Orange — Stipulation for Custody and Visitation

Source: https://www.occourts.org/system/files/selfhelp/shc-fl-01.pdf

SUPERIOR COURT OF CALIFORNIA Self-Help Services COUNTY OF ORANGE www.occourts.org/self-help

STIPULATION AND ORDER FOR CUSTODY AND VISITATION OF CHILDREN

SELF-HELP FORM PACKET

SHC-FL-01 (Rev. 07/15/2026)

Self-Help Services can review your completed forms before you file them with the Court. To request a review of your completed forms, visit your nearest Self-Help Center location: • Central Justice Center: 700 Civic Center Drive West, Santa Ana, 92701 • Costa Mesa Justice Complex: 3390 Harbor Blvd., Costa Mesa, 92626 • Harbor Justice Center: 4601 Jamboree Road, Newport Beach, 92660 • Lamoreaux Justice Center: 341 The City Drive South, Orange 92868 • North Justice Center: 1275 N. Berkeley Ave., Fullerton, 92832 • Stephen K. Tamura-West Justice Center: 8141 13th St., Westminster, 92683

www.occourts.org/self-help

FL-355

PARTY WITHOUT ATTORNEY OR ATTORNEY STATE BAR NUMBER: FOR COURT USE ONLY

NAME:

FIRM NAME:

STREET ADDRESS:

CITY: STATE: ZIP CODE:

TELEPHONE NO.: FAX NO.:

EMAIL ADDRESS:

ATTORNEY FOR (name):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS:

MAILING ADDRESS:

CITY AND ZIP CODE:

BRANCH NAME:

PETITIONER:

RESPONDENT:

OTHER PARENT/PARTY: STIPULATION AND ORDER FOR CUSTODY CASE NUMBER: AND/OR VISITATION (PARENTING TIME) MODIFICATION

Notice: If there are allegations or findings of abuse, the judge may not enter an order based on a stipulation until you have a hearing. The parties signing this stipulation agree that:

1. This court has jurisdiction over the minor children because California is the children's home state.

2. The habitual residence of the children is the United States of America.

   In addition, the parties agree that (check item 3 or 4):

3. The attached agreement, dated (specify): and consisting of (number): pages is their agreement for custody and/or visitation (parenting time).

4. The attached forms are their agreement for custody and/or visitation (parenting time): FL-341 FL-341(A) FL-341(B) FL-341(C) FL-341(D) FL-341(E) The parties further agree that (check all that apply):

5. a. Their agreement is in best interest of their child or children and they ask that it be made the order of the court. b. (1) The case involves allegations of a history of abuse or substance abuse by (check all that apply): (a) Petitioner Respondent Other parent/party is (or are) alleged to have a history of abuse against any of the following persons: a child, the other parent, their current spouse, or the person they live with or are dating or engaged to. (b) Petitioner Respondent Other parent/party is (or are) alleged to have the habitual or continual illegal use of controlled substances, or the habitual or continual abuse of alcohol, or the habitual or continual abuse of prescribed controlled substances. (2) Even though there are allegations specified above, the parties agree that the stipulation for child custody or unsupervised visitation (parenting time) is in the best interests of the child and is specific as to time, day, place, and manner of transfer (exchange) of the child, as Family Code sections 3011(a)(5)(B) and 6323(c) require.

6. The parties acknowledge they were advised that any violation of this order may result in civil or criminal penalties, or both.

Each party declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:

Type or Print Name Signature of Petitioner Date:

Type or Print Name Signature of Respondent

Date:

Type or Print Name Signature of Attorney for Petitioner

Date:

Type or Print Name Signature of Attorney for Respondent

Judicial Council of California, courts.ca.gov Stipulation and Order for Custody FL-355, Page 1 of 2Rev. July 1, 2026, Optional Form and/or Visitation (Parenting Time)

FL-355 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

Date:

Type or Print Name Signature of Other Parent/Party

Date:

Type or Print Name Signature of Attorney for Other Parent/Party

FINDINGS AND ORDERS

THE COURT FINDS:

