FORM 5.5 Stipulation for an Agreed Order of Custody

IN THE COURT OF COMMON PLEAS OF

__________________ COUNTY, PENNSYLVANIA

CIVIL ACTION LAW

PLAINTIFF

No. CI -

DEFENDANT

STIPULATION FOR AN AGREED ORDER OF CUSTODY

AND NOW, the parties, by and through their attorneys, stipulate and agree as follows:

1. The parties shall have joint legal custody of their minor child, legal custody being defined as

the legal right to make major decisions affecting the upbringing of the child, including but not

limited to medical, religious and educational decisions. The parties agree to discuss and consult

with one another on these decisions with a view to adopting a harmonious policy calculated to

promoting the child's best interests.

2. Each party has a right to be kept informed of the child's educational and medical development

and shall have a right of access to the child's educational and medical records. Each party shall

be entitled to complete and full information concerning the children from each other and from

any doctor, dentist, teacher or similar authority, and to have copies of any reports, notices or

other communications given to either party as a parent. Within ten (10) days of the date of this

stipulation, Defendant shall provide Plaintiff with a complete list of all the children's teachers,

medical care providers, close friends and the friends' parents, along with telephone numbers and

addresses for each.

3. Each party shall notify the other of any matter relating to the children which could reasonably

be expected to be of significant concern to the other party.

4. Defendant shall have primary physical custody of the child.

5. Plaintiff shall have partial physical custody of the child, using the following four-week

rotation cycle:

A. Week One: Plaintiff shall have partial physical custody of the child from Friday night at 6:00

P.M. to Sunday night at 7:00 P.M., if the child has school the following Monday, or 9:00 P.M. if

the child does not have school the following Monday. Week one in the parties' four-week

rotation cycle shall commence on __________________, 20______;

B. Week Two: Plaintiff shall have partial physical custody of the child from Friday night at

6:00 P.M. to Saturday night at 7:00 P.M.;

C. Week Three: Plaintiff shall have partial physical custody of the child from Friday night at

6:00 P.M. to Sunday night at 7:00 P.M., if the child has school the following Monday, or 9:00

P.M. if the child does not have school the following Monday;

D. Week Four: Defendant shall have sole custody of the child for the entire weekend. After the

fourth weekend, the parties shall have completed the four-week rotation cycle, and shall begin

again with Week One.

6. Plaintiff shall have partial physical custody of the child for not more than four (4) weeks

during the summer; provided that Plaintiff spends no more than two (2) consecutive weeks with

the child during the summer, and gives notice to Defendant of [his/her] exact plans for summer

vacation with the child no later than __________________ of each year.

7. With respect to holidays, Plaintiff and Defendant shall alternate spending New Year's Day,

Memorial Day, July 4th, Labor Day, and Thanksgiving with the child beginning with Plaintiff on

[state holiday], 20______. Plaintiff shall have the child on [Father's/ Mother's] Day. Whenever a

holiday falls on a Thursday before, or a Monday after, one of Plaintiff's weekends with the child,

then the child shall stay with Plaintiff through that Thursday or Sunday night, whichever the case

may be. By way of illustration, if the child is to spend Thanksgiving with Plaintiff during one

particular year, then the child shall spend Thursday night with Plaintiff should the ensuing

weekend be Plaintiff's in the ordinary course. In the event of a conflict between a holiday and

either one of the parties' weekends, the holiday shall take priority. Finally, with respect to

holidays, the parties agree to return the child at a reasonable hour, keeping in mind [his/her]

school schedule and other activities.

8. The child shall spend Christmas Eve through Christmas Day at 12:00 noon with Defendant,

and shall spend Christmas Day at 12:00 noon to December 26 at 12:00 noon with Plaintiff.

The remainder of the child's Christmas vacation through New Year's Day shall be shared

equally by Plaintiff and Defendant.

9. The parties recognize that the __________________ area provides the child with a familiar

and congenial environment in which the child possesses significant relationships with friends,

relatives, teachers and classmates. Therefore, neither party shall remove the child from the

__________________ area, or more than twenty (20) miles from their present residences, for

the purpose of changing the residence of the child to a location outside the ________________

area, or for any other reason, without the express written agreement of the other party, or with

leave of the Court of Common Pleas of __________________ County, Pennsylvania obtained

prior to removing the child and not obtained on an ex parte basis. If either party desires to

establish a residence with the child more than twenty (20) miles from the present residences, he

or she shall give the other party at least ninety (90) days written notice in advance of the

proposed move and all information requested by the other party about the proposed move. If the

parties are unable to agree about the proposed relocation, the Court of Common Pleas of

__________________ County, Pennsylvania, shall have exclusive jurisdiction of the parties and

the child to enter an appropriate primary custody/partial custody Order. Neither party shall

relocate with the child unless and until such Order is entered by the Court of Common Pleas of

__________________ County.

10. Each party shall have reasonable telephone and mail access to the child when in the

custody of the other parent.

11. Neither party shall impair the other party's right to custody or interfere with the other

parent's custody when the child is with that parent.

12. Neither party shall disparage the other party in front of the child, attempt to alienate the

affections of the child from the other party, or allow third parties to attempt to alienate the

affections of the child from the other party.

13. The parties shall not involve the child in any of the disputes concerning him/her, including

but not limited to financial matters.

14. Day-to-day decisions shall be the responsibility of the parent having physical custody at that

time. Additionally, the parent having physical custody of the child at the time of an emergency

shall have the right to make any immediate decisions necessitated by the emergency. However,

that parent shall inform the other parent of the emergency and consult with him/her regarding the

emergency as soon as is practicable. If either parent should be unreachable at their office or

residence, then that party shall provide the other party with the necessary information to facilitate

notification of an emergency.

15. The foregoing schedule is based upon Plaintiff living in __________________ and

Defendant living in __________________. The relocation of either party from their current

residences shall form a basis for change of this custody schedule and no such relocation shall

take place without the non-relocating party's express consent or court order after a full hearing.

16. Each party shall promptly notify the other of any travel plans, travel arrangements, and any

delays which might affect the custodial arrangements. Each party shall provide the other party

notice reasonably in advance of any scheduled trip with an itinerary including names of hotels or

residence addresses and telephone numbers for the applicable periods of time.

17. This Stipulation shall be entered as an Order of the Court.

__________________

Plaintiff

__________________

Defendant

BY THE COURT:

Date: ______

__________________