Parenting Time Complaint

Please be advised that the Friend of the Court will only enforce parenting time as described in your court order. Agreements between the parties will not and cannot be enforced by our office. You must submit your complaint within 56 days of the date the violation first occurs. You must specify the dates you were denied or your complaint will be returned to you. Please be aware that the other parent may be provided with a copy of this complaint.

Case Number:
Your Name:
Address:
City, State, Zip

Home Phone:
Work Phone:

Other Parent's Name:
Address:
City, State, Zip

Home Phone:
Work Phone:

Child's Name:		Birthdate:
Child's Name:		Birthdate:
Child's Name:		Birthdate:

I was to have parenting time with my child(ren) according to the court order beginning on

Date:		at (Time):
Until (Date):		at (Time):

I was denied my parenting time because:
(Maximum 230 characters - 230 remaining)


Did you go to the exchange point to pick up the child(ren) for parenting time?	YesNo
Did you appear for your parenting time at the appropriate time?	YesNo
If you were late, approximately how late?
Were you offered make up time for this complaint?	YesNo
Did you exercise make up time for this complaint?	YesNo

If your complaint has to do with court ordered parenting time but does not pertain to an actual denial of parenting time, please explain: (Maximum 230 characters - 230 remaining)


What action are you requesting from the Friend of the Court?
	Read my complaint and make it part of my file, but do not take action at this time.
	Review and take action to resolve my complaint.
	Refer my complaint to Mediation. (Friend of the Court offers Mediation to parents as an alternative to resolving custody and parenting time disputes. Mediation involves both parents meeting together voluntarily with a mediator who will assist them in developing a resolution to their disputes. Mediation is free and confidential.)

Signature:

Date:


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