IN THE COURT OF COMMON PLEAS FOR ADAMS COUNTY, PENNSYLVANIA CIVIL ACTION - LAW

Name(ParentPlan)
NamePLAINTIFF
vs.
NameDEFENDANT 1
and (if applicable):
NameDEFENDANT 2
Name_2(ParentPlan)
Name_3(ParentPlan)
CASE NO(ParentPlan)

CASE NO. _____

ACTION IN CUSTODY

PARENTING PLAN

This parenting plan involves the following child/children:

Child's INITIALSAgeWhere does the child live?
1.
2.
3.
Age1(ParentPlan) (format: numeric)
Childlive1(ParentPlan)
ChildInitials1(ParentPlan)
ChildInitials2(ParentPlan)
Age2(ParentPlan) (format: numeric)
Childlive2(ParentPlan)
ChildInitials3(ParentPlan)
Age3(ParentPlan) (format: numeric)
Childlive3(ParentPlan)

If you have children not addressed by this parenting plan, name here:

Child's INITIALSAgeWhere does the child live?
1. ____________________
2. ____________________
3. ____________________
Age4(ParentPlan) (format: numeric)
Childlive4(ParentPlan)
ChildInitials4(ParentPlan)
ChildInitials5(ParentPlan)
Age5(ParentPlan) (format: numeric)
Childlive5(ParentPlan)
ChildInitials6(ParentPlan)
Age6(ParentPlan) (format: numeric)
Childlive6(ParentPlan)

Parenting Plan – Form #1 Page 1 of 7