SUPERIOR COURT OF WASHINGTON COUNTY OF ) ) In re the Marriage of: ) NO. ) ) PARENTING PLAN ) [ ] PROPOSED (PP) Petitioner ) [ ] TEMPORARY (PPT) and ) [ ] FINAL ORDER (PP) Respondent. ) This parenting plan is: [ ] the final parenting plan signed by the court pursuant to a decree of dissolution entered on (Date). [ ] the final parenting plan signed by the court pursuant to an order entered on (Date) which modifies a previous parenting plan or custody decree. [ ] a temporary parenting plan signed by the court. [ ] proposed by (NAME) IT IS HEREBY ORDERED, ADJUDGED AND DECREED: I. GENERAL INFORMATION This parenting plan applies to the following children: Name Birthdate II. BASIS FOR RESTRICTIONS 2.1 PARENTAL CONDUCT (RCW 26.09.191(1), (2)). [ ] Does not apply. [ ] The [ ] father's [ ] mother's residential time with the children shall be limited, and mutual decision-making and designation of a dispute resolution process other than court action shall not be required because this parent has engaged in the conduct which follows. [ ] Willful abandonment that continues for an extended period of time or substantial refusal to perform parenting functions. [ ] Physical, sexual or a pattern of emotional abuse of a child. [ ] A history of acts of domestic violence as defined in RCW 26.50.010(1) or an assault or sexual assault which causes grievous bodily harm or the fear of such harm. 2.2 OTHER FACTORS (RCW 26.09.191(3)). [ ] Does not apply. [ ] The [ ] mother's [ ] father's involvement or conduct may have an adverse effect on the child's best interests because of the existence of the factors which follow. [ ] Neglect or substantial nonperformance of parenting functions. [ ] A long-term emotional or physical impairment which interferes with the performance of parenting functions as defined in RCW 26.09.004. [ ] A long-term impairment resulting from drug, alcohol, or other substance abuse that interferes with the performance of parenting functions. [ ] The absence or substantial impairment of emotional ties between the parent and child. [ ] The abusive use of conflict by the parent which creates the danger of serious damage to the child's psychological development. [ ] A parent has withheld from the other parent access to the child for a protracted period without good cause. [ ] Other: III. RESIDENTIAL SCHEDULE These provisions set forth where the child(ren) shall reside each day of the year and what contact the child(ren) shall have with each parent. 3.1 PRE-SCHOOL SCHEDULE. [ ] There are no children of preschool age. [ ] Prior to enrollment in school, the child(ren) shall reside with the [ ] mother [ ] father, except for the following days and times when the child(ren) will reside with or be with the other parent: from (Day and Time) to (Day and Time) [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: from (Day and Time) to (Day and Time) [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: 3.2 SCHOOL SCHEDULE. Upon enrollment in school, the child(ren) shall reside with the [ ] mother [ ] father, except for the following days and times when the child(ren) will reside with or be with the other parent: from (Day and Time) to (Day and Time) [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: from (Day and Time) to (Day and Time) [ ] every week [ ] every other week [ ] the first and third week of the month [ ] the second and fourth week of the month [ ] other: [ ] The school schedule will start when each child begins [ ] kindergarten [ ] first grade [ ] other: 3.3 SCHEDULE FOR WINTER VACATION. The child(ren) shall reside with the [ ] mother [ ] father during winter vacation, except for the following days and times when the child(ren) will reside with or be with the other parent: 3.4 SCHEDULE FOR SPRING VACATION. The child(ren) shall reside with the [ ] mother [ ] father during spring vacation, except for the following days and times when the child(ren) will reside with or be with the other parent: 3.5 SUMMER SCHEDULE. Upon completion of the school year, the child(ren) shall reside with the [ ] mother [ ] father, except for the following days and times when the child(ren) will reside with or be with the other parent: [ ] Same as school year schedule. [ ] Other: 3.6 VACATION WITH PARENTS. [ ] Does not apply. [ ] The schedule for vacation with parents is as follows: 3.7 SCHEDULE FOR HOLIDAYS. The residential schedule for the child(ren) for the holidays listed below is as follows: With