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| Name | Birthdate | Social Security No. |
| _______________________ | _______________________ | _______________________ |
| _______________________ | _______________________ | _______________________ |
| _______________________ | _______________________ | _______________________ |
| With Mother | With Father |
|
| (Specify Year | (Specify Year |
|
| Odd/Even/Every) | Odd/Even/Every) |
|
| New Years Day | ___________________ | ___________________ |
| Martin Luther King Day | ___________________ | ___________________ |
| Presidents Day | ___________________ | ___________________ |
| Easter | ___________________ | ___________________ |
| Passover | ___________________ | ___________________ |
| Memorial Day | ___________________ | ___________________ |
| July 4th | ___________________ | ___________________ |
| Labor Day | ___________________ | ___________________ |
| Veterans Day | ___________________ | ___________________ |
| Thanksgiving Day | ___________________ | ___________________ |
| Christmas Eve | ___________________ | ___________________ |
| Christmas Day | ___________________ | ___________________ |
| Hanukkah | ___________________ | ___________________ |
| With Mother | With Father |
|
| Mothers Day | Every | _____________ |
| Fathers Day | _____________ |
Every |
| Mothers Birthday | Every | _____________ |
| Fathers Birthday | _____________ |
Every |
| Childs Birthday | X | X |
| X Specify odd/even/every year |
||
| [ ] Other: | _____________ |
_____________ |
________________________________________________________________
2.10 TRANSPORTATION ARRANGEMENTS.
Transportation arrangements for the child(ren) between parents shall be as follows:
______________________________________________________________
______________________________________________________________
Transportation costs shall be [ ] paid equally OR [ ] paid by [ ] Mother [ ] Father.
2.11 DESIGNATION OF CUSTODIAN.
The children named in this parenting plan are scheduled to reside the majority of the time with the [ ] mother [ ] father. This parent is designated the custodian of the child(ren) solely for purposes of all other state and federal statutes which require a designation or determination of custody. THIS DESIGNATION SHALL NOT AFFECT EITHER PARENTS RIGHTS AND RESPONSIBILITIES UNDER THIS PARENTING PLAN.
2.12 OTHER:
________________________________________________________________
________________________________________________________________
III. CHILD SUPPORT PER TENNESSEE GUIDELINES OR DEVIATIONS
3.1 FINANCIAL SUPPORT.
[ ] The [ ] Mother [ ] Father will pay child support, in accordance with the Tennessee Child Support Guidelines, in the amount of $______________ per ____week; ____month; ____ twice per month; or _____every two weeks, beginning the ________ day of ____________________ 20__ .
Deviations:
________________________________________________________________
________________________________________________________________
Payment shall be made
_____ Directly to the other parent
_____ To the Central Child Support Receiving Unit, P. O. Box 305200, Nashville, TN 37229, and sent to the other parent at __________________________________________
_____ Direct deposit to the other parent at ____________________ Bank.
This amount shall not be prorated unless otherwise specified.
_____ By Wage Assignment Order [Attach Order] to be presented by counsel to ______________________________________, the employer of the payor, for on-going child support payments.
[ ] Other provisions for financial support:
________________________________________________________________
________________________________________________________________
The parties affirmatively acknowledge that no action by either or both of them will be effective to reduce or modify child support after the due date of each payment. The parties further understand that Court approval must be obtained before child support can be reduced or modified, unless such payments are automatically reduced or terminated under the terms of this parenting plan.
3.2 TAX EXEMPTION.
[ ] The [ ] Mother [ ] Father will receive the tax exemption for the child(ren) [so long as the child support is current on the 15th day of January of each year] in [ ] each [ ] alternating years starting for the year ____________. Each party shall provide to the other, by or before April 15 of every year, a copy of their respective W-2 form and a copy of the first two pages of their tax return. Where a copy of the first two pages of the return is to be provided, that copy may be provided on or before August 15 if an extension is sought, in which case a copy of the request for extension will be furnished on or before April 15 of each year.
[ ] Other provisions regarding tax deduction:
____________________________________________________________
3.3 HEALTH INSURANCE.
[ ] The [ ] mother [ ] father will maintain medical/hospital insurance on the minor child(ren) and he/she shall provide proof of continuing coverage by February 15th of each year. If available to either parent through their employment, the
[ ] Mother
[ ] Father shall maintain dental/orthodontic insurance on the child(ren).
