Child Custody Form

1122 Patterson Street, Houston, TX, 77002
info@acmelaw.com
www.acmelaw.com
(111) 1234511

Case Number

Plaintiff's Name

First NameLast Name

Defendant's Name

First NameLast Name

Names and Birth Dates of Child(ren)

Has physical custody been decided?

YesNo

We agree that most of the time, our child(ren) will live with First Name Last Name , except during times described below.

Specified Times

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.

AgreeDisagree

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.

AgreeDisagree

We agree that 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.

AgreeDisagree

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.

AgreeDisagree

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.

AgreeDisagree

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

AgreeDisagree

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).

AgreeDisagree

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

AgreeDisagree

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

AgreeDisagree

Specified Holidays and Vacations with Plaintiff

Specified Holidays and Vacations with Defendant

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

AgreeDisagree

Signature Date

Date

Signature of the Plaintiff

Signature of the Defendant

Child Custody Form

A. Physical Custody Options

B. Holidays and Vacation Options

C. Follow-up Mediation Help