1. This court has jurisdiction over the minor children because California is the children's home state.

2. The habitual residence of the children is the United States of America.

3. The parties have been advised that any violation of this order may result in civil or criminal penalties, or both.

4. The court finds that this order is in the best interests of the child or children listed in the parties' agreement.

5. Even though there are allegations in this case of a history of abuse or substance abuse by a party or parties, the court orders
   sole custody, joint custody, or unsupervised visitation (parenting time) to a party or parties with an alleged history of abuse or
   substance abuse, as provided in the parties' stipulation.
   a. As required by Family Code section 3011(a)(5)(A), the court's reasons for making the orders (check all that apply):
   (1) Are in writing and filed separately. (Form FL-351 may be used for this purpose.)
   (2) Were recorded as follows (specify): In a minute order By a court reporter
   (specify):

   b. The court finds that the order is in the best interests of the child and is specific as to time, day, place, and manner of
   transfer (exchange) of the child, as Family Code sections 3011(a)(5)(A) and 6323(c) require.

6. The court adopts the parties' agreement regarding child custody and/or visitation (parenting time) as the order of the court, as specified in the attached:

   Document dated (specify): and consisting of (number): pages or forms: Form FL-341 Form FL-341(A) Form FL-341(B) Form FL-341(C) Form FL-341(D) Form FL-341(E)

7. Other orders:

Date: Judicial Officer

Stipulations and Family Code section 3044

Where past abuse has been found or alleged, the court must not sign a stipulation in which the parties state that Family Code section 3044 does not apply. When there has been a finding of domestic violence in the last five years, the court must not sign a stipulation in which the parties agree that the presumptions have been rebutted. The court must independently determine the best interest of the child in these cases.

Rev. July 1, 2026 Stipulation and Order for Custody FL-355, Page 2 of 2 and/or Visitation (Parenting Time)

FL-341 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

CHILD CUSTODY AND VISITATION (PARENTING TIME) ORDER ATTACHMENT

TO Findings and Order After Hearing (form FL-340) Judgment (form FL-180) Judgment (form FL-250) Stipulation and Order for Custody and/or Visitation (Parenting Time) (form FL-355) (specify):

1. Jurisdiction. This court has jurisdiction to make child custody orders in this case under the Uniform Child Custody Jurisdiction and Enforcement Act (Fam. Code, §§ 3400±3465).

2. Notice and opportunity to be heard. The responding party was given notice and an opportunity to be heard, as provided by the laws of the State of California.

3. Country of habitual residence. The country of habitual residence of the child or children in this case is (specify):

4. Penalties for violating this order. If you violate this order, you may be subject to civil or criminal penalties, or both.

5. Child abduction prevention. There is a risk that one of the parties will take the children out of California without the other party's permission. (Child Abduction Prevention Order Attachment (form FL-341(B)) is attached and must be obeyed.)

6. The court refers the parties to child custody mediation or child custody recommending counseling as follows:

7. Child custody. Custody of the minor children of the parties is awarded as follows:
   Legal custody to: Physical custody to: a. Child's Name Birth Date
   (person who decides about the child's (person the child
   health, education, and welfare) regularly lives with)

   b. Joint legal custody of the child or children will be exercised as specified in the following order: Attachment 7b (form MC-025 may be used for this purpose) Joint Legal Custody Attachment (form FL-341(E))

8. Child custody and visitation (parenting time) involving allegations of a history of abuse or substance abuse

   a. Allegations have been raised in form FL-311, other documents filed in the court, or in a court hearing that (1) Petitioner Respondent Other parent/party is (or are) alleged to have a history of abuse against any of the following persons: a child, the other parent, their current spouse, or the person they live with or are dating or engaged to. (2) Petitioner Respondent Other parent/party is (or are) alleged to have the habitual or continual illegal use of controlled substances, or the habitual or continual abuse of alcohol, or the habitual or continual abuse of prescribed controlled substances.

   b. The court does NOT grant sole or joint custody of the minor children to: may be used for this purpose). Petitioner Respondent Other parent/party

   c. (1) Even though there are allegations of a history of abuse or substance abuse, the court GRANTS sole or joint custody of the minor child as set out in item 7. (2) As required by Family Code section 3011(a)(5)(A), the court's reasons for making the orders: (A) Are in writing and filed separately (form FL-351 may be used for this purpose). (B) Were recorded as follows: In a minute order By a court reporter (specify): (3) The court finds that the order is in the best interests of the child, protects the safety of the parties and the child, and is specific as to time, day, place, and manner of transfer (exchange) of the child as Family Code sections 3011(a)(5)(A) and 6323(c) require. THIS IS A COURT ORDER.

