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West Virginia Worksheet for Individual Proposed Parenting Plan

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West Virginia Worksheet for Individual Proposed Parenting Plan
West Virginia Worksheet for Individual Proposed Parenting Plan
SCA-FC-128 Rev.12/2001(F) Worksheet for Individual Proposed Parenting Plan Page 1 of 4
IN THE FAMILY COURT OF ________________ COUNTY, WEST VIRGINIA
In Re:
The Marriage / Children of: Civil Action No. ___________________
___________________________, and ____________________________.
Petitioner Respondent
___________________________ ____________________________
___________________________ ____________________________
Address Address
___________________________ ____________________________
Daytime Phone Daytime Phone
WORKSHEET FOR INDIVIDUAL PROPOSED PARENTING PLAN
This Worksheet completed by: ______________________________ Date: ____________
(Print your name.)
PARENTING RESPONSIBILITIES
Complete the following list which shows how you and the other parent have shared
parenting responsibilities in the last twelve months before your divorce was filed. Do not
provide information for any time after the filing of the divorce.
This list is for the children named: ________________________________________________.
(A) Daily Physical Needs and Care
Examples: feeding; bedtime and wake-up routines; care when child is sick or hurt;
bathing, grooming, personal hygiene, dressing; recreation and play; physical safety;
transportation.
Mother _____% Father _____%
(B) Developmental Needs
Examples: learning to walk, talk, and use eating utensils; toilet training; development of
self-confidence and maturity.
Mother _____% Father _____%
(C) Development of Proper Behavior
Examples: discipline; instruction in manners; assignment and supervision of chores.
Mother _____% Father _____%
(D) Educational Matters
Examples: making school arrangements; communicating with teachers and counselors;
supervision of homework; monitoring grades and discussing school related matters.
Mother _____% Father _____%
West Virginia Worksheet for Individual Proposed Parenting Plan
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