child(ren) during the other parent's scheduled times without that parent's prior consent.

Agree Disagree

When one of us knows in advance that we will not be able to take care of our child(ren) for more than one day, we will offer the other parent the chance to provide care during that time. We agree to make arrangements like this as far in advance as possible.

Agree Disagree

As much as possible, we agree to make sure that our child(ren)'s regular activities can continue while in our care.

Agree Disagree

We agree to support our child(ren)'s interests and activities, such as sports practice and games, medical appointments, dancing and music lessons andrecitals, religious activities, school and extra-curricular activities, parties and other social gatherings and club activities, as much as possible. We will both try to attend these activities, whether or not they take place during our scheduled time with our child(ren).

Agree Disagree

We agree to work out individualized holiday and vacation schedules and follow them accordingly.

Agree Disagree

We agree that the scheduled holiday and vacation schedules may be changed later on with mutual consent.

Agree Disagree

If a dispute arises regarding our parenting issues, we may be called to attend a mediation program of the court.

Agree Disagree

Signature Date

Signature of the Plaintiff

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Signature of the Defendant

Sign here

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