Mother With Father (Specify Year (Specify Year Odd/Even/Every) Odd/Even/Every) New Year's Day Martin Luther King Day Presidents Day Memorial Day July 4th Labor Day Veterans Day Thanksgiving Day Christmas Eve Christmas Day [ ] For purposes of this parenting plan, a holiday shall begin and end as follows (set forth times): [ ] Holidays which fall on a Friday or a Monday shall include Saturday and Sunday. [ ] Other: 3.8 SCHEDULE FOR SPECIAL OCCASIONS. The residential schedule for the child(ren) for the following special occasions (i.e., birthdays) is as follows: With Mother With Father (Specify Year (Specify Year Odd/Even/Every) Odd/Even/Every) [ ] Other: 3.9 PRIORITIES UNDER THE RESIDENTIAL SCHEDULE. [ ] Does not apply. [ ] For purposes of this parenting plan the following days shall have priority: [ ] Parent's vacations have priority over holidays. Holidays have priority over other special occasions. Special occasions have priority over school vacations. [ ] Other: 3.10 RESTRICTIONS. [ ] Does not apply because there are no limiting factors in paragraphs 2.1 or 2.2. [ ] The [ ] father's [ ] mother's residential time with the children shall be limited because there are limiting factors in paragraphs 2.1 and 2.2. The following restrictions shall apply when the children spend time with this parent: [ ] There are limiting factors in paragraph 2.2, but there are no restrictions on the [ ] father's [ ] mother's residential time with the children for the following reasons: 3.11 TRANSPORTATION ARRANGEMENTS. Transportation arrangements for the child(ren), other than costs, between parents shall be as follows: 3.12 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 parent's rights and responsibilities under this parenting plan. 3.13 OTHER: 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 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 [ ] mother [ ] father [ ] joint [ ] mother [ ] father [ ] joint [ ] mother [ ] father [ ] joint [ ] mother [ ] father [ ] joint [ ] mother [ ] father [ ] joint [ ] mother [ ] father [ ] joint 4.3 RESTRICTIONS IN DECISION MAKING. [ ] Does not apply because there are no limiting factors in paragraphs 2.1 and 2.2 above. [ ] Sole decision making shall be ordered to the [ ] mother [ ] father for the following reasons: [ ] A limitation on the other parent's decision-making authority is mandated by RCW 26.09.191 (See paragraph 2.1). [ ] 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: (a) The existence of a limitation under RCW 26.09.191; (b) The history of participation of each parent in decision making in each of the areas in RCW 26.09.184(4)(a); (c) Whether the parents have demonstrated ability and desire to cooperate with one another in decision making in each of the areas in RCW 26.09.184(4)(a); and (d) The parents' geographic proximity to one another, to the extent that it affects their ability to make timely mutual decisions. [ ] There are limiting factors in paragraph 2.2, but there are no restrictions on mutual decision making for the following reasons: V. DISPUTE RESOLUTION [ ] Disputes between the parties, other than child support disputes, shall be submitted to (list person or agency): [ ] counseling by , or [ ] mediation by , or [ ] arbitration by . The cost of this process shall be allocated between the parties as follows: [ ] % mother % father. [ ] based on each party's proportional share of income from line 6 of the child support worksheets. [ ] as determined in the dispute resolution process. 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 superior court. [ ] No dispute resolution process, except court action, shall be ordered, because [ ] a limiting factor under RCW 26.09.191 applies or [ ] one parent is unable to afford the cost of the proposed dispute resolution process. VI. OTHER PROVISIONS [ ] There are no other provisions. [ ] There are the following other provisions: VII. 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 Washington that this plan has been proposed in good faith and that the statements in Part II of this Plan are true and correct. Mother Date and Place of Signature Father Date and Place of Signature VIII. 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 RCW 9A.40.070(2). 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 parent's obligations under the plan are not affected. Dated: Judge/Commissioner Presented by: Approved for entry: Signature Signature Print or Type Name Print or Type Name