Physical Custody (where the child/ren live):

The child/ren’s residence is with:

Describe which days and which times of the day the child/ren will be with each person:

Sunday: _____

Monday: _____

Tuesday: _____

Wednesday: ___

Thursday: ___

Friday: _____

Saturday: ___

Describe where and when the child/ren will be dropped off and/or picked up (day and time of day):

Drop-Off:

Where:_____

When: ___

Pick-Up:

Where: ___

When: _____