Judicial Council of California, courts.ca.gov Child Custody and Visitation (Parenting Time) FL-341, Page 1 of 4Rev. July 1, 2026, Optional Form Fam. Code, §§ 3011, 3020, 3022, 3025, Order Attachment3040±3044, 3048, 3100, 6340, 7604

FL-341 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

9. Visitation (parenting time)

   a. Reasonable right of visitation to the party without physical custody (not appropriate in cases involving domestic violence) b. -page document c. No visitation (parenting time) d. The visitation (parenting time) will be supervised as specified in the attached Supervised Visitation (Parenting Time) and Exchanges Order (FL-341(A)). e. Visitation (parenting time) for the petitioner respondent other (name): will be in person, by virtual visitation (not in person), and/or other ways as specified below: (1) In person, as follows (a) Weekends starting (date): (Note: The first weekend of the month is the first weekend with a Saturday.) Start of (or After) School Weekend Day(s) Times (if applicable) 1st from at a.m. p.m. start of after to at a.m. p.m. start of after 2nd from at a.m. p.m. start of after to at a.m. p.m. start of after 3rd from at a.m. p.m. start of after to at a.m. p.m. start of after 4th from at a.m. p.m. start of after to at a.m. p.m. start of after 5th from at a.m. p.m. start of after to at a.m. p.m. start of after

(i) The parties will alternate the fifth weekends, with the petitioner respondent other parent/party having the initial fifth weekend, starting (date): (ii) The petitioner respondent other parent/party will have the fifth weekend in odd even numbered months. (b) Alternate weekends starting (date): from at a.m. p.m. start of after to at a.m. p.m. start of after

(c) Weekdays starting (date):

from at a.m. p.m. start of after
to at a.m. p.m. start of after

(d) Other visitation (parenting time) days and restrictions are listed in Attachment 9e(1)(d)
(form MC-025 may be used for this purpose) as follows:

(2) Virtual visitation, as follows:

THIS IS A COURT ORDER.

Rev. July 1, 2026 Child Custody and Visitation (Parenting Time) FL-341, Page 2 of 4 Order Attachment

FL-341 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

9. e. (3) Other ways visitation can happen that are in the best interests of the child are as follows:

10. Supervised visitation (parenting time)

    Until further order of the court other (specify): petitioner respondent other parent/party (name): will have supervised visitation (parenting time) with the minor children according to the attached Supervised Visitation (Parenting Time) and Exchanges Order (form FL-341(A)).

11. Transportation for visitation (parenting time) and place of exchange

a. The children must be driven only by a licensed and insured driver. The vehicle must be legally registered with the
Department of Motor Vehicles, and must have child restraint devices properly installed, as required by law.

b. Transportation to begin the visits will be provided by the petitioner respondent
other (specify):
c. Transportation from the visits will be provided by the petitioner respondent
other (specify):
d. The exchange point at the beginning of the visit will be at (address):

e. The exchange point at the end of the visit will be at (address):

f. During the exchanges, the party driving the children will wait in the car and the other party will wait in the home (or
exchange location) while the children go between the car and the home (or exchange location).
g. Other (specify):

12. Travel with children. The petitioner respondent other parent/party (name):

must have written permission from the other parent or a court order to take the children out of
a. The state of California.
b. The following counties (specify):
c. Other places(specify):

THIS IS A COURT ORDER.

Rev. July 1, 2026 Child Custody and Visitation (Parenting Time) FL-341, Page 3 of 4 Order Attachment

FL-341 PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

13. Holiday schedule. The children will spend holiday time as listed (Children's Holiday Schedule Attachment (form FL-341(C)) may be used for this purpose.)

