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PETITIONER: CASE NUMBER: RESPONDENT:

TO Petition Response Request for Order Responsive Declaration to Request for Order Other (specify):

1. Visitation (Parenting Time). a. Reasonable right of parenting time (visitation) to the party without physical custody (not appropriate in cases involving domestic violence). b. See the attached _____-page document dated (specify date): c. The parties will go to child custody mediation or child custody recommending counseling at (specify date, time, and location):

   d. No visitation (parenting time). e. Visitation (parenting time). (Specify start and ending date and time. If applicable, check "start of" OR "after school.") Petitioner’s Respondent’s Other Parent’s/Party’s parenting time (visitation) will be as follows: (1) Weekends starting (date): (Note: the first weekend of the month is the first weekend with a Saturday.) 1st 2nd 3rd 4th 5th weekend of the month. from ___________ at _______ a.m. p.m./ if applicable, specify: start of school (day of week) (time) after school to ___________ at _______ a.m. p.m./ if applicable, specify: start of school (day of week) (time) after school (a) The parties will alternate the fifth weekends, with the petitioner respondent other parent/party having the initial fifth weekend, which starts (date): (b) The petitioner respondent other parent/party will have the fifth weekend in odd even numbered months. (2) Alternate weekends starting (date): from ___________ at _______ a.m. p.m./ if applicable, specify: start of school (day of week) (time) after school to ___________ at _______ a.m. p.m./ if applicable, specify: start of school (day of week) (time) after school (3) Weekends starting (date): from ___________ at _______ a.m. p.m./ if applicable, specify: start of school (day of week) (time) after school to ___________ at _______ a.m. p.m./ if applicable, specify: start of school (day of week) (time) after school (4) Other visitation (parenting time) days and restrictions are: listed in attachment as follows:

Form Approved for Mandatory Use Page 3 of 3 FL-16 (Adopted 01/01/11, Revised 07/01/19) RESPONSE TO PETITION FOR GRANDPARENT VISITATION