Parenting Time Complaint Response

Enclosed please find a copy of a parenting time complaint regarding your case. Please respond to the complaint on this form and return within twenty-one (21) days. If you fail to respond, the Friend of the Court will take action without your input or information.

Case Number:
Your Name:
Address:
City, State, Zip
Is this address new?	YesNo

Home Phone:
Work Phone:

Other Parent's Name:
Address:
City, State, Zip
Is this address new?	YesNo

Home Phone:
Work Phone:

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

I am responding to the Friend of the Court letter dated:

What is your response to the complaint?
(Maximum 340 characters - 340 remaining)

How have you and the other parent attempted to resolve this complaint (If resolved, when did make-up parenting time take place)?
(Maximum 275 characters - 275 remaining)

Has make up time been offered?	YesNo

What action are you requesting from the Friend of the Court?
	I agree to make-up parenting time as requested.
	I do not agree to the make-up parenting time as requested.
	The other parent and I have resolved this complaint, parenting time has resumed, and no other action is necessary.
	Refer the 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 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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