14. Additional custody provisions. The parties will follow the additional custody provisions listed attached schedule. (Additional Provisions²Physical Custody Attachment (form FL-341(D)) may be used for this purpose.)

15. Access to children's records. Both the custodial and noncustodial parent have the right to access records and information about their minor children (including medical, dental, and school records) and consult with professionals who are providing services to the children.

16. Other (specify):

    THIS IS A COURT ORDER.

Rev. July 1, 2026 Child Custody and Visitation (Parenting Time) FL-341, Page 4 of 4 Order Attachment

FL-341(A) PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY:

SUPERVISED VISITATION (PARENTING TIME) AND EXCHANGES ORDER

ATTACHMENT TO: Child Custody and Visitation (Parenting Time) Order Attachment (form FL-341) Other (specify):

1. Evidence has been presented in support of a request that the contact of Petitioner Respondent Other Parent/Party with the child or children be supervised based upon allegations of child abduction physical abuse drug abuse neglect sexual abuse domestic violence alcohol abuse RWKHU (specify): Petitioner Respondent Other Parent/Party disputes these allegations and the court reserves the findings on

these issues pending further investigation and hearing or trial.

2. The court finds, under Family Code section 3100, that the best interest of the child or children requires that visitation by Petitioner Respondent Other Parent/Party must, until further order of the court, be limited to contact supervised by the person or supervised visitation center set forth in this order pending further investigation and hearing or trial.

THE COURT MAKES THE FOLLOWING ORDERS

3. CHILDREN a. Name: Date of birth:

   b. Name: Date of birth:

   c. Name: Date of birth:

   The names and birthdates of additional children are attached to the order.

4. PROFESSIONAL SUPERVISED VISITATION WITH CHILDREN
   a. Provider Information (check one):
   (1) Chosen provider (name): Telephone:
   Address (if known):

   If the chosen provider cannot provide services, parties must use the alternate provider.

   Alternate provider (name): Telephone:
   Address (if known):

   Petitioner Respondent Other Parent/Party to contact the provider by (date):

   (2) The parties have not yet chosen a provider. A list of professional providers (check all that apply):
   is attached to this order.
   was given in court to: Petitioner Respondent Other Parent/Party
   Petitioner Respondent Other Parent/Party must choose and contact a provider
   by (date):
   (3) The professional provider will be a mutually agreed-upon third party as arranged by the parties.
   (4) Other (specify):

   b. Frequency of visits (check one):
   (1) Once a week, for (number of hours for each visit):
   (2) Two times each week, for (number of hours for each visit):
   (3) According to the schedule specified in: Form FL-341 Other (specify):

   c. Visits must be (check one):
   (1) In person at a safe location.
   (2) Virtual visitation (not in person).
   (3) Other (specify):

   d. Payment responsibility: Petitioner: % Respondent: % Other: %

   THIS IS A COURT ORDER.

Judicial Council of California, courts.ca.gov Rev. January 1, 2026; Mandatory Form Supervised Visitation (Parenting Time) FL-341(A), Page 1 of 2 Fam. Code, §§ 3100, 3031 and Exchanges Order

FL-341(A) PETITIONER/PLAINTIFF: CASE NUMBER: RESPONDENT/DEFENDANT: OTHER PARENT/PARTY:

5. NONPROFESSIONAL SUPERVISED VISITATION WITH CHILDREN
   a. Nonprofessional provider (person) to supervise visits:
   Name: Relationship to child:
   Address (if known):
   Telephone (if known):

   b. Frequency of visits (check one):
   (1) Once a week, for (number of hours for each visit):
   (2) Two times each week, for (number of hours for each visit):
   (3) According to the schedule specified in: Form FL-341 Other (specify):

   c. Visits must be (check one):
   (1) In person at a safe location. (specify location):
   (2) Virtual visitation (not in person). (Provider, child, and visiting parent may need to access the internet.)
   (3) Other (specify):

   d. Resources for nonprofessional providers:
   (1) Find your Declaration (form FL-324(NP)) at: courts.ca.gov/sites/default/files/courts/default/2024-11/fl324np.pdf.
   (2) For online information, go to: www2.courtinfo.ca.gov/accesstovisitation/story_html5.html.

