Form JD-FM-284 "Custody Agreement and Parenting Plan" - Connecticut

What Is Form JD-FM-284?

This is a legal form that was released by the Connecticut Superior Court - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the Connecticut Superior Court;
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  • Fill out the form in our online filing application.

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CUSTODY AGREEMENT AND
STATE OF CONNECTICUT
PARENTING PLAN
SUPERIOR COURT
JD-FM-284 New 6-20
www.jud.ct.gov
C.G.S. § 46b-56
For information on ADA accommodations,
Instructions
contact a court clerk or go to: www.jud.ct.gov/ADA.
Complete all of the sections of this form that apply to you.
Judicial district of
At (Town)
Docket number
Plaintiff's name (Last, first, middle initial)
Defendant's name (Last, first, middle initial)
The plaintiff and defendant agree that:
Upon approval by the court, this parenting plan will be:
(Select one)
Temporary: This agreement will apply until the case is completely concluded or this agreement is changed by a later
court order.
OR
Final: All completed sections will be incorporated in the court's final order in this case.
OR
Post-Judgment Modification: This agreement changes a final custody and/or visitation order from before.
This parenting plan is for the following child(ren) born to, or adopted by, the parents:
Name
Birth date
Name
Birth date
A. Decision-Making Responsibility:
(Select one)
Joint Legal Custody: Both parents will share equally in the responsibility for making major decisions about the child(ren).
OR
Sole Legal Custody: (parent's name)
will have the sole decision-making
authority on major decisions about the child(ren).
OR
Other:
B. Physical Custody and Parenting Time:
1. Regular Schedule:
(Select one)
The child(ren) will live with (parent’s name)
, except for the following
days and times when the other parent will have parenting time with the child(ren):
OR
The parents will have equal, or approximately equal, parenting time with the child(ren) as follows:
OR
Other:
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Page 1 of 7
CUSTODY AGREEMENT AND
STATE OF CONNECTICUT
PARENTING PLAN
SUPERIOR COURT
JD-FM-284 New 6-20
www.jud.ct.gov
C.G.S. § 46b-56
For information on ADA accommodations,
Instructions
contact a court clerk or go to: www.jud.ct.gov/ADA.
Complete all of the sections of this form that apply to you.
Judicial district of
At (Town)
Docket number
Plaintiff's name (Last, first, middle initial)
Defendant's name (Last, first, middle initial)
The plaintiff and defendant agree that:
Upon approval by the court, this parenting plan will be:
(Select one)
Temporary: This agreement will apply until the case is completely concluded or this agreement is changed by a later
court order.
OR
Final: All completed sections will be incorporated in the court's final order in this case.
OR
Post-Judgment Modification: This agreement changes a final custody and/or visitation order from before.
This parenting plan is for the following child(ren) born to, or adopted by, the parents:
Name
Birth date
Name
Birth date
A. Decision-Making Responsibility:
(Select one)
Joint Legal Custody: Both parents will share equally in the responsibility for making major decisions about the child(ren).
OR
Sole Legal Custody: (parent's name)
will have the sole decision-making
authority on major decisions about the child(ren).
OR
Other:
B. Physical Custody and Parenting Time:
1. Regular Schedule:
(Select one)
The child(ren) will live with (parent’s name)
, except for the following
days and times when the other parent will have parenting time with the child(ren):
OR
The parents will have equal, or approximately equal, parenting time with the child(ren) as follows:
OR
Other:
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Plaintiff's name (Last, first, middle initial)
Defendant's name (Last, first, middle initial)
Docket number
B. Physical Custody and Parenting Time: (Continued)
2. Telephone Contact:
Each parent may have reasonable telephone contact with the child(ren) during the child(ren)’s normal waking hours,
except as follows:
3. Holiday Schedule:
(Select one)
The parents will share holidays as they may agree from time to time.
OR
The parents agree to the holiday schedule below. Whenever the holiday schedule is different from the regular
schedule, the parents will follow the holiday schedule. (Select the boxes that apply and indicate the years of the
holiday (even or odd) and the parenting time. For any holiday for which you do not want or need to make an
agreement that will become part of the court order, leave all of the applicable boxes unchecked. Use the blank
spaces at the bottom of the chart to add any other holidays that you want to make an agreement on.)
