Child Decision-making Questionnaire with Parenting Time and Holiday Schedule

This may help you decide the Best Interests of your child.

Child’s Full Name	Date of Birth	City of Birth

Have there been any other proceedings regarding decision-making of your children?   ___________________

If yes, where?   ___________________

Where     (at     what     address)     does     your     child/ren     currently     live?   ___________________

With whom?    ___________________

For how long?  ___________________

What is your educational level?   What is your spouse’s educational level?   ___________________

Do you or your spouse have any children from a previous relationship?   If yes, list names, date of birth, and place where they live.

1. ____________________
2. ____________________

Do you have any specific physical or emotional health problems? If yes, please describe:   ___________________

Does your spouse have any physical or emotional health problems? ___________________ If yes, describe:

Do your children have any physical or emotional health problems? ___________________  If yes, describe:

Is any special treatment of your child required?   ___________________

Any special medication?     ___________________

Who is your child’s doctor?   ___________________

Dentist?   ___________________

Who takes your child to the doctor?   ___________________

Who takes your child to school/day care most days?   ___________________

What school/day care does your child attend?   ___________________

Who helps with homework?   ___________________

Who reads bedtime stories?   ___________________

Who takes care of bathing the children?   ___________________

Who attends parent-teacher conferences?   ___________________

Who prepares the child’s meals?   ___________________

Who does the grocery shopping?   ___________________

Who does the clothes shopping?   ___________________

Who does the dishes?   ___________________

Who does the child’s laundry?   ___________________

Is your child involved in any activities?   ___________________

If yes, describe:   ___________________

Who goes to the games?   ___________________

Who is the coach or teacher?   ___________________

Is your child involved in any other type of activity, group, club, or hobby?   ___________________

If yes, describe:   ___________________

Who is your child’s teacher?   ___________________

What is your religious affiliation? Your spouse’s?   ___________________

Does your child attend church with either parent?   ___________________

Has your  child  expressed  a  preference  for  where  he/she  would  like  to  live?   ___________________

If  yes, who?   ___________________

Who has provided the primary care of the child since birth?   ___________________

Do you believe that you should have primary physical decision-making of your child?   ___________________

Do you believe that you and your spouse can peacefully make decisions regarding your child in the future?   ___________________

JOINT LEGAL DECISION MAKING: The condition under which both parents share legal decision-making and neither parents’ rights are superior except as specifically set forth by the court or by decision of the parents.

Can you share in making decisions jointly about: (Yes or No)

Medical issues?   ___________________

School issues?   ___________________

Religious issues?   ___________________

Recreation issues?   ___________________

JOINT PHYSICAL CUSTODY: The condition under which the physical residence of the child is shared by the parents in a manner that assures that the child has substantially equal time and contact with each parent.

It is possible to have joint legal decision-making and one parent have primary physical decision-making and the other parent has parenting time.

Please answer the following and explain in detail:

1. What do you wish for legal decision-making?
2. What are the child’s wishes for legal decision-making? (Do not ask the child if you do not already know.)
3. What is the child’s relationship with the parents and other family members?
4. What is the child’s adjustment to home, school, and community?
5. What is the mental and physical health of everyone involved?
6. Which parent is more helpful in facilitating parenting time with the other parent?
7. Who has provided primary care of the child in the past?
8. Has either parent used coercion to obtain a decision-making agreement?
9. Have the parents gone to the required parenting class?
10. Has either parent filed a false report of abuse or neglect?

Parenting Time Worksheet

1. Which parent will have primary physical decision-making of the child (with whom will the child live with primarily, more than half time)?   ___________________
2. Will the parents have an approximately equal parenting time plan with the child(ren)?   ___________________
3. What is address of the child’s primary residence or the address the child will use for school and other information?   ___________________
4. If there is joint physical decision-making, what is the day-to-day schedule for the child?   ___________________

Parenting Time Calendar
	S	M	T	W	T	F	S
Week One
Week Two
Week Three
Week Four
Week Five

1. Who will drive and pick up?   ___________________
2. At what time?   ___________________

How will the parents communicate? (Via email, phone, text, etc.)   ___________________

Do the grandparents have special time with the child?   ___________________

Will the child go to day care or a babysitter? If yes, who?   ___________________

Will the other parent have first right of refusal?   ___________________

What last name does the child use?   ___________________