   (3) For information about safe locations and virtual visits, go to: selfhelp.courts.ca.gov/guide-supervised-visitation.

6. SUPERVISED EXCHANGES (Drop-off and Pick-up of Children)
   a. Type of provider:
   (1) Professional provider
   Name: Relationship to child:
   Address (if known):
   Payment responsibility Petitioner: % Respondent: % Other: %

   Petitioner Respondent Other Parent/Party to contact the provider by (specify date)
   (date):
   Location of supervised exchanges to be decided by the professional provider.

   (2) Nonprofessional provider
   Name: Relationship to child:
   Address (if known):
   Telephone (if known):
   Safe location for exchanges:
   (For more information, see item 5d. Resources for nonprofessional providers.)

   b. Supervised exchanges will be according to the schedule specified:
   (1) In form FL-341
   (2) Other (specify):
   (3) Below:

7. THE COURT FURTHER ORDERS

   THIS IS A COURT ORDER.

Rev. January 1, 2026 Supervised Visitation (Parenting Time) FL-341(A), Page 2 of 2 and Exchanges Order

FL-341(B) PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

CHILD ABDUCTION PREVENTION ORDER ATTACHMENT
TO ✖ Child Custody and Visitation (Parenting Time) Order Attachment (form FL-341)
Custody Order—Juvenile—Final Judgment (form JV-200)
Other (specify):

1. The court finds there is a risk that (specify name of party): will take the child without permission because that party (check all that apply):

   a. has violated—or threatened to violate—a custody or visitation (parenting time) order in the past. b. does not have strong ties to California. c. has done things that make it easy for him or her to take the children away without any permission, such as (check all that apply): quit a job. sold his or her home. closed a bank account. ended a lease. sold or gotten rid of assets. hidden or destroyed documents. applied for a passport, birth certificate, or school or medical records. Other (specify):

   d. has a history of (check all that apply): domestic violence. child abuse. not cooperating with the other parent or party in parenting. e. has a criminal record. f. has family or emotional ties to another county, state, or foreign country. (NOTE: If item "f" is checked, at least one other factor must be checked, too.)

THE COURT ORDERS, to prevent the party in item 1 from taking the children without permission:

2. Supervised visitation (parenting time). The terms are (check one):
   as specified on attached form FL-341(A) as follows:

3. The party in item 1 must post a bond for $ . The terms of the bond are (specify):

4. The party in item 1 must not move from the following locations with the children without permission in writing from the
   other parent or party or a court order:
   Current residence Current school district (specify):
   This county Other (specify):

5. The party in item 1 must not travel with the children out of (check all that apply):
   this county. the United States.
   California. Other (specify):

6. The party in item 1 must register this order in the state of (specify): before the children can
   travel to that state for visits.

7. The party in item 1 must not apply for a passport or any other vital document, such as a visa or birth certificate, that
   can be used for travel.
   THIS IS A COURT ORDER. Page 1 of 2

Form Adopted for Mandatory Use CHILD ABDUCTION PREVENTION ORDER ATTACHMENT Family Code, § 3048; 42 U.S.C. § 11601 Judicial Council of California www.courts.ca.gov FL-341(B) [Rev. July 1, 2016]

FL-341(B) PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

8. The party in item 1 must turn in all the children's passports and other vital documents in the party's possession or control as specified below (List the documents that must be turned in. Include the details for turning in the documents to the court, one of the attorneys, the other party, or another person):

9. The party in item 1 must give the other parent or party the following before traveling with the children: The children's travel itinerary Copies of round-trip airline tickets Addresses and telephone numbers where the children can be reached at all times An open airline ticket for the other parent in case the children are not returned Other (specify):

10. The party in item 1 must notify the embassy or consulate of (specify country): about
    this order and provide the court with proof of that notification within (specify number): days.

11. The party in item 1 must get a custody and visitation (parenting time) order equivalent to the most recent U.S. order before the children may travel to that country for visits. The court recognizes that foreign orders may be changed or enforced according to the laws of that country.