[ ] Uncovered medicals and dental/orthodontic care, including deductibles and co-payments, if any, will be
[ ] borne by the __________________
[ ] divided equally by the parties
[ ] _____________________________
[ ] Other: ________________________________________________
(This may include counseling)
3.4 LIFE INSURANCE.
[ ] The mother shall insure her own life in the minimum amount of $___________________, whole or term, which may not decrease in face amount during the minority of any child. The policy shall name the __ other parent OR the __ other parent as trustee of the funds to serve without bond or accounting as beneficiary for the support of the child(ren). The choice of the secondary beneficiary(ies) is up to the policy owner.
[ ] The father shall insure his own life in the minimum amount of $___________________, whole or term, which may not decrease in face amount during the minority of any child. The policy shall name the __ other parent OR the __ other parent as trustee of the funds to serve without bond or accounting as beneficiary for the support of the child(ren). The choice of the secondary beneficiary(ies) is up to the policy owner. The choice of the secondary beneficiary(ies) is up to the policy owner.
[ ] Other provisions regarding life insurance:
________________________________________________
________________________________________________
IV. DECISION MAKING
4.1 DAY TO DAY DECISIONS
Each parent shall make decisions regarding the day-to-day care and control of each child while the child is residing with that parent. Regardless of the allocation of decision making in this parenting plan, either parent may make emergency decisions affecting the health or safety of the children.
4.2 CHILD NURTURE AND DAILY NEEDS.
Mother and Father will behave with respect to each other and the child(ren) so as to provided a loving, stable, consistent and nurturing relationship with the child(ren) even though they are divorced. Mother and Father agree they will not speak badly of each other or the members of the family or friends of the other parent. They will encourage the child to continue to love and respect the other parent and to be comfortable in new family units.
When each child is in the care of a parent, that parent will insure the child will be properly groomed, fed and clothed. The child will be given proper physical, health and day care (if both parents work and the child is less than 12 years old).
4.3 MAJOR DECISIONS.
Major decisions regarding each child shall be made as follows:
Education decisions [ ] mother [ ] father [ ] joint
Non-emergency health care [ ] mother [ ] father [ ] joint
Religious upbringing [ ] mother [ ] father [ ] joint
Extra-curricular activities [ ] mother [ ] father [ ] joint
_______________________ [ ] mother [ ] father [ ] joint
_______________________ [ ] mother [ ] father [ ] joint
4.3.1 SPECIAL EDUCATION.
The following provision is made with respect to the child(ren) and any special or private schooling upon which the mother and father may agree: ______________ __________________________________________________________________ __________________________________________________________________
4.3.2 SCHOOLS TO BE ATTENDED.
The child(ren) are in the following grades and schools:
Child 1. ___________________ ____________ ____________________
[Childs name] [Grade] [School]
Child 2. ___________________ _________ _________________________
[Childs name] [Grade] [School]
Child 3. ___________________ _________ _________________________
[Childs name] [Grade] [School]
Child 4. ___________________ _________ _________________________
[Childs name] [Grade] [School]
Child 1 will continue to attend ___________________________ [elementary school] until the ______ grade, at which time Child 1 will then attend __________________ __________________ [middle school] and _________________________________ [high school] in the feeder system of ____________________________ [elementary school], since it is recognized that most of Child 1s classmates will also do so.
Child 2 will continue to attend ___________________________ [elementary school] until the ______ grade, at which time Child 2 will then attend __________________ __________________ [middle school] and _________________________________ [high school] in the feeder system of ____________________________ [elementary school], since it is recognized that most of Child 2s classmates will also do so.
Child 3 will continue to attend ___________________________ [elementary school] until the ______ grade, at which time Child 3 will then attend __________________ __________________ [middle school] and _________________________________ [high school] in the feeder system of ____________________________ [elementary school], since it is recognized that most of Child 3s classmates will also do so.
Child 4 will continue to attend ___________________________ [elementary school] until the ______ grade, at which time Child 4 will then attend __________________ __________________ [middle school] and _________________________________ [high school] in the feeder system of ____________________________ [elementary school], since it is recognized that most of Child 4s classmates will also do so.