Time
Holiday
Plaintiff
Defendant
From
To
Even
Odd
Even
Odd
New Year’s Eve
Even
Odd
Even
Odd
New Year’s Day
Easter
Even
Odd
Even
Odd
4th of July
Even
Odd
Even
Odd
Halloween
Even
Odd
Even
Odd
Veterans' Day
Even
Odd
Even
Odd
Thanksgiving
Even
Odd
Even
Odd
Hanukkah
Even
Odd
Even
Odd
Christmas Eve
Even
Odd
Even
Odd
Christmas Day
Even
Odd
Even
Odd
Mother’s Day
Even
Odd
Even
Odd
Father’s Day
Even
Odd
Even
Odd
Even
Odd
Even
Odd
Lincoln’s Birthday
Even
Odd
Even
Odd
Even
Odd
Even
Odd
Even
Odd
Even
Odd
On Monday state or federal holidays, the child(ren) will stay in the care of the parent who has them during the
weekend just before that holiday unless otherwise specified in the above chart, or as follows:
4. Summer Schedule:
(Select one)
During the summer months when the child(ren) are not in school:
The parents will continue to follow the Regular Schedule in Section B.1. of this agreement.
OR
The parents agree to the following changes to the Regular Schedule:
(except during summer vacation time with either parent as agreed to in Section B.5. of this agreement)
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JD-FM-284 New 6-20
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Plaintiff's name (Last, first, middle initial)
Defendant's name (Last, first, middle initial)
Docket number
B. Physical Custody and Parenting Time: (Continued)
5. Summer Vacation:
(Select all that apply)
Each parent is entitled to
week(s) of summer vacation with the child(ren) and will work out the details of
summer vacation by (date)
of each year.
If a parent is entitled to 2 or more weeks of vacation with the child(ren), the weeks
may
may not
(Select one)
be consecutive.
6. Transportation and Exchange of Child(ren) Schedule:
(Select all that apply)
Transportation arrangements for exchanges of the child(ren) between the parents for the regular schedule will be
as follows:
Transportation arrangements for exchanges of the child(ren) between the parents for holidays or the summer
schedule, if different from above, will be as follows:
Unless both parents agree on a different meeting place, the exchange of the child(ren) will be at:
Other:
7. Travel:
(Select all that apply)
A parent who travels overnight outside of Connecticut with the child(ren) will keep the other parent informed of the
travel plans, including transportation information and address(es), and telephone number(s) at which the travelling
parent and child(ren) may be reached.
Neither parent will travel with the child(ren) outside of Connecticut for longer than
days at a time without
the prior written consent of the other parent or an order of the court.
C. General Parenting Responsibilities:
Unless there is a court order stating otherwise, the parents agree to the following terms:
• Each parent will promote a healthy, beneficial relationship between the child(ren) and the other parent and will not
demean or speak negatively in any manner that would damage the relationship between either parent and the child(ren).
• Neither parent will abuse alcohol or use illegal drugs when the child(ren) are in their care. Neither parent will allow
the child(ren) to be in the presence of anyone abusing alcohol or using illegal drugs.
• A parent asking for a temporary change to the parenting schedule will act in good faith and ask the other parent about
the change as soon as possible. The parents will adjust parenting schedules fairly when family situations, illnesses, or
other commitments make temporary changes reasonable.
• Each parent will be responsible for making sure that the child(ren) attend regularly scheduled activities, including, but not
limited to, sports and extracurricular activities, while the child(ren) are with that parent.
D. Information Sharing and Access, Including Telephone and Electronic Access:
Unless there is a court order stating otherwise, the parents agree to the following terms:
• Both parents have equal rights to inspect and receive the child(ren)’s school records, and both parents are encouraged
to talk with school staff about the child(ren)’s welfare and education. Both parents are encouraged to participate in and
attend the child(ren)’s school events.
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JD-FM-284 New 6-20
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Plaintiff's name (Last, first, middle initial)
Defendant's name (Last, first, middle initial)
Docket number
D. Information Sharing and Access, Including Telephone and Electronic Access: (Continued)
• Both parents have equal rights to inspect and receive governmental agency and law enforcement records about the
child(ren).
• Both parents have equal rights to talk with any person who may provide care or treatment for the child(ren) and to inspect
and receive the child(ren)’s medical, dental, or psychological records, unless there are other statutory restrictions.