12. Enforcing the order. The court authorizes any law enforcement officer to enforce this order. In this county, contact the Child Abduction Unit of the Office of the District Attorney at (phone number and address):

13. Other orders (specify):

14. This order is valid in other states and in any country that has signed the Hague Convention on Child Abduction.

    NOTICE TO AUTHORITIES IN OTHER STATES AND COUNTRIES

This court has jurisdiction to make child custody orders under California's Uniform Child Custody Jurisdiction and Enforcement Act (Fam. Code, § 3400 et seq.) and the Hague Convention on Civil Aspects of International Child Abduction (42 U.S.C. § 11601 et seq.). If jurisdiction is based on other factors, they are listed above in item 13.

Date:

JUDICIAL OFFICER

THIS IS A COURT ORDER.

FL-341(B) [Rev. July 1, 2016] CHILD ABDUCTION PREVENTION ORDER ATTACHMENT Page 2 of 2

FL-341(C) PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

CHILDREN'S HOLIDAY SCHEDULE ATTACHMENT

TO Petition Response Request for Order Responsive Declaration to Request for Order ✖ Stipulation and Order for Custody and/or Visitation of Children Findings and Order After Hearing or Judgment Visitation Order—Juvenile Other (specify):

1. Holiday parenting. The following table shows the holiday parenting schedules. Write "Petitioner," "Respondent," "Other Parent," or "Other Party" to specify each parent's (or party's) years—odd or even numbered years or both ("every year")—and under "Times," specify the starting and ending days and times. Note: Unless specifically ordered, a child's holiday schedule order has priority over the regular parenting time.

   Times (from when to when) Every Year Even Numbered Odd Numbered
   (Unless noted below, all single- Petitioner/ Years Years
   day holidays start at a.m. Respondent/ Petitioner/ Petitioner/
   and end at p.m.) Other Parent/Party Respondent/ Respondent/

Holidays Other Parent/Party Other Parent/Party December 31 (New Year's Eve)

January 1 (New Year's Day)

Martin Luther King's Birthday (weekend)

February 12 (Lincoln's Birthday)

President's Day (Weekend)

President's Week Recess, first half

President's Week Recess, second half

Spring Break, first half

Spring Break, second half

Mother's Day

Memorial Day (weekend)

Father's Day

July 4th

Summer Break:

Labor Day (weekend)

Columbus Day (weekend)

Halloween

November 11 (Veterans Day)

Thanksgiving Day

Thanksgiving weekend

December/January School Break

Child's birthday (date):

Child's birthday (date):

Child's birthday (date):

Mother's birthday (date):

Father's birthday (date): Other Parent's/Party's birthday (date):

Breaks for year-round schools:

Form Approved for Judicial Council of California Optional Use CHILDREN'S HOLIDAY SCHEDULE ATTACHMENT Family Code, §§ Page3003,13083of 2 FL-341(C) [Rev. July 1, 2016] www.courts.ca.gov

FL-341(C) PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

1. Holiday parenting (continued)

   Times (from when to when) Every Year Even Numbered Odd Numbered
   (Unless noted below, all single- Petitioner/ Years Years
   day holidays start at a.m. Respondent/ Petitioner/ Petitioner/
   and end at p.m.) Other Parent/Party Respondent/ Respondent/

Other Holidays Other Parent/Party Other Parent/Party

Any three-day weekend not specified in item 1 will be spent with the parent or party who would normally have that weekend. 2WKHU VSHFLI\

2. Vacations

The Petitioner Respondent Other Parent/Party: a. May take vacation with the children of up to (specify number): days weeks the following number of times per year (specify): b. Must notify the other parent or party in writing of vacation plans a minimum of (specify number): days in advance and provide the other parent or party with a basic itinerary that includes dates of leaving and returning, destinations, flight information, and telephone numbers for emergency purposes. (1) The other parent or party has (number): days to respond if there is a problem with the vacation schedule. (2) If the parties cannot agree on the vacation plans (check all that apply): (A) They must confer to try to resolve any disagreement before filing for a court hearing. (B) In even-numbered years, the parties will follow the suggestions of Petitioner Respondent Other Parent/Party for resolving the disagreement.

