Check all that apply:

____ Mother / Father (circle one) will have sole legal custody of the child(ren).

____ Mother / Father (circle one) will have joint legal custody of the child(ren).

____ Mother / Father (circle one) will have sole physical custody of the child(ren).

____ Mother / Father (circle one) will have joint physical custody of the child(ren).

____ Mother / Father will have primary physical custody of the child(ren), with the other parent having liberal visitation with the child(ren).

Shared physical custody arrangements:

____ Mother / Father (circle one) will have the child(ren) in her/his custody every week from _________day at ____ o'clock a.m. / p.m. (circle one) to _________day at ____ o'clock a.m. / p.m. (circle one), and at all other relevant times the child(ren) will be in the custody of the other parent.

____ Mother / Father (circle one) will have custody of the child(ren) every other week, and at all other relevant times the child(ren) will be in the custody of the other parent.

____ Mother / Father (circle one) will have custody of the child(ren) during the school year, and the other parent will have custody of the child(ren) during school vacations and the summer months.

____ Mother / Father (circle one) will have custody of the child(ren) according to a week-to-week schedule, as jointly determined by them in accordance with their schedules and the schedules of their child(ren).

____ Mother and Father will share custody of the child(ren) according to the following schedule:
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Primary physical custody with liberal visitation arrangements:

____ The noncustodial parent will have visitation with the child(ren) every weekend from _________day at ____ o'clock a.m. / p.m. (circle one) to _________day at ____ o'clock a.m. / p.m. (circle one).

____ The noncustodial parent will have visitation with the child(ren) every other weekend from _________day at ____ o'clock a.m. / p.m. (circle one) to _________day at ____ o'clock a.m. / p.m. (circle one)

____ The noncustodial parent will have visitation with the child(ren) one evening each week as follows: ________________________________________________
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____ The noncustodial parent will have visitation with the child(ren) according to the following schedule:
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____ The noncustodial parent will have visitation with the child(ren) on the following days:

____ Child's birthday
____ Parent's birthday
School breaks (list):
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____ New Year's Day
____ Valentine's Day
____ Passover
____ Easter
____ Memorial Day
____ Fourth of July
____ Labor Day
____ Thanksgiving
____ Hanukkah
____ Christmas Eve
____ Christmas Day
____ Kwanzaa
Other religious holidays (list):
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Other special days (list):
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