In the event [ ] Mother [ ] Father moves from the neighborhood of the feeder system in which the child(ren) presently are educated, then the child(ren) will be enrolled in the Middle School and High School of the public school feeder system for that neighborhood. If [ ] Mother [ ] Father plans to move, he/she will consult with [ ] Mother [ ] Father as soon as possible after any such decision is considered but in any event at least ninety(90) days before any such decision to move is to be implemented. Upon graduation from High School, Mother and Father will consult with respect to the college education of the children. In the event that either parent will desire that the children attend college and if the other parent is not willing to contribute to the expense of college education, then the parent desiring the college education will have the decision making authority with respect thereto. In the event that both parents contribute to the college education, then decisions with respect to that education will be shared, and the parents will consult on all major aspects of that education. Education decisions not covered herein will be made by [ ] Mother [ ] Father after consultation.
4.3.3 EXTRACURRICULAR ACTIVITIES.
Both parents have encouraged the child(ren) to engage in extracurricular activities, and to that end they are willing to share in the expense of, and will jointly consult with respect to, the following: __________________________________________________________________________________________________________________________ _________________________________________________________________. To the extent that one parent is not willing to participate in the funding of any extracurricular activity, then the other parent will have the sole decision-making authority with respect to that activity, and the non-contributing parent will not object. There will be no comment made with respect to financial non-contribution of one parent in the provision of extracurricular activities by the other. Neither parent will engage in the provision of extracurricular activities for the child(ren) which will result in the exclusion, whether intentional or unintentional, of the other. As the child(ren) enter teenage years, the child(ren) will be permitted to attend social functions sponsored by their school or church as well as private parties, provided both parents are satisfied that alcohol and drugs are not available at those functions. Both parents will consult with respect to any such function and will, where possible, reach a joint decision on whether the child(ren) may attend. In the event that there is any disagreement with respect to the attendance at such a function or if there is an extracurricular matter not covered hereunder, [ ] Mother [ ] Father will make the decision.
4.3.4 RELIGIOUS UPBRINGING.
The child(ren) will attend _______________________ [place of worship], and the parents will continue, where possible, to attend with the child(ren). Before any change in the religious affiliation of the child(ren), the parents will consult in advance and attempt to reach an agreement with respect to any such change. In the event the parents are unable to agree with respect to religious upbringing, [ ] Mother [ ] Father will make the decision.
4.3.5 MISCELLANEOUS.
The parents will consult regarding providing a vehicle to any child after the childs 16th birthday. If the parents are unable to reach an agreement as to the type or cost of any vehicle, [ ] Mother [ ] Father will make the decision.
4.4 PRIVATE SCHOOL AND COLLEGE (Optional).
The parties agree as follows regarding private school [elementary and high school] and college or vocational training after high school.
____________________________________________________________
____________________________________________________________
4.5 INTERPERSONAL RELATIONSHIPS.
Both Father and Mother will encourage and foster relationships of each child with other children, family members and, where appropriate, other persons, to insure each child has a well-rounded upbringing. In addition, the parents will expose each child as to many of the following activities as they can:
____________________________________________________________
____________________________________________________________
4.6 OTHER PROVISIONS.
The following special provisions apply to decision making:
____________________________________________________________
____________________________________________________________
4.7 RESTRICTIONS IN DECISION MAKING.
[ ] Does not apply.
[ ] Sole decision making shall be ordered to the [ ] Mother [ ] Father for the following reasons:
_________________________________________________________________
[ ] A limitation on the other parents decision-making authority is mandated by TCA § 36-6-406 .
[ ] Both parents are opposed to mutual decision making.
[ ] One parent is opposed to mutual decision making, and such opposition is reasonably based on the following criteria:
[ ] The existence of a limitation under TCA § 36-6-406;
[ ] The history of participation of each parent in decision making in each of the areas in TCA § 36-6-406;
[ ] Whether the parents have demonstrated ability and desire to cooperate with one another in decision making in each of the areas in TCA § 36-6-406; and
[ ] The parents geographic proximity to one another, to the extent that it affects their ability to make timely mutual decisions.
V. DISPUTE RESOLUTION
[ ] Disputes between the parties, other than the child support disputes, shall be submitted to:
[ ] Counseling by _______________________________________--____, or
[ ] Mediation by ____________________________________________, or
[ ] Arbitration by ___________________________________________, or
[ ] Court Process due to Order of Protection or Restrictions.
The cost of this process shall be allocated between the parties as follows:
[ ] _______% Mother _______ % Father.
[ ] based on each partys proportional share of income from the child support guidelines.
[ ] as determined in the dispute resolution process or by the Court.