(C) In odd-numbered years, the parties will follow the suggestions of Petitioner Respondent
Other Parent/Party for resolving the disagreement.
(D) Other (specify):
c. This vacation may be outside the state of California.
d. Any vacation outside California the United States requires prior written consent of the other parent or
a court order.
e. 2WKHU VSHFLI\

FL-341(C) [Rev. July 1, 2016] CHILDREN'S HOLIDAY SCHEDULE ATTACHMENT Page 2 of 2

FL-341(D) PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

ADDITIONAL PROVISIONS—PHYSICAL CUSTODY ATTACHMENT

TO Petition Response Request for Order Responsive Declaration to Request for Order ✖ Stipulation and Order for Custody and/or Visitation of Children Findings and Order After Hearing or Judgment Custody Order—Juvenile—Final Judgment Other (specify):

The additional provisions to physical custody apply to (specify parties): Petitioner Respondent Other Parent/Party

1. Notification of parties' current address. Petitioner Respondent Other Parent/Party
   must notify all parties within (specify number): days of any change in his or her
   a. address for residence mailing work e-mail
   b. telephone/message number at home cell phone work the children's schools
   The parties may not use such information for the purpose of harassing, annoying, or disturbing the peace of the other or
   invading the other's privacy. No residence or work address is needed if a party has an address with the State of
   California's Safe at Home confidential address program.

2. 1RWLILFDWLRQ RI SURSRVHG PRYH RI FKLOG Each party must notify the other (specify number): days before any
   planned change in residence of the children. The notification must state, to the extent known, the planned address of the
   children, including the county and state of the new residence. The notification must be sent by certified mail, return receipt
   requested.

3. Child care.
   a. The children must not be left alone without age-appropriate supervision.
   b. The parties must let each other know the name, address, and phone number of the children's regular child-care
   providers.

4. Right of first option of child care. In the event any party requires child care for (specify number): hours or more
   while the children are in his or her custody, the other party or parties must be given first opportunity, with as much prior
   notice as possible, to care for the children before other arrangements are made. Unless specifically agreed or ordered by the
   court, this order does not include regular child care needed when a party is working.

5. Canceled visitation (parenting time).
   a. If the noncustodial party fails to arrive at the appointed time and fails to notify the custodial party that he or she will
   be late, then the custodial party need wait for only (specify number): minutes before considering the
   visitation (parenting time) canceled.

b. If the noncustodial party is unable to exercise visitation (parenting time) on a given occasion, he or she must notify the custodial party (specify): at the earliest possible opportunity. Other (specify):

c. If the children are ill and unable to participate in the scheduled visitation (parenting time), the custodial party must
give the noncustodial party (specify):
as much notice as possible.
A doctor's excuse.
Other (specify):

6. Phone contact between parties and children.
   a. The children may have telephone access to the parties and the parties may have telephone access to the
   children at reasonable times, for reasonable durations.
   b. The custodial parent must make the child available for the following scheduled telephone contact (specify child's
   telephone contact with each party):

   c. No party or any other third party may listen to, monitor, or interfere with the calls.

Form Approved for Optional Use ADDITIONAL PROVISIONS—PHYSICAL CUSTODY ATTACHMENT Family Code, §§ 3003, 3024, 3083 Judicial Council of California www.courts.ca.gov FL-341(D) [Rev. July 1, 2016]

FL-341(D) PETITIONER: CASE NUMBER: RESPONDENT: OTHER PARENT/PARTY:

7. No negative comments. The parties will not make or allow others to make negative comments about each other or about their past or present relationships, family, or friends within hearing distance of the children.

8. Discussion of court proceedings with children. Other than age-appropriate discussion of the parenting plan and the children's role in mediation or other court proceedings, the parties will not discuss with the children any court proceedings relating to custody or visitation (parenting time).

9. No use of children as messengers. The parties will communicate directly with each other on matters concerning the children and may not use the children as messengers between them.

10. Alcohol or substance abuse. The petitioner respondent other parent/party may not consume
    alcoholic beverages, narcotics, or restricted dangerous drugs (except by prescription) within (specify number): hours
    before or during periods of time with the children and may not permit any third party to do so in the presence of the
    children.

