Child’s Birthday ___ ___ ___ ___ Mother’s Day ___ ___ ___ ___ Father’s Day ___ ___ ___ ___ Other ___ ___ ___ ___ Other ___ ___ ___ ___ Other ___ ___ ___ ___ Summer Schedule/ Vacation Plans:

The quick brown fox jumps over the lazy dog.

Summer Schedule/ Vacation Plans:

Special Activities or School Activities:

Child’s Initials List Activity Both attend? If not, which parent attends?

Parenting Plan – Form #1 Page 5 of 7