The counseling, mediation or arbitration process shall be commenced by notifying the other party by [ ] written request [ ] certified mail [ ] other: ______________________________________________________________
In the dispute resolution process:
(a) Preference shall be given to carrying out this Parenting Plan.
(b) Unless an emergency exists, the parents shall use the designated process to resolve disputes relating to implementation of the plan, except those related to financial support.
(c) A written record shall be prepared of any agreement reached in counseling or mediation and of each arbitration award and shall be provided to each party.
(d) If the court finds that a parent has used or frustrated the dispute resolution process without good reason, the court shall award attorneys fees and financial sanctions to the other parent.
(e) The parties have the right of review from the dispute resolution process to the court.
[ ] No dispute resolution process, except court action, shall be ordered, because [ ] a limiting factor under TCA § 36-6-108 applies or [ ] one parent is unable to afford the cost of the proposed dispute resolution process.
VI. STANDARD PARENTING RIGHTS
Pursuant to TCA § 36-6-101(a), unless otherwise provided therein, both parents are entitled to the following rights:
1. unimpeded telephone conversations with the child at least twice each week at reasonable times and for a reasonable duration;
2. sending mail to the child which the custodial parent will not open and will not censor;
3. receiving notice and relevant information as soon as practical (but not more than 24 hours) in the event of hospitalization, major illness, or death of the child;
4. receiving, directly from the school, copies of the childs report cards, attendance records, teachers names, class schedules, standardized test scores, and other records which are customarily made available to parents. A written request must be made to the school with a current mailing address and payment must be made for the reasonable cost of duplicating and mailing these records;
5. receiving, directly from the childs physician and other health care providers, copies of the childs medical records. A written request must be made to the health care provider with a current mailing address and payment must be made for the reasonable cost of duplicating and mailing these records;
6. to be free of derogatory remarks made about the noncustodial parent and his or her family by the custodial parent to the child or in the childs presence.
In addition, both parents agree that they shall:
7. whenever possible, give forty-eight (48) hours notice to the other parent of all extracurricular activities, and the opportunity to participate or observe, including, but not limited to, the following:
a. School activities
b. Athletic activities
c. Church activities; and
d. Other activities as to which parental participation or observation would be appropriate.
8. if one parent leaves the state with the minor child(ren) for more than two (2) days, provide the other parent with an itinerary with telephone numbers to use in case of an emergency.
9. have access and participation in education, including the right of access to the minor child(ren) for lunch and other activities on the same basis that is provided to all parents, provided the participation or access is reasonable and does not interfere with day-to-day operations or with the childs educational performance.
VII. OTHER PROVISIONS
[ ] There are no other provisions.
[ ] _________________________________________________________
[ ] Either parent shall have the right to apply to the Court for relief in the event mediation is unsuccessful.
VIII. DECLARATION FOR PROPOSED PARENTING PLAN
[ ] Does not apply.
[ ] (Only sign if this is a proposed parenting plan.) I declare under penalty of perjury under the laws of the State of Tennessee that this plan has been proposed in good faith, that it is in the child(ren)s best interest(s), and that my statements of income and my statements herein are true and correct.
___________________________________ ______________________
Mother Date and Place of Signature
___________________________________ _______________________
Father Date and Place of Signature
IX. ORDER BY THE COURT
It is ORDERED, ADJUDGED AND DECREED that the Parenting Plan set forth above is adopted and approved as an order of this court.
WARNING: Violation of residential provisions of this order with actual knowledge of its terms is punishable by contempt of court and may be a criminal offense under TCA § 39-13-306. Violation of this order may subject a violator to arrest.
When mutual decision making is designated but cannot be achieved, the parties shall make a good faith effort to resolve the issue through the dispute resolution process.
If a parent fails to comply with a provision of this plan, the other parents obligations under this plan are not affected.
Dated: ______________________
_________________________________
Judge
Presented by:
____________________________________
Signature
____________________________________
Print or Type Name
____________________________________
Signature
____________________________________
Print or Type Name
Mediation Services provided by:
______________________________
(Name)
______________________________
_____________________________
(Address)
______________________________
(Phone)
If you have questions or need information about TBA's Dispute Resolution Section, you may contact: Lynn C. Pointer, Sections/Committees Coordinator, Tennessee Bar Association, 221 Fourth Avenue North. Suite 400, Nashville, TN 37219. Email: lpointer@tnbar.org
Phone: (615) 383-7421 and Fax: (615) 297-8058.
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© Copyright 2002 Tennessee Bar Association
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