• Each parent has a continuing responsibility to provide a residential, mailing, or contact address and contact telephone
number to the other parent.
• Each parent has a continuing responsibility to tell the other parent about any emergency circumstances or substantial
changes or decisions affecting the child(ren), including the child(ren)’s medical needs, as promptly as possible.
E. Methods for Resolving Disputes:
(Select one)
In the future, if the parents have joint legal custody and they have a disagreement about major parenting decisions,
they will try to resolve it together in the best interests of the child(ren). If the parents are unable to resolve the
disagreement, they will seek the help of the following neutral third party (Name)
.
Only if the parents are unable to resolve the disagreement after seeking help from the third party will either of them ask
the court to decide the issue.
OR
Other:
F. Financial Responsibilities (Child Support Orders):
(Select all that apply and attach the Worksheet for the Connecticut Child Support and Arrearage Guidelines, form CCSG-1)
The parents agree that the following financial responsibilities (child support orders) will continue until:
• The child(ren) reach age 18; or
• If any child is unmarried and a full-time high school student, until that child completes 12th grade or reaches age 19,
whichever happens first; or
• Until these responsibilities are changed by a court order or another agreement that the court approves.
The parents understand that the amounts and percentages for the financial responsibilities below must follow the Child
Support and Arrearage Guidelines (the Guidelines) unless one of the deviation criteria (acceptable reasons not to follow the
Guidelines) applies. (These guidelines are available in the Clerk’s Offices, Court Service Centers, and on the Judicial
Branch website at: https://www.jud.ct.gov/Publications/ChildSupport/CSguidelines.pdf.)
Current Support:
1.
The
plaintiff
defendant
will pay $
weekly
monthly
to the other
(Select one)
parent and/or the State of Connecticut as Current Support.
(Select one)
The Current Support amount follows the amount required by the Guidelines;
OR
The Current Support amount does not follow the amount required by the Guidelines, which calls for the
plaintiff
defendant
to pay: $
weekly
monthly
.
(Select one)
The reason that this amount does not follow the Guidelines is: (See the Guidelines for acceptable reasons not
to follow the Guidelines.)
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JD-FM-284 New 6-20
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Plaintiff's name (Last, first, middle initial)
Defendant's name (Last, first, middle initial)
Docket number
F. Financial Responsibilities (Child Support Orders): (Continued)
Arrearage:
2.
The
plaintiff
defendant
owes to the other parent and/or the State of Connecticut an arrearage
(Select one)
in child support in the amount of $
, and will pay $
weekly
monthly
in addition to Current Support until the arrearage is paid off.
(Select one)
The Arrearage amount follows the amount required by the Guidelines;
OR
The Arrearage amount does not follow the amount required by the Guidelines, which calls for the
plaintiff
defendant
to pay: $
weekly
monthly
.
(Select one)
The reason that this amount does not follow the Guidelines is: (See the Guidelines for acceptable reasons not
to follow the Guidelines.)
Health Care Coverage Contribution:
3.
(Select all that apply)
The
plaintiff
defendant
will provide
medical
dental
insurance coverage for the
(Select one)
child(ren) by:
(Select all that apply)
Keeping the current coverage or its equivalent;
Getting and keeping coverage that is available at a reasonable cost (5% of net income for a low-income parent
or 7.5% of net income for a parent who is not low-income according to the Guidelines);
Applying for and keeping HUSKY insurance until I can get medical insurance coverage that is available at a
reasonable cost (5% of net income for a low-income parent or 7.5% of net income for a parent who is not
low-income according to the Guidelines); OR
Other:
(specify)
The
plaintiff
defendant
will pay $
weekly
monthly
(Select one)
(Select one)
Cash Medical Support to (name)
or the State, as their interests may appear,
toward the cost of premiums for health insurance coverage provided by
or
(name)
by HUSKY or another public entity as long as the child(ren) are covered by this health insurance plan or by HUSKY.
The
plaintiff
defendant
will pay $
weekly
monthly
(Select one)
(Select one)
Cash Medical Support to
(name of provider or person obligated to pay the provider)
toward the following ongoing extraordinary medical or dental expenses:
until (date)
or until these expenses are fully paid.
The Health Care Coverage Contribution
follows
does not follow
the Guidelines. If this contribution
(Select one)
does not follow the Guidelines the reason is: (See the Guidelines for acceptable reasons not to follow the Guidelines.)
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