
PARENTING ISSUES CHECKLIST
GENERAL INFORMATION:
Name:
_______________________________________________________________________
Date of marriage:
______________________________________________________________
Children of marriage:
Name:________________________________ Date of birth:
______________________
Address:
_______________________________________________________________
Name:________________________________ Date of birth:
______________________
Address:
_______________________________________________________________
Name:________________________________ Date of birth:
______________________
Address:
_______________________________________________________________
Name:________________________________ Date of birth:
______________________
Address:
_______________________________________________________________
PARENTING ISSUES
Decision-Making:
|
Educational: |
q |
Joint |
q |
Mother |
q |
Father |
|
Daycare |
q |
Joint |
q |
Mother |
q |
Father |
|
Medical/Dental/Mental Health: |
q |
Joint |
q |
Mother |
q |
Father |
|
Spiritual Training: |
q |
Joint |
q |
Mother |
q |
Father |
|
Recreational/Extracurricular
Activities: |
q |
Joint |
q |
Mother |
q |
Father |
|
Other (specify): |
q |
Joint |
q |
Mother |
q |
Father |
Residential Care:
|
Child(ren) to live primarily with: |
q |
Both |
q |
Mother |
q |
Father |
If both, I’m thinking about
the following schedule:
|
|
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
|
Week 1 |
qFather
qMother
qOther
|
qFather
qMother
qOther
|
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
|
Week 2
|
qFather
qMother
qOther
|
qFather
qMother
qOther
|
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
|
Drop
off location:
|
|
|
|
|
|
|
|
Parenting Time:
If you think both parents
will not share residential care, what kind of parenting time
(visitation) schedule, including overnights, are you thinking
about?
|
|
Sunday |
Monday |
Tuesday |
Wednesday |
Thursday |
Friday |
Saturday |
|
Week 1 |
qFather
qMother
qOther
|
qFather
qMother
qOther
|
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
|
Week 2
|
qFather
qMother
qOther
|
qFather
qMother
qOther
|
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
qFather
qMother
qOther |
|
Drop off
(D) or pick-up (P) Time:
(a.m. or
p.m.)
|
|
|
|
|
|
|
|
|
Pick-up or Drop off location:
|
|
|
|
|
|
|
|
Thoughts About Major Holidays and Special
Occasions:
Event
|
Party spending time with child(ren) |
Odd years |
Even years |
All Years |
Time & Place of exchange |
|
q
Spring Break |
|
|
|
|
|
|
q
Easter Day/Weekend |
|
|
|
|
|
|
q
Mother’s Day |
|
|
|
|
|
|
q
Memorial Day |
|
|
|
|
|
|
q
Father’s Day |
|
|
|
|
|
|
q
July 4th |
|
|
|
|
|
|
q
Labor Day |
|
|
|
|
|
|
q
Thanksgiving Day/Break |
|
|
|
|
|
|
q
Christmas Eve |
|
|
|
|
|
|
q
Christmas Day |
|
|
|
|
|
|
q
Winter Break |
|
|
|
|
|
|
q
Summer Break |
|
|
|
|
|
|
q
Other (Identify)
|
|
|
|
|
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|
q
Other (Identify)
|
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|
|
|
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|
q
Other (Identify)
|
|
|
|
|
|
Thoughts About Other Holidays
and Special Occasions:
Event
|
Party spending time with child(ren) |
Odd years |
Even years |
All Years |
Time & Place of exchange |
|
q
Martin Luther
King, Jr. Day/Weekend |
|
|
|
|
|
|
q
President’s Day/Weekend |
|
|
|
|
|
|
q
New Year’s Eve |
|
|
|
|
|
|
q
New Year’s Day |
|
|
|
|
|
|
q
Mother’s Birthday |
|
|
|
|
|
|
q
Father’s Birthday |
|
|
|
|
|
|
q
Halloween |
|
|
|
|
|
|
q
Children’s Birthdays |
|
|
|
|
|
|
q
Other (Identify)
|
|
|
|
|
|
|
q
Other (Identify)
|
|
|
|
|
|
|
q
Other (Identify)
|
|
|
|
|
|
Other Thoughts About Parenting
Time:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Child Support:
Your monthly income:
____________________________________________________
Your spouse’s monthly income:
____________________________________________
Party paying for health
insurance for child(ren): _________________________________
Total monthly health insurance
premium: ______________________________________
Portion of health insurance
premium for child(ren):
_____________________________
Number of children in daycare
during school year: _______________________________
Number of children in daycare
during summer and school vacations: ________________
Party paying for daycare for
child(ren): ________________________________________
Amount paid per week for
daycare during school year: ___________________________
Amount paid per week for
daycare during school vacations: _______________________
Amount paid per month for
extra-curricular activities: ____________________________
Party paying for
extra-curricular activities:
_____________________________________
Other special expenses for
child(ren) (list):
____________________________________
____________________________________
____________________________________
____________________________________
Party paying for other special
expenses: _______________________________________