A parent has one or more of these problems as follows (check all that apply): Abandonment intentionally – (Parent’s name): 2 abandoned a child listed in for an extended time. Neglect substantially – (Parent’s name): refused to perform his/her parenting duties for a child listed in 2. Child Abuse (or someone – (Parent’s name): living in that home) abused or threatened to abuse a child. The abuse parent’s was (check all that apply): physical sexual repeated emotional abuse. Domestic Violence (or – (Parent’s name): someone living in that home) has a history of domestic violence as parent’s defined in RCW 26.50.010(1). Assault (or someone – (Parent’s name): living in that home) has assaulted or sexually assaulted someone parent’s causing grievous physical harm or fear of such harm. Sex Offense – has been convicted (Parent’s name): of a sex offense as an adult. Someone living in home has name): (parent’s ’s been convicted as an adult or adjudicated as a juvenile of a sex offense. b. Other problems that may harm the (If a parent has any of children’s best interests. may these problems, the court limit that contact with the children and right to parent’s make decisions for the children.) Neither parent has any of these problems. (Skip to 4.) A parent has one or more of these problems as follows (check all that apply): Neglect name): neglected – (Parent’s his/her parental duties towards a child listed in 2. Emotional or physical problem name): – (Parent’s has a long-term emotional or physical problem that gets in the way of his/her ability to parent. Substance Abuse name): has a – (Parent’s long-term problem with drugs, alcohol, or other substances that gets in the way of his/her ability to parent. Lack of emotional ties name): – (Parent’s 2. has few or no emotional ties with a child listed in Abusive use of conflict name): – (Parent’s uses conflict in a way that endangers or damages the psychological development of a child listed in 2. Withholding the child name): – (Parent’s has kept the other parent away from a child listed in 2 for a long time, without a good reason. Other (specify):
A parent has one or more of these problems as follows (check all that apply): Abandonment – (Parent’s name): intentionally abandoned a child listed in 2 for an extended time. Neglect – (Parent’s name): substantially refused to perform his/her parenting duties for a child listed in 2. Child Abuse – (Parent’s name): (or someone living in that parent’s home) abused or threatened to abuse a child. The abuse was (check all that apply): physical sexual repeated emotional abuse. Domestic Violence – (Parent’s name): (or someone living in that parent’s home) has a history of domestic violence as defined in RCW 26.50.010(1). Assault – (Parent’s name): (or someone living in that parent’s home) has assaulted or sexually assaulted someone causing grievous physical harm or fear of such harm. Sex Offense – (Parent’s name): has been convicted of a sex offense as an adult. Someone living in (parent’s name): ’s home has been convicted as an adult or adjudicated as a juvenile of a sex offense. b. Other problems that may harm the children’s best interests. (If a parent has any of these problems, the court may limit that parent’s contact with the children and right to make decisions for the children.) Neither parent has any of these problems. (Skip to 4.) A parent has one or more of these problems as follows (check all that apply): Neglect – (Parent’s name): neglected his/her parental duties towards a child listed in 2. Emotional or physical problem – (Parent’s name): has a long-term emotional or physical problem that gets in the way of his/her ability to parent. Substance Abuse – (Parent’s name): has a long-term problem with drugs, alcohol, or other substances that gets in the way of his/her ability to parent. Lack of emotional ties – (Parent’s name): has few or no emotional ties with a child listed in 2. Abusive use of conflict – (Parent’s name): uses conflict in a way that endangers or damages the psychological development of a child listed in 2. Withholding the child – (Parent’s name): has kept the other parent away from a child listed in 2 for a long time, without a good reason. Other (specify):
WA-Parenting-Plan-Template.docx