11. No exposure to cigarette or medical marijuana smoke. The parties will not expose the children to secondhand cigarette or medical marijuana smoke.

12. No interference with schedule of any party without that party's consent. The parties will not schedule activities for the children during the other party's scheduled visitation (parenting time) without the other party's prior agreement.

13. Third-party contact.
    a. The children will have no contact with (specify name):
    b. The children must not be left alone in the presence of (specify name):

14. Children's clothing and belongings.
    a. Each party will maintain clothing for the children so that the children do not have to make the exchanges with
    additional clothing.
    b. The children will be returned to the other party with the clothing and other belongings they had when they arrived.

15. Log book. The parties will maintain a "log book" and make sure that the book is sent with the children between their homes. Using businesslike notes (no personal comments), parties will record information related to the health, education, and welfare issues that arise during the time the children are with them.

16. Terms and conditions of order may be changed. The terms and conditions of this order may be added to or changed as the needs of the children and parties change. Such changes will be in writing, dated and signed by the parties; each party will retain a copy. If the parties want a change to be a court order, it must be filed with the court in the form of a court document.

17. Other (specify):

FL-341(D) [Rev. July 1, 2016] ADDITIONAL PROVISIONS—PHYSICAL CUSTODY ATTACHMENT Page 2 of 2

FL-341(E)

PETITIONER: CASE NUMBER:
RESPONDENT:

OTHER PARENT/PARTY:

JOINT LEGAL CUSTODY ATTACHMENT

TO Petition Response Request for Order Responsive Declaration to Request for Order ✖ Stipulation and Order for Custody and/or Visitation of Children Findings and Order After Hearing or Judgment Custody Order—Juvenile—Final Judgment Other (specify):

NOTICE! In exercising joint legal custody, the parties may act alone, as long as the action does not conflict with any orders about the physical custody of the children. Use this form only if you want to ask the court to make orders specifying when the consent of both parties is required to exercise legal control of the children and the consequences for failing to obtain mutual consent.

1. The parties (specify): Petitioner Respondent Other Parent/Party will have joint legal custody of the children.

2. In exercising joint legal custody, the parties will share in the responsibility and discuss in good faith matters concerning the health, education, and welfare of the children. The parties must discuss and consent in making decisions on the following matters: a. Enrollment in or leaving a particular private or public school or daycare center b. Beginning or ending of psychiatric, psychological, or other mental health counseling or therapy c. Participation in extracurricular activities d. Selection of a doctor, dentist, or other health professional (except in emergency situations) e. Participation in particular religious activities or institutions f. Out-of-country or out-of-state travel g. Other (specify):

3. If a party does not obtain the consent of the other party to those items in 2, which are granted as court orders: a. He or she may be subject to civil or criminal penalties. b. The court may change the legal and physical custody of the minor children. c. 2WKHU FRQVHTXHQFHV VSHFLI\

4. Special decision making designation and access to children's records
   a. The petitioner respondent other parent/party will be responsible for making decisions
   regarding the following issues (specify):

   b. Both the custodial and noncustodial parent have the right to access records and information about their minor children
   (including medical, dental, and school records) and consult with professionals who are providing services to the children.

5. Health-care notification.
   a. Each party must notify the other of the name and address of each health practitioner who examines or treats the
   children; such notification must be made within (specify number): days of the first treatment or examination.

   b. Each party is authorized to take any and all actions necessary to protect the health and welfare of the children,
   including but not limited to consent to emergency surgical procedures or treatment.The party authorizing such
   emergency treatment must notify the other party as soon as possible of the emergency situation and of all
   procedures or treatment administered to the children.
   c. The parties are required to administer any prescribed medications for the children.

6. School notification. Each party will be designated as a person the children's school will contact in the event of an emergency.

7. Name. The parties will not change the last name of the children or have a different name used on the children's medical, school, or other records without the written consent of the other party.

8. Other (specify):

Form Approved for Optional Use JOINT LEGAL CUSTODY ATTACHMENT Family Code, §§ 3003, 3025, 3083 Judicial Council of California www.courts.ca.gov FL-341(E) [Rev